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
('810231784', 'W11017854', 'W11017854', 'WYBILLINGS', 'Billings Clinic - Same Day Care', 'John', 'L', 'Swanson', 'PA-C', 'Family Practice', NULL, NULL, NULL, 'O', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59105', '4062382501', '4062382868', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487646949', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017855', 'W11017855', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Jennifer', NULL, 'Leachman', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382900', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740373208', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017856', 'W11017856', 'WYBILLINGS', 'Billings Clinic - Occupational Therapy', 'Donna', NULL, 'Umali', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', NULL, 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487607545', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017857', 'W11017857', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Randy', NULL, 'Holland', 'PA-C', 'Internal Medicine', 'Family Practice', NULL, NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', 'PO Box 37000', 'Billings', 'Custer', 'MT', '59107', NULL, NULL, NULL, NULL, NULL, '0.00', '17.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053422154', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017858', 'W11017858', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Richard', NULL, 'Teff', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982675104', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017859', 'W11017859', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'James', NULL, 'Shaffer', 'MD', 'Pediatrics', NULL, 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, '2009-05-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205811312', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017860', 'W11017860', 'WYBILLINGS', 'Billings Clinic - Emergency', 'Randy', NULL, 'Thompson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669408597', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017861', 'W11017861', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Eric', NULL, 'Saberhagen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528012184', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017862', 'W11017862', 'WYBILLINGS', 'Billings Clinic - Peds', 'Nadine', NULL, 'Seger', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255464046', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017863', 'W11017863', 'WYBILLINGS', 'Billings Clinic - Neurology', 'Thais', NULL, 'Weibel', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062382805', NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '17.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023060027', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017864', 'W11017864', 'WYBILLINGS', 'Billings Clinic - Neurology', 'Thais', NULL, 'Weibel', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2008-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023060027', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017865', 'W11017865', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Kristine', 'A', 'Martin', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382900', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, NULL, NULL, NULL, '0.00', '17.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679611602', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017866', 'W11017866', 'WYBILLINGS', 'Billings Clinic - Dietary', 'Therese', NULL, 'Hrncirik', 'RD', 'Dietician', NULL, NULL, NULL, 'B', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2008-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487803250', 0, 'Y', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017867', 'W11017867', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Amber', NULL, 'Arthur', 'PT', 'Physical Therapy', NULL, 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, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720238397', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017868', 'W11017868', 'WYBILLINGS', 'Billings Clinic - Cancer Center', 'Jennifer', 'K', 'Finn', 'LCSW', 'Mental Health', 'Social Worker', 'Oncology', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649436601', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017869', 'W11017869', 'WYBILLINGS', 'Billings Clinic Hospital', NULL, NULL, 'Billings Clinic Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574000', NULL, 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005301', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017870', 'W11017870', 'WYBILLINGS', 'Billings Clinic Home Oxygen and Medical Equipment', NULL, NULL, 'Billings Clinic Home Oxygen and Medical Equipment', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '801 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '8003251774', NULL, 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005300', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017871', 'W11017871', 'WYBILLINGS', 'Aspen Meadows', NULL, NULL, 'Aspen Meadows', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '3155 Ave C', 'Billings', 'Yellowstone', 'MT', '59102', '4066568818', NULL, 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005105', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017872', 'W11017872', 'WYBILLINGS', '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, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093738395', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017873', 'W11017873', 'WYBILLINGS', '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, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194985572', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017874', 'W11017874', 'WYBILLINGS', '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, '2009-05-01', '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', 'W11017875', 'W11017875', 'WYBILLINGS', '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, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003801275', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017876', 'W11017876', 'WYBILLINGS', '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, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588838213', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017877', 'W11017877', 'WYBILLINGS', 'Billings Clinic - Pathology', 'Jeannie', NULL, 'Muir', 'MD', 'Pathology', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, NULL, NULL, NULL, '0.00', '17.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093738395', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017878', 'W11017878', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Farroukh', '', 'Ajir', 'MD', 'Neurosurgery', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385809', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385809', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-12-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780751693', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017879', 'W11017879', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Timothy', NULL, 'Berger', 'MD', 'Hospitalist', NULL, NULL, NULL, 'B', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4062382572', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-01-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588682637', 0, 'Y', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017880', 'W11017880', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Jeffrey', 'M', 'Tomlin', 'MD', 'Neurosurgery', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366530321', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017881', 'W11017881', 'WYBILLINGS', '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, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932372943', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017882', 'W11017882', 'WYBILLINGS', 'Billings Clinic', 'Sarah', NULL, 'Stewart', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062383417', '4064461913', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932372943', 0, 'y', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017883', 'W11017883', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Jay', 'M', 'Levy', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385809', NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891718144', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017884', 'W11017884', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Jay', 'M', 'Levy', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382501', '4062385809', NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891718144', 0, 'y', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017885', 'W11017885', 'WYBILLINGS', 'Billings Clinic - Research', 'Melinda', 'K', 'Luce', 'PA-C', 'Physical Medicine and Rehabilitation', 'Rheumatology', NULL, NULL, 'O', '1045 N 30th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062558470', '4062382978', NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245250703', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017886', 'W11017886', 'WYBILLINGS', 'Billings Clinic - Research', 'Melinda', 'K', 'Luce', 'PA-C', 'Physical Medicine and Rehabilitation', 'Rheumatology', NULL, NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062558470', '4062382978', NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245250703', 0, 'y', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017887', 'W11017887', 'WYBILLINGS', 'Billings Clinic - Occupational Therapy', 'Leslie', 'M', 