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
('870546052', 'W11022320', 'W11022320', 'UT01', 'Professional Physical Therapy & Sports Medicine', 'Wendell', 'Buck', 'Mendenhall', 'PT', 'Physical Therapy', '', '', NULL, 'B', '1325 S 800 E Ste 215', 'Orem', '', 'UT', '84097', '8017682723', '8017682725', '1325 S 800 E Ste 215', 'Orem', '', 'UT', '84097', '8017682723', '8017682725', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1417148347', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546052', 'W11022321', 'W11022321', 'UT01', 'Professional Physical Therapy & Sports Medicine', 'Steven', 'J', 'Orrock', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '1325 S 800 E  Ste 215', 'Orem', 'Utah', 'UT', '84097', '8017682723', '8017682725', NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1629125174', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022322', 'W11022322', 'UT01', 'ProRehab Castledale', 'Scott', 'Ross', 'Labrum', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4353815100', '4353815099', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1457343725', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022323', 'W11022323', 'UT01', 'ProRehab Castledale', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4353815100', '4353815099', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1386801363', 0, 'Y', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022324', 'W11022324', 'UT01', 'ProRehab East Carbon', 'Jeffrey', 'Nathan', 'Ohlwiler', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4358881500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4358881500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1669464939', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022325', 'W11022325', 'UT01', 'ProRehab Price', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'Y', 0, '2011-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022326', 'W11022326', 'UT01', 'ProRehab Price', 'David', '', 'Hume', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1184686404', 0, 'Y', 0, '2011-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022327', 'W11022327', 'UT01', 'ProRehab Price', 'Darrin', 'Michael', 'Hurdsman', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1639161920', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022328', 'W11022328', 'UT01', 'ProRehab Price', 'David', 'Edmond', 'Nelson', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1568454858', 0, 'Y', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022329', 'W11022329', 'UT01', 'ProRehab Price', 'Clayton', 'Lloyd', 'Taylor', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1093995292', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W11022330', 'W11022330', 'UT01', 'ProRehab Vernal', 'David', NULL, 'Hume', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Duchesne', 'UT', '84001', '4357811502', '4357811505', NULL, NULL, 'Duchesne', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1184686404', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022331', 'W11022331', 'UT01', 'Registered Physical Therapists', 'Greg', 'Jonathon', 'Baker', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8014460990', '8014460909', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8014460990', '8014460909', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1558348516', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022332', 'W11022332', 'UT01', 'Registered Physical Therapists', 'Jeanne', '', 'LaJom', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', '', 'UT', '84094', '8014460990', '8014460909', '9720 S 1300 E Ste W 200', 'Sandy', '', 'UT', '84094', '8014460990', '8014460909', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1508059643', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022333', 'W11022333', 'UT01', 'Registered Physical Therapists', 'Jared', 'M', 'Suker', 'DPT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', '', 'UT', '84094', '8014460990', '8014460909', '9720 S 1300 E Ste W 200', 'Sandy', '', 'UT', '84094', '8014460990', '8014460909', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1649416728', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022334', 'W11022334', 'UT01', 'Registered Physical Therapists', 'Scott', 'C', 'Benson', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1447237490', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022335', 'W11022335', 'UT01', 'Registered Physical Therapists', 'Jeffrey', '', 'Eckert', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1144404831', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022336', 'W11022336', 'UT01', 'Registered Physical Therapists', 'Larry', 'Don', 'Fullmer', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1821075912', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022337', 'W11022337', 'UT01', 'Registered Physical Therapists', 'Jason', 'C', 'West', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1952389371', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022338', 'W11022338', 'UT01', 'Registered Physical Therapists', 'Drew', 'Richard', 'Norwood', 'PT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8016762210', '8016762212', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8016762210', '8016762212', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1851378830', 0, 'Y', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022339', 'W11022339', 'UT01', 'Registered Physical Therapists', 'Brent', 'L', 'Miller', 'PT', 'Physical Therapy', '', '', NULL, 'O', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', '9720 S 1300 E Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2010-06-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1720065840', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022340', 'W11022340', 'UT01', 'Registered Physical Therapists', 'Larry', 'Don', 'Fullmer', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1821075912', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022341', 'W11022341', 'UT01', 'Registered Physical Therapists', 'Aaron', NULL, 'Hackett', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1215019567', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022342', 'W11022342', 'UT01', 'Registered Physical Therapists', 'Joshua', NULL, 'Harward', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1922003417', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022343', 'W11022343', 'UT01', 'Registered Physical Therapists', 'Stanford', 'K', 'Hirai', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1972580074', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022344', 'W11022344', 'UT01', 'Registered Physical Therapists', 'Trevor', NULL, 'Stevenson', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1982681078', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W11022345', 'W11022345', 'UT01', 'Registered Physical Therapists', 'Steven', 'R', 'Verhaaren', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '9720 S 1300 E  Ste W 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1174500268', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841274681', 'W11022346', 'W11022346', 'UT01', 'Rehab Services of Craig', 'Melissa', 'Kell', 'Detzner', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 711185', 'Salt Lake City', NULL, 'UT', '84171', '9708249359', '9708246777', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1922192152', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('841274681', 'W11022347', 'W11022347', 'UT01', 'Rehab Services of Craig', 'John', 'T', 'Pearson', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 711185', 'Salt Lake City', NULL, 'UT', '84171', '9708249359', '9708246777', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1194828798', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('841274681', 'W11022348', 'W11022348', 'UT01', 'Rehab Services of Craig', 'Valerie', NULL, 'Pleasant', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 711185', 'Salt Lake City', NULL, 'UT', '84171', '9708249359', '9708246777', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1265538128', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('841274681', 'W11022349', 'W11022349', 'UT01', 'Rehab Services of Craig', 'Kathryn', NULL, 'Roof', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 711185', 'Salt Lake City', NULL, 'UT', '84171', '9708249359', '9708246777', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1013176056', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W11022350', 'W11022350', 'UT01', 'Rocky Mountain Therapy Services', 'Todd', 'Elliot', 'Brown', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1093708166', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W11022351', 'W11022351', 'UT01', 'Rocky Mountain Therapy Services', 'Mitchell', '', 'Felix', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1144213216', 0, 'Y', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W11022352', 'W11022352', 'UT01', 'Rocky Mountain Therapy Services', 'B', 'Jay', 'Ludwig', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1245251800', 0, 'Y', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W11022353', 'W11022353', 'UT01', 'Rocky Mountain Therapy Services', 'Kristen', 'V', 'Nielsen-Jones', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8019645565', '8014175016', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1568457000', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('870502207', 'W11022409', 'W11022409', 'UT01', 'Wasatch Therapy', 'Ernest', 'Casius', 'Chavez', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8017748600', '8017748681', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1013016559', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W11022410