'Arnold-McGuire', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '2062382500', NULL, NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740458785', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017888', 'W11017888', 'WYBILLINGS', 'Billings Clinic - Occupational Therapy', 'Leslie', 'M', 'Arnold-McGuire', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '2062382500', NULL, NULL, NULL, 'Yellowstone', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740458785', 0, 'y', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017889', 'W11017889', 'WYBILLINGS', '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, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245250703', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017890', 'W11017890', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'David', NULL, 'Smith', 'NP', 'Family Practice', NULL, 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, '2009-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306098546', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W11017930', 'W11017930', 'WYBILLINGS', 'North Big Horn Hospital', 'Sarah', 'A', 'Ryan', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075482771', NULL, NULL, NULL, 'Big Horn', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659328391', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017931', 'W11017931', 'WYBILLINGS', 'Powell Valley Health Care Inc', 'Sarah', 'A', 'Ryan', 'MD', 'Urology', NULL, NULL, NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', NULL, NULL, NULL, 'Park', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659328391', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017932', 'W11017932', 'WYBILLINGS', 'Powell Valley Health Care Inc', 'Richard', 'B', 'Melzer', 'MD', 'Urology', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', NULL, '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407953086', 0, 'N', 0, '2011-08-22', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017933', 'W11017933', 'WYBILLINGS', 'Powell Valley Health Care Inc', 'Lawrence', 'W', 'Klee', 'MD', 'Urology', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', NULL, '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568557080', 0, 'N', 0, '2011-08-22', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017934', 'W11017934', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'Fernando', NULL, 'Boschini', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1333 W 5h St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721083', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891714770', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017935', 'W11017935', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'Walter', NULL, 'Degnan', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-04-28', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558384404', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017936', 'W11017936', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'Scott', '', 'Sample', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '1333 W 5h St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721083', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1558444216', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017937', 'W11017937', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'James', 'D', 'Knostman', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-04-28', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306929377', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017938', 'W11017938', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'Heather', 'L', 'McGuire', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508806100', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017939', 'W11017939', 'WYBILLINGS', 'Sheridan Memorial Hospital', 'Gregory', NULL, 'Mock', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', '          ', '', '', '', '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942308101', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017940', 'W11017940', 'WYBILLINGS', 'Wyoming Radiology & MRI', 'Michael', 'A', 'Morone', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1458 West 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076739729', NULL, '1458 West 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076739729', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407954456', 0, 'N', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017941', 'W11017941', 'WYBILLINGS', 'Wyoming Radiology & MRI', 'James', 'M', 'Burke', 'MD', 'Oncology', 'Hematology and Oncology', NULL, NULL, 'O', '1458 West 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076739729', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578586418', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017942', 'W11017942', 'WYBILLINGS', 'Hot Springs Co Memorial Hosp', 'Gail', 'A', 'Kleman', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', ' 150 East Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, NULL, NULL, 'Hot Springs', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932292414', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017943', 'W11017943', 'WYBILLINGS', 'Hot Springs Co Memorial Hosp', 'James', 'M', 'Burke', 'MD', 'Oncology', 'Hematology and Oncology', NULL, NULL, 'O', '150 East Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, NULL, NULL, 'Hot Springs', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578586418', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017944', 'W11017944', 'WYBILLINGS', 'Hot Springs Co Memorial Hosp', 'Roger', 'G', 'Santala', 'MD', 'Oncology', 'Hematology and Oncology', NULL, NULL, 'O', '150 East Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, NULL, NULL, 'Hot Springs', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396828059', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017945', 'W11017945', 'WYBILLINGS', 'Hot Springs Co Memorial Hosp', 'Stephen', NULL, 'Mainini', 'MD', 'Internal Medicine', 'Pulmonary', NULL, NULL, 'O', '150 East Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, NULL, NULL, 'Hot Springs', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2009-04-28', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336242114', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017946', 'W11017946', 'WYBILLINGS', 'Washakie Medical Center Outreach Clinic', 'Michael', 'A', 'Morone', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073478801', NULL, '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073478801', '          ', '', '', '', '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407954456', 0, 'N', 0, '2012-05-01', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11017947', 'W11017947', 'WYBILLINGS', 'Washakie Medical Center Outreach Clinic', 'Stephen', NULL, 'Mainini', 'MD', 'Internal Medicine', 'Pulmonary', NULL, NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073478801', NULL, NULL, NULL, 'Washakie', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336242114', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('870281337', 'W11017948', 'W11017948', 'UT01', NULL, 'Clark', 'C', 'Larsen', 'DPM', 'Podiatry', '', '', NULL, 'O', '5801 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8012611391', NULL, '5801 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8012611391', '', 'WiseSTD6A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427130335', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6454, -111.882, NULL, NULL),
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('870284475', 'W11017950', 'W11017950', 'UT01', 'Granger Medical Clinic', 'Sandra', 'J', 'Lehman', 'OD', 'Optometry', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653678', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653678', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598708182', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11017951', 'W11017951', 'UT01', 'Granger Medical Clinic', 'Sandra', 'J', 'Lehman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653678', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653678', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598708182', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W11017952', 'W11017952', 'UT01', 'Quest Diagnostics-Draper', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '11760 S 700 E Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015235839', '8019770658', '11760 S 700 E Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015235839', '8019770658', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.5377, -111.871, NULL, NULL),
('870468377', 'W11017953', 'W11017953', 'UT01', 'University Health Care', 'Richard', 'D', 'Sontheimer', 'MD', 'Dermatology', '', '', 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', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-03-02', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376511600', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870468377', 'W11017954', 'W11017954', 'UT01', 'University Health Care', 'Richard', 'D', 'Sontheimer', 'MD', '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', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-03-02', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376511600', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W11017955', 'W11017955', 'WY01', 'Mountain Towers HC & Rehab Ctr', '', '', 'Mountain Towers HC & Rehab Ctr', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', NULL, '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1215946546', 0, 'N', 0, '2012-04-25', NULL, NULL, 41.1392, -104.777, NULL, NULL),
('522085558', 'W11017956', 'W11017956', 'ID02', 'Kindred Transitional Care and Rehabilitation', '', '', 'Kindred Transitional Care and Rehabilitation', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '1001 S Hilton', 'Boise', 'Ada', 'ID', '83705', '2083454464', NULL, '1001 S Hilton', 'Boise', 'Ada', 'ID', '83705', '2083454464', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', '2013-03-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538181672', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W11017957', 'W11017957', 'ID02', 'Kindred Nursing and Rehabilitation Caldwell', '', '', 'Kindred Nursing and Rehabilitation Caldwell', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '210 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084591522', NULL, '210 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084591522', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1881616878', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W11017958', 'W11017958', 'ID02', 'Kindred Nursing and Rehabilitation Canyon West', '', '', 'Kindred Nursing and Rehabilitation Canyon West', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '2814 S Indiana', 'Caldwell', 'Canyon', 'ID', '83605', '2084590808', NULL, '2814 S Indiana', 'Caldwell', 'Canyon', 'ID', '83605', '2084590808', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', '2013-03-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1902810492', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W11017959', 'W11017959', 'ID02', 'Kindred Nursing and Rehabilitation Nampa', '', '', 'Kindred Nursing and Rehabilitation Nampa', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '404 Horton', 'Nampa', 'Canyon', 'ID', '83651', '2084469292', NULL, '404 Horton', 'Nampa', 'Canyon', 'ID', '83651', '2084469292', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1265455273', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11017960', 'W11017960', 'UT01', 'Bateman Chiropractic', 'Cameron', 'J', 'Bateman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1654 W Reunion Ave Ste B', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013029680', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447443452', 0, 'N', 0, '2009-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11017961', 'W11017961', 'UT01', NULL, 'Justin', NULL, 'Biggs', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '943 S Main St Ste 1', 'Cedar City', NULL, 'UT', '84720', '4358678883', NULL, NULL, NULL, 'Iron', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386898807', 0, 'N', 0, '2009-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11017962', 'W11017962', 'ID02', '', 'Stephen', 'K', 'Burtenshaw', 'DC', 'Chiropractic', '', '', NULL, 'O', '8752 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', NULL, '8752 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386652691', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W11018000', 'W11018000', 'WYBILLINGS', 'Billings Clinic - Bozeman OB/GYN', 'Patricia', NULL, 'Oriet', 'WHCNP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '925 Highland Blvd Ste 1210', 'Bozeman', 'Gallatin', 'MT', '59715', '4065879202', '4065879748', NULL, NULL, 'Gallatin', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881792042', 0, 'N', 0, '2009-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W11018002', 'W11018002', 'WYBILLINGS', 'Billings Clinic - Bozeman OB/GYN', 'Stacy', NULL, 'Shomento', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '925 Highland Blvd Ste 1210', 'Bozeman', 'Gallatin', 'MT', '59715', '4065879202', '4065879748', NULL, NULL, 'Gallatin', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497838379', 0, 'N', 0, '2009-05-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11018003', 'W11018003', 'WYBILLINGS', 'Billings Clinic - Bozeman OB/GYN', 'Katie', NULL, 'Sonnek', 'RD', 'Dietician', NULL, NULL, NULL, 'O', '925 Highland Blvd Ste 1210', 'Bozeman', NULL, 'MT', '59715', '4065879202', '4065879748', NULL, NULL, 'Gallatin', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144334921', 0, 'N', 0, '2009-05-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11018004', 'W11018004', 'WYBILLINGS', 'Billings Clinic - Bozeman OB/GYN', 'Alice', '', 'Wong', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '925 Highland Blvd Ste 1210', 'Bozeman', 'Gallatin', 'MT', '59715', '4065879202', '4065879748', '925 Highland Blvd Ste 1210', 'Bozeman', 'Gallatin', 'MT', '59715', '4065879202', '4065879748', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912080896', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018015', 'W11018015', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('631105917', 'W11018005', 'W11018005', 'UT01', 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', 'Health South Rehabilitation Hospital of Utah (inpatient services only)', 'GROUP', 'Hospital', 'Skilled Nursing Facility', NULL, NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015613400', NULL, '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015613400', '          ', '', '', '1', '0.00', '100.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467425173', 0, 'N', 0, '2014-03-25', NULL, NULL, 40.6046, -111.853, NULL, NULL),
('631105917', 'W11018006', 'W11018006', 'UT01', 'Health South Rehabilitation Hospital of Utah', '', '', 'Health South Rehabilitation Hospital of Utah (inpatient services only)', 'GROUP', 'Hospital', 'Skilled Nursing Facility', NULL, NULL, 'B', 'PO Box 952228', 'Dallas', 'Dallas', 'TX', '75395', '8015613400', NULL, '8074 S 1300 E', 'Sandy', 'Dallas', 'UT', '84094', NULL, NULL, '', NULL, '1', '0.00', '100.00', '0.00', 3, '2009-05-15', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467425173', 0, 'y', 0, '2009-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W11018007', 'W11018007', 'WY01', 'College Hill Womens Center', 'Daryl', '', 'Kaan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3000 College Dr Ste 8', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', NULL, '3000 College Dr Ste 8', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-05-15', '2012-07-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073618203', 0, 'N', 0, '2012-07-12', NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'W11018008', 'W11018008', 'UT01', 'Olympus Clinic', 'Amy', 'L', 'Banks', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2012-03-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1861437113', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W11018009', 'W11018009', 'UT01', 'Exodus Healthcare Network', 'Kwanza', 'N', 'Devlin', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871716845', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W11018010', 'W11018010', 'UT01', 'Exodus Healthcare Network', 'Kwanza', 'N', 'Devlin', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', NULL, '3336 S Pioneer Pkwy Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871716845', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('262011935', 'W11018011', 'W11018011', 'WY01', NULL, 'Amber', 'C', 'Robbins', 'MD', 'Dermatology', '', '', NULL, 'O', '206 N Brooks St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076728941', NULL, '206 N Brooks St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076728941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', '', '', '', 'HCFA|UB|', '1982870697', 0, 'n', 0, '2012-05-10', NULL, NULL, 44.7992, -106.957, NULL, NULL),
('870372827', 'W11018012', 'W11018012', 'UT01', NULL, 'Laura', 'J', 'Springhetti', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2009-05-15', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962640177', 0, 'Y', 0, '2009-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W11018013', 'W11018013', 'UT01', 'Families First Pediatrics', 'Alicia', '', 'Christiansen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2011-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992750095', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W11018014', 'W11018014', 'UT01', 'Families First Pediatrics', 'Alicia', '', 'Christiansen', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2011-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992750095', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018016', 'W11018016', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870358028', 'W11018017', 'W11018017', 'UT01', NULL, 'Robert', 'A', 'Frampton', 'MD', 'Family Practice', '', '', NULL, 'O', '24 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017985359', NULL, '24 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017985359', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013002898', 0, 'n', 0, '2012-05-08', NULL, NULL, 40.1101, -111.653, NULL, NULL),
('870519691', 'W11018018', 'W11018018', 'UT01', 'Utah Cancer Specialists', 'Scott', 'J', 'Samuelson', 'MD', 'Hematology and Oncology', 'Oncology', 'Internal Medicine', NULL, 'O', '5121 S Cottonwood St Ste A-2', 'Murray', 'Salt Lake', 'UT', '84107', '8012633416', NULL, '5121 S Cottonwood St Ste A-2', 'Murray', 'Salt Lake', 'UT', '84107', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922288588', 0, 'N', 0, '2012-06-14', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('870519691', 'W11018019', 'W11018019', 'UT01', 'Utah Cancer Specialists', 'Scott', 'J', 'Samuelson', 'MD', 'Hematology and Oncology', 'Oncology', 'Internal Medicine', NULL, 'B', '1121 E 3900 S Ste C-240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633416', NULL, '1121 E 3900 S Ste C-240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922288588', 0, 'N', 0, '2012-06-14', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11018020', 'W11018020', 'ID01', 'U-U Cardiology Division', '', '', 'U-U Cardiology Division', 'MD', 'Cardiovascular Disease', 'Cardiology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', '8015877290', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', '8015877290', '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, 40.7685, -111.837, NULL, NULL),
('870678993', 'W11018021', 'W11018021', 'UT01', 'Families First Pediatrics', 'Zachary', 'R', 'Zarbock', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780862425', 0, 'N', 0, '2012-08-20', NULL, NULL, 40.5622, -111.928, NULL, NULL),
('870678993', 'W11018022', 'W11018022', 'UT01', 'Families First Pediatrics', 'Zachary', 'R', 'Zarbock', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780862425', 0, 'y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('841416411', 'W11018057', 'W11018057', 'ID02', 'Advantage Psychological Services', 'Scott', 'H', 'Armentrout', 'PSYD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '1070 N Curtis Rd Ste 210', 'Boise', 'Ada', 'ID', '83706', '2089062007', NULL, '1070 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDPHD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-15', '2013-02-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619002987', 0, 'n', 0, '2009-05-15', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('311651314', 'W11018058', 'W11018058', 'UT01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-05-21', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W11018059', 'W11018059', 'TX01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-05-21', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W11018060', 'W11018060', 'WY01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-05-21', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('264093211', 'W11018061', 'W11018061', 'UTMH1', 'Destination Hope Counseling, Inc', 'Nancy', 'L', 'Belliston', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '1190 North Spring Creek Place Ste D-2', 'Springville', 'Utah', 'UT', '84663', '8018064226', NULL, '1190 North Spring Creek Place Ste D-2', 'Springville', 'Utah', 'UT', '84663', '8018064226', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2009-05-15', '2009-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841468147', 0, 'n', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('264256598', 'W11018062', 'W11018062', 'UT01', NULL, 'Thomas', 'R', 'Austad', 'DPM', 'Podiatry', '', '', NULL, 'O', '1885 W 4400 S', 'Roy', 'Weber', 'UT', '84067', '8017313833', NULL, '1885 W 4400 S', 'Roy', 'Weber', 'UT', '84067', '8017313833', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1710085261', 0, 'N', 0, '2011-05-24', NULL, NULL, 41.1834, -112.026, NULL, NULL),
('205954281', 'W11018063', 'W11018063', 'TX01', '', 'David', '', 'Salazar', 'MD', 'Pulmonary', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-01-01', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104810910', 0, 'N', 0, '2014-03-13', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('205954281', 'W11018064', 'W11018064', 'TX01', '', 'David', '', 'Salazar', 'MD', 'Pulmonary', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 260', 'San Antonio', 'Bexar', 'TX', '78229', '2104813119', NULL, '7940 Floyd Curl Dr Ste 260', 'San Antonio', 'Bexar', 'TX', '78229', '2104813119', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-01-01', '2010-10-11', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104810910', 0, 'N', 0, '2013-12-11', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('208810434', 'W11018065', 'W11018065', 'UT01', NULL, 'Ryan', 'M', 'Hanson', 'AUD', 'Audiology', 'Pediatric Audiology', '', NULL, 'O', '945 W Hospital Dr Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356374327', NULL, '945 W Hospital Dr Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356374327', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841415734', 0, 'n', 0, '2014-03-20', NULL, NULL, 39.6064, -110.834, NULL, NULL),
('900347306', 'W11018066', 'W11018066', 'WY01', 'Evanston Surgical Center', '', '', 'Evanston Surgical Center', 'GROUP', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', NULL, '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004777', 0, 'n', 0, '2011-06-10', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('621560557', 'W11018067', 'W11018067', 'ID02', 'West Valley Clinic at Middleton', 'Kristin', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-04-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558351569', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11018068', 'W11018068', 'ID02', 'West Valley Clinic at Parma', 'Kristine', '', 'Kingery', 'PA', 'Family Practice', '', '', NULL, 'O', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', NULL, '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-04-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679517155', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11018069', 'W11018069', 'ID02', 'The Clinic at Wilder', 'Kelly', '', 'Pesnell', 'NP', 'Family Practice', '', '', NULL, 'O', '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', NULL, '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-04-14', '2012-04-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992785463', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6779, -116.91, NULL, NULL),
('621560557', 'W11018070', 'W11018070', 'ID02', 'The Clinic at Wilder', 'Amy', 'L', 'Gallaway', 'NP', 'Family Practice', '', '', NULL, 'O', '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', NULL, '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-04-14', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306817226', 0, 'Y', 0, '2013-08-30', NULL, NULL, 43.6779, -116.91, NULL, NULL),
('204186533', 'W11018071', 'W11018071', 'ID02', 'Fazzio Clinic', 'Julie', '', 'Madsen', 'MD', 'General Surgery', '', '', NULL, 'O', '7301 W Emerald St Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083218600', '2083218626', '7301 W Emerald St Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083218600', '2083218626', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-04-14', '2012-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639287865', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11018072', 'W11018072', 'ID01', 'Saint Alphonsus Pediatric Orthopedics', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '6500 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-04-14', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'n', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11018073', 'W11018073', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'Tarik', '', 'Qasim', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-04-14', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1962608646', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820425454', 'W11018074', 'W11018074', 'ID01', 'Boise Anesthesia, PA', 'Brad', '', 'Foss', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '5033722740', '2083759530', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '5033722740', '2083759530', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2009-04-14', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1831339068', 0, 'n', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W11018075', 'W11018075', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673674', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673674', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-04-14', '2012-09-19', 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1063601177', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W11018076', 'W11018076', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', NULL, '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-04-14', '2012-09-19', 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1063601177', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('460500210', 'W11018077', 'W11018077', 'ID01', 'Saint Alphonsus Trauma Physician Services', '', '', 'Saint Alphonsus Trauma Physician Services', 'GROUP', '', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728162', '0000000000', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728162', '0000000000', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-04-14', '2014-06-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008552', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11018078', 'W11018078', 'UT01', 'University of Utah Hospital', 'Craig', NULL, 'Parkin', 'PT', 'Physical Therapy', 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, '2009-03-10', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000008071', 0, 'N', 0, '2009-06-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876157946', 'W11018079', 'W11018079', 'UT01', 'University Ear, Nose, and Throat Associates', 'Mitchell', 'R', 'Udy', 'AUD', 'Audiology', '', '', 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, '2009-04-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134174543', 0, 'N', 0, '2012-09-18', 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
('876157946', 'W11018080', 'W11018080', 'UT01', 'University Ear, Nose, and Throat Associates', 'Mitchell', 'R', 'Udy', 'AUD', 'Audiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817514', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817514', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134174543', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11018081', 'W11018081', 'UT01', 'University Health Care', 'Nathan', 'D', 'Hatton', 'MD', 'Internal Medicine', 'Pulmonary', 'Critical Care', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-03-03', '2012-08-26', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942398763', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11018082', 'W11018082', 'UT01', 'U-U Pulmonary Division', 'Nathan', 'D', 'Hatton', 'MD', 'Internal Medicine', 'Pulmonary', 'Critical Care', 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, '2009-03-03', '2012-08-26', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942398763', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11018083', 'W11018083', 'UT01', 'University Health Care', 'Anupam', 'R', 'Verma', 'MD', 'Pediatrics', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-03-16', '2009-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144258302', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11018084', 'W11018084', 'UT01', 'Pediatric Inpatient Services', 'Anupam', 'R', 'Verma', 'MD', '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', NULL, '0.00', '15.00', '0.00', 3, '2009-03-16', '2009-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144258302', 0, 'y', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11018085', 'W11018085', 'UT01', 'Huntsman Cancer Hospital', 'Launce', '', 'Gie-Chuan Gouw', 'MD', 'Hematology and Oncology', 'Oncology', 'Internal Medicine', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-02-18', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689788325', 0, 'N', 0, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11018086', 'W11018086', 'UT01', 'U-U Hematology / Oncology Division', 'Launce', '', 'Gie-Chuan Gouw', 'MD', 'Hematology and Oncology', 'Oncology', 'Internal Medicine', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-02-18', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689788325', 0, 'y', 0, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11018087', 'W11018087', 'UT01', 'University Hsugarhouse Family Health Clinic', 'Jackson', 'J', 'Woods', 'MD', 'Family Practice', '', '', 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', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417065475', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11018088', 'W11018088', 'UT01', 'Madsen Health Center Family Practice Clinic', 'Jackson', 'J', 'Woods', 'MD', 'Family Practice', '', '', NULL, 'o', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417065475', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11018089', 'W11018089', 'UT01', 'University Dept of Family and Prevenative Medicine', 'Jackson', 'J', 'Woods', 'MD', 'Family Practice', '', '', 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', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417065475', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11018090', 'W11018090', 'UT01', 'U Of U Dialysis Program', 'Jill', 'L', 'Neilson', 'RD', 'Renal Dietitian', '', '', 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, '2007-08-09', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114106275', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('208803868', 'W11018091', 'W11018091', 'ID02', 'Gem Family Practice', 'Jennice', 'M', 'Cordova', 'PA', 'Family Practice', '', '', NULL, 'O', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083653455', NULL, '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083653455', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-05-15', '2012-02-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609856079', 0, 'N', 0, '2012-02-24', NULL, NULL, 0, 0, NULL, NULL),
('870278438', 'W11018092', 'W11018092', 'UTMH1', 'Cornerstone Counseling Center', 'Andrew', 'A', 'Briefer', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '660 S 200 E Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013552846', NULL, '660 S 200 E Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013552846', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-05-15', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487745410', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W11018093', 'W11018093', 'WY01', 'Yellowstone Behavioral Health Center', 'Sandra', '', 'Holland', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-05-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437398716', 0, 'n', 0, '2013-02-22', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W11018094', 'W11018094', 'WY01', 'Yellowstone Behavioral Health Center', 'Randalene', '', 'Washburn', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-05-15', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073753893', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W11018095', 'W11018095', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '3460 S Pioneer Parkway', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Parkway', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870622942', 'W11018096', 'W11018096', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '1240 S 850 W', 'Vernal', 'Uintah', 'UT', '84078', '4357893342', NULL, '1240 S 850 W', 'Vernal', 'Uintah', 'UT', '84078', '4357893342', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.4385, -109.545, NULL, NULL),
('870622942', 'W11018097', 'W11018097', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '415 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992200', NULL, '415 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992200', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870622942', 'W11018104', 'W11018104', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '650 E 4500 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012810027', NULL, '650 E 4500 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012810027', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6743, -111.874, NULL, NULL),
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('330363116', 'W11018131', 'W11018131', 'UT01', 'Quest Diagnostics-SLC', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '470 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012624421', '8012632619', '470 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012624421', '8012632619', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.6871, -111.878, NULL, NULL),
('870470656', 'W11018132', 'W11018132', 'UT01', NULL, 'G', 'S', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012989100', NULL, '440 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012989100', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1598853079', 0, 'N', 0, '2014-07-02', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('942854057', 'W11018133', 'W11018133', 'UTIHC04', 'Bear River Valley Hospital', 'Lance', '', 'Barker', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074515', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074515', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801089214', 0, 'N', 0, '2013-04-10', NULL, NULL, 41.7162, -112.201, NULL, NULL),
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('942854057', 'W11018176', 'W11018176', 'UTIHC03', 'Primary Childrens Medical Center', 'Michelle', '', 'Greene', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '', '', '', '', '0.00', '10.00', '0.00', 8, '2009-05-29', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508971276', 0, 'N', 0, '2014-06-11', 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
('942854057', 'W11018177', 'W11018177', 'UTIHC03', 'Primary Childrens Medical Center', 'Linda', '', 'Lewis', 'APRN', 'Family Practice', '', '', NULL, 'O', '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770631079', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018178', 'W11018178', 'UTIHC03', 'Primary Childrens Medical Center', 'Alan', 'K', 'Stotts', 'MD', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', 'Orthopedic Surgery', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902859473', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018179', 'W11018179', 'UTIHC03', 'Dixie Regional Medical Center', 'Lewis', 'D', 'Taub', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730102963', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018180', 'W11018180', 'UTIHC03', 'Primary Childrens Medical Center', 'Marcella', 'Rae', 'Woiczik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-05-19', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1053408708', 0, 'N', 0, '2009-11-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018181', 'W11018181', 'UTIHC02', 'Primary Childrens Medical Center', 'Lori', 'Dawn', 'Frasier', 'MD', 'Pediatrics', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016633600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016633600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-05-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356499669', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018182', 'W11018182', 'UTIHC02', 'Primary Childrens Medical Center', 'Michelle', '', 'Greene', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '', '', '', '', '0.00', '10.00', '0.00', 8, '2009-05-29', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508971276', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018183', 'W11018183', 'UTIHC02', 'Primary Childrens Medical Center', 'Linda', '', 'Lewis', 'APRN', 'Family Practice', '', '', NULL, 'O', '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770631079', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018184', 'W11018184', 'UTIHC02', 'Primary Childrens Medical Center', 'Alan', 'K', 'Stotts', 'MD', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', 'Orthopedic Surgery', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902859473', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018185', 'W11018185', 'UTIHC02', 'Primary Childrens Medical Center', 'Marcella', 'Rae', 'Woiczik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-05-19', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1053408708', 0, 'N', 0, '2009-11-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018138', 'W11018138', 'UTIHC04', 'Sevier Valley Medical Center', 'Rex', 'K', 'Belnap', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'O', '1000 N Main Street', 'Richfield', 'Sevier', 'UT', '84701', '4358930332', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-11-08', '2009-06-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659476950', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018159', 'W11018159', 'UTIHC04', 'Sevier Valley Medical Center', 'Thomas', 'J', 'Tavenner', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'O', '1000 N Main Street', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-11-08', '2009-06-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912002536', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018164', 'W11018164', 'UTIHC01', 'Sevier Valley Medical Center', 'Rex', 'K', 'Belnap', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'O', '1000 N Main Street', 'Richfield', 'Sevier', 'UT', '84701', '4358930332', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-11-08', '2009-06-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659476950', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018172', 'W11018172', 'UTIHC01', 'Sevier Valley Medical Center', 'Thomas', 'J', 'Tavenner', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'O', '1000 N Main Street', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-11-08', '2009-06-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912002536', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018199', 'W11018199', 'UT01', 'Gero - Psych', 'Michael', 'A', 'Kligman', 'MD', 'Mental Health', 'Psychiatry', '', 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', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679615918', 0, 'Y', 0, '2011-09-21', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W11018200', 'W11018200', 'UT01', 'Davis Hospital (Hospitalist)', 'Syed', 'O', 'Masood', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Davis', 'UT', '84095', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-08-18', '2009-06-15', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518981455', 0, 'Y', 0, '2009-06-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018201', 'W11018201', 'UT01', 'Jordan Valley Hospital', 'Bruce', 'H', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2010-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1285664078', 0, 'Y', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018202', 'W11018202', 'UT01', 'Pioneer Valley Hospital', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-11-01', '2010-10-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018203', 'W11018203', 'UT01', 'Salt Lake Senior Clinic', 'John', 'C', 'Luras', 'MD', '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', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619084928', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W11018204', 'W11018204', 'UT01', 'Salt Lake Senior Clinic', 'Keith', 'J', 'Lane', 'MD', 'Internal Medicine', 'Geriatric Medicine', NULL, NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558370361', 0, 'N', 0, '2009-06-05', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W11018205', 'W11018205', 'UT01', 'Cardiovascular Consultants of Utah', 'Gary', '', 'Zubair', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', NULL, '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2011-10-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000019756', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018206', 'W11018206', 'UT01', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W11018207', 'W11018207', 'UT01', 'Cardiovascular Consultants of Utah', 'Thomas', 'Robert', 'Calame', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-07-21', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801888748', 0, 'N', 0, '2009-06-08', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W11018208', 'W11018208', 'UT01', 'Salt Lake Regional Hospital', 'Michael', '', 'Wren', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053323725', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018209', 'W11018209', 'UT01', 'Salt Lake Regional Hospital', 'Alina', '', 'Dalmendray', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386654168', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11018210', 'W11018210', 'UTMH1', 'Axis-One Inc', 'Blake', 'T', 'Halliday', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2009-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710068473', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11018211', 'W11018211', 'UTMH1', 'Axis-One Inc', 'Blake', 'T', 'Halliday', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '20 W 100 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '20 W 100 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2009-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710068473', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W11018212', 'W11018212', 'WY01', 'Yellowstone Behavioral Health Center', 'Kristin', 'R', 'Sween', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225205867', 0, 'n', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11018213', 'W11018213', 'UT01', 'Standard Optical', 'Rhett', 'D', 'Veater', 'OD', 'Optometry', '', '', NULL, 'O', '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', NULL, '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154438182', 0, 'n', 0, '2012-05-03', NULL, NULL, 40.5877, -111.938, NULL, NULL),
('870179340', 'W11018214', 'W11018214', 'UT01', 'Standard Optical', 'Rhett', 'D', 'Veater', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154438182', 0, 'n', 0, '2012-05-03', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W11018215', 'W11018215', 'UT01', 'Standard Optical', 'Lee', 'B', 'Wren', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', NULL, '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', NULL, NULL, 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', '2009-10-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396832655', 0, 'N', 0, '2009-06-08', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11018216', 'W11018216', 'UTMH1', 'Jordan West Family Counseling', 'Madelynne', '', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326087420', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'W11018275', 'W11018275', 'TX01', 'Northeast OB/GYN Associates', 'Celyna', 'D', 'Delgado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12709 Toepperwein Ste 309', 'San Antonio', 'Bexar', 'TX', '78233', '2106574099', NULL, '12709 Toepperwein Ste 309', 'San Antonio', 'Bexar', 'TX', '78233', '2106574099', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417946625', 0, 'N', 0, '2012-08-23', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('264333033', 'W11018276', 'W11018276', 'TX01', 'Institute for Womens Health', '', '', 'Institute for Womens Health', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006854', 0, 'Y', 0, '2014-07-24', 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
('264333033', 'W11018277', 'W11018277', 'TX01', 'Institute for Womens Health', 'Valentin', '', 'Almendarez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037615', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11018278', 'W11018278', 'TX01', 'Institute for Womens Health', 'Daniel', 'A', 'Calderon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083603252', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11018279', 'W11018279', 'TX01', 'Institute for Womens Health', 'Karen', 'M', 'Carcamo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235129271', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11018280', 'W11018280', 'TX01', 'Institute for Womens Health', 'Carlos', 'A', 'Cardenas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487643664', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11018281', 'W11018281', 'TX01', 'Institute for Womens Health', 'Elisa', 'F', 'Carroll', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962491159', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11018282', 'W11018282', 'TX01', 'Institute for Womens Health', 'Victor', 'L', 'Casiano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '367 E Ramsey', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679562862', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870281028', 'W11018369', 'W11018369', 'UT01', 'Central Utah Clinic PC-Radiology', '', '', 'Central Utah Clinic PC-Radiology', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013758858', '8018124699', 'PO Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013758858', '8018124699', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834774', 0, 'Y', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W11018380', 'W11018380', 'UT01', 'Central Utah Clinic', 'Mitchell', 'W', 'Larsen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928546', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018381', 'W11018381', 'UT01', 'Central Utah Clinic', 'Mitchell', 'W', 'Larsen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928546', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W11018383', 'W11018383', 'UT01', 'Central Utah Clinic', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'Y', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W11018455', 'W11018455', 'UT01', 'Wasatch Otolaryngology Group', 'Randal', 'B', 'Gibb', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679675383', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018456', 'W11018456', 'UT01', 'Wasatch Otolaryngology Group', 'Randal', 'B', 'Gibb', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679675383', 0, 'Y', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12002616', 'W12002616', 'UT01', 'Central Utah Clinic', 'Kent', 'M', 'Gledhill', 'MD', 'Radiologist', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871539833', 0, 'Y', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018458', 'W11018458', 'UT01', 'Central Utah Clinic', 'Stanley', 'W', 'Green', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184610065', 0, 'Y', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12002630', 'W12002630', 'UT01', 'Central Utah Clinic', 'Terry', 'C', 'Hammond', 'MD', 'Nephrology', '', '', NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', NULL, '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1124064845', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870281028', 'W11018460', 'W11018460', 'UT01', 'Central Utah Clinic', 'Wynn', 'H', 'Hemmert', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003874736', 0, 'Y', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018461', 'W11018461', 'UT01', 'Central Utah Clinic', 'Wynn', 'H', 'Hemmert', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003874736', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018462', 'W11018462', 'UT01', 'Central Utah Clinic', 'Chun', '', 'Hwang', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649238080', 0, 'Y', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018463', 'W11018463', 'UT01', 'Central Utah Clinic', 'Richard', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144323163', 0, 'Y', 0, '2013-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018464', 'W11018464', 'UT01', 'Central Utah Clinic', 'Robert', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1407959695', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018465', 'W11018465', 'UT01', 'Central Utah Clinic', 'Scott', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1578666533', 0, 'Y', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018466', 'W11018466', 'UT01', 'Central Utah Clinic PC', 'Curtis', 'C', 'Johnson', 'MD', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1205939089', 0, 'Y', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018467', 'W11018467', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'W', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1285692400', 0, 'Y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018468', 'W11018468', 'UT01', 'Central Utah Clinic PC', 'Kirt', 'M', 'Kimball', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1548363419', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018469', 'W11018469', 'UT01', 'Central Utah Clinic', 'Brent', 'T', 'Layton', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1346286317', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018470', 'W11018470', 'UT01', 'Central Utah Clinic', 'E', 'William', 'Leroy', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356432009', 0, 'Y', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018471', 'W11018471', 'UT01', 'Central Utah Clinic', 'E', 'William', 'Leroy', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356432009', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018472', 'W11018472', 'UT01', 'Central Utah Clinic', 'Kent', 'G', 'Marshall', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962422543', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018473', 'W11018473', 'UT01', 'Central Utah Clinic', 'Kent', 'G', 'Marshall', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962422543', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018474', 'W11018474', 'UT01', 'Central Utah Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'Y', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018475', 'W11018475', 'UT01', 'Central Utah Clinic', 'Lawrence', 'K', 'Nobuhara', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1740399385', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018476', 'W11018476', 'UT01', 'Central Utah Clinic', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018477', 'W11018477', 'UT01', 'Central Utah Clinic', 'Richard', 'K', 'Olsen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932157138', 0, 'Y', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018478', 'W11018478', 'UT01', 'Central Utah Clinic', 'Samuel', 'R', 'Peterson', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073571295', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018479', 'W11018479', 'UT01', '', 'McKay', 'L', 'Platt', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1336230085', 0, 'Y', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018480', 'W11018480', 'UT01', 'Central Utah Clinic', 'Mark', 'C', 'Sanderson', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073604609', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018481', 'W11018481', 'UT01', 'Central Utah Clinic', 'Mark', 'C', 'Sanderson', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073604609', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018482', 'W11018482', 'UT01', 'Central Utah Clinic', 'Douglas', 'R', 'Smith', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144288580', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018483', 'W11018483', 'UT01', 'Central Utah Clinic', 'Greg', 'B', 'Smith', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1255377222', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018484', 'W11018484', 'UT01', 'Central Utah Clinic', 'John', 'K', 'Staheli', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Salt Lake', 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275591620', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11018485', 'W11018485', 'UT01', 'Central Utah Clinic', 'Gerald', 'B', 'Stephanz', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932138195', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11018054', 'W11018054', 'UTIHC02', '', 'Ellaine', '', 'Cheung', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '', '', '', '', '0.00', '10.00', '0.00', 8, '2009-04-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639261761', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W11018056', 'W11018056', 'UTIHC02', '', 'Louis', '', 'Morales', 'MD', 'Plastic Surgery', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621600', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821060948', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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('742145952', 'W11018526', 'W11018526', 'TX01', 'Endocrinology-Nuclear Medicine Associates PA', 'Jeannie', 'A', 'Baquero', 'MD', 'Endocrinology', '', '', NULL, 'O', '1303 McCullough Ave Ste 374', 'San Antonio', 'Bexar', 'TX', '78212', '2102235483', NULL, '1303 McCullough Ave Ste 374', 'San Antonio', 'Bexar', 'TX', '78212', '2102235483', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-06-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1255301149', 0, 'N', 0, '2012-05-21', NULL, NULL, 29.4412, -98.4924, NULL, NULL),
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('205934739', 'W11018528', 'W11018528', 'ID02', 'Family Medicine Health Center', 'Julie', 'Anne', 'Lyons', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-06-01', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1982620787', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11018530', 'W11018530', 'ID02', 'Family Medicine Health Center', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'n', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11018532', 'W11018532', 'ID02', 'Family Medicine Health Center', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'n', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('870710584', 'W11018538', 'W11018538', 'UTMH1', 'Jordan West Family Counseling', 'Susan', '', 'Macnamara', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-06-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437390473', 0, 'N', 0, '2013-02-22', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11018539', 'W11018539', 'UT01', 'Ogden Clinic', 'Walter', 'E', 'Smith', 'DO', 'Radiology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-05', '2009-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063460913', 0, 'Y', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11018540', 'W11018540', 'UT01', 'Ogden Clinic', 'Walter', 'E', 'Smith', 'DO', 'Radiology', '', '', NULL, 'O', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', NULL, '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-05', '2009-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063460913', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('262427082', 'W11018541', 'W11018541', 'TX01', 'San Antonio Premier Internal Medicane', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 145', 'San Antonio', 'Bexar', 'TX', '78222', '2104473033', NULL, '4212 E Southcross Blvd Ste 145', 'San Antonio', 'Bexar', 'TX', '78222', '2104473033', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-06-05', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871557454', 0, 'n', 0, '2013-07-11', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
('262427082', 'W11018542', 'W11018542', 'TX01', 'San Antonio Premier Internal Medicane', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1746', 'San Antonio', 'Bexar', 'TX', '78296', '2104473033', NULL, 'PO Box 1746', 'San Antonio', 'Bexar', 'TX', '78296', '2104473033', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-06-05', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871557454', 0, 'y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11018543', 'W11018543', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Mark', '', 'Jepson', 'NP', 'Mental Health', '', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083673002', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083673002', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2009-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1306089271', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6062, -116.266, NULL, NULL),
('208192593', 'W11018544', 'W11018544', 'ID02', 'Mercy Physician Group Dallan Woods', 'John', '', 'Johnson', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656990', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656990', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-06-04', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164402681', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820432465', 'W11018545', 'W11018545', 'ID03', 'Family Care Physicians', 'Alice', '', 'Trabert', 'NP-C', 'Family Practice', '', '', NULL, 'O', '112 5th Ave W', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', '112 5th Ave W', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-11-01', '2013-06-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245229558', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('461965952', 'W11018546', 'W11018546', 'ID02', 'NeuroScience Associate', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '', 'IDPPONEURO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-06-04', '2011-09-08', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407001852', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('264025855', 'W11018547', 'W11018547', 'UT01', NULL, 'Henry', '', 'Lewis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 W 100 N Ste S103', 'Vernal', 'Uintah', 'UT', '84078', '4357811011', NULL, '150 W 100 N Ste S103', 'Vernal', 'Uintah', 'UT', '84078', '4357811011', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1811923501', 0, 'n', 0, '2012-05-30', NULL, NULL, 40.4571, -109.531, NULL, NULL),
('264025855', 'W11018548', 'W11018548', 'UT01', NULL, 'Henry', '', 'Lewis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357811011', NULL, 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357811011', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1811923501', 0, 'y', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
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('104448620', 'W11018550', 'W11018550', 'WY01', 'Welch Cancer Center', 'John', 'P', 'Stamato', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 6607', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', NULL, 'PO Box 6607', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', 'Sheridan Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1225080831', 0, 'y', 0, '2012-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('202210584', 'W11018553', 'W11018553', 'ID02', 'Idaho Gastroenterology Associates', 'Mark', 'L', 'Lloyd', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', NULL, '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730174301', 0, 'n', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('371448473', 'W11018554', 'W11018554', 'ID02', 'Idaho Gastroenterology Associates', 'David', 'W', 'Wood', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', NULL, '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659367993', 0, 'n', 0, '2012-01-12', NULL, NULL, 0, 0, NULL, NULL),
('371448473', 'W11018555', 'W11018555', 'ID02', 'Idaho Gastroenterology Associates', 'David', 'W', 'Wood', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', NULL, '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659367993', 0, 'n', 0, '2012-01-12', NULL, NULL, 0, 0, NULL, NULL),
('331021494', 'W11018556', 'W11018556', 'ID02', 'Idaho Gastroenterology Associates', 'Ellen', 'B', 'Hunter', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', NULL, '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1174518740', 0, 'n', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('331021494', 'W11018557', 'W11018557', 'ID02', 'Idaho Gastroenterology Associates', 'Ellen', 'B', 'Hunter', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', NULL, '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1174518740', 0, 'n', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('820466934', 'W11018558', 'W11018558', 'ID02', 'Idaho Gastroenterology Associates', 'John', 'T', 'Witte', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', NULL, '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1063407641', 0, 'n', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
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('450579015', 'W11018584', 'W11018584', 'UT01', 'St Marks South Jordan Family Practice', 'Anne', 'M', 'Dubosky', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-30', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295769446', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('621762570', 'W11018586', 'W11018586', 'UT01', 'Ashley Valley Physician Practice', 'Petar', 'M', 'Ilievski', 'MD', 'Urology', '', '', NULL, 'O', '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', NULL, '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-05', '2011-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093788465', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
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('263624373', 'W11018590', 'W11018590', 'UT01', 'Color Country Pediatrics', 'Gia', 'D', 'Miller', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 3040', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', NULL, 'PO Box 3040', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346232618', 0, 'Y', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
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('870560763', 'W11018592', 'W11018592', 'UT01', 'Utah Navajo Health System', 'Michele', '', 'Lyman', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447253091', 0, 'Y', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
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('841367175', 'W11018603', 'W11018603', 'UT01', 'Canyon View Medical Group', 'Michael', '', 'McLay', 'MD', 'Family Practice', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', NULL, '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1063605475', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841431327', 'W11018604', 'W11018604', 'UT01', 'Utah Cancer Institute ', 'Benjamin', '', 'Kim', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688223', NULL, '1220 E 3900 S Ste 4F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688223', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487681102', 0, 'N', 0, '2012-06-01', NULL, NULL, 40.6871, -111.856, NULL, NULL),
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('202422775', 'W11018607', 'W11018607', 'UT01', 'Wasatch Endocrinology Inc', 'Joyce', 'C', 'Ferrone', 'NP', 'Endocrinology', 'Diabetes', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017460776', NULL, 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017460776', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2012-11-19', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811107261', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('202422775', 'W11018608', 'W11018608', 'UT01', 'Wasatch Endocrinology Inc', 'Joyce', 'C', 'Ferrone', 'NP', 'Endocrinology', 'Diabetes', '', NULL, 'O', '807 E South Temple Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017460776', NULL, '807 E South Temple Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017460776', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2013-09-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811107261', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('202717899', 'W11018609', 'W11018609', 'UT01', 'Evolutionary Healthcare', 'Christopher', 'A', 'Gay', 'MD', 'Family Practice', '', '', NULL, 'O', '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', NULL, '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1205926805', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.765, -111.878, NULL, NULL),
('202142366', 'W11018610', 'W11018610', 'ID02', 'Donaldson Chiropractic Inc', 'Martin', 'S', 'Donaldson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1203 10Th St', 'Nampa', 'Canyon', 'ID', '83651', '2084676567', NULL, '1203 10Th St', 'Nampa', 'Canyon', 'ID', '83651', '2084676567', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679632566', 0, 'n', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('270154086', 'W11018611', 'W11018611', 'UTMH1', NULL, 'Mary', 'A', 'Carter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013188634', NULL, '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013188634', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518926880', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11018612', 'W11018612', 'UT01', 'Granger Medical Clinic', 'Jana', 'D', 'Bingman', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801073663', 0, 'Y', 0, '2012-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11018613', 'W11018613', 'UT01', 'Granger Medical Clinic', 'Jana', 'D', 'Bingman', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653600', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653600', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801073663', 0, 'N', 0, '2012-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11018614', 'W11018614', 'UT01', 'Granger Medical Clinic', 'Jana', 'D', 'Bingman', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801073663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('731698522', 'W11018615', 'W11018615', 'UT01', 'Tooele Orthopaedics & Sports Medicine Specialists', 'Craig', 'A', 'Packham', 'PA-C', 'Orthopedic Surgery', 'Physical Therapy', NULL, NULL, 'O', '2356 N 400 E Ste 102', 'Tooele', 'Tooele', 'UT', '84074', '4358339180', '4358339177', '2356 N 400 E', 'Tooele', 'Tooele', 'UT', '84074', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104920354', 0, 'N', 0, '2009-09-15', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W11018616', 'W11018616', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, '1492 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-05-18', '2014-04-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'N', 0, '2009-06-15', NULL, NULL, 41.0893, -111.993, NULL, NULL);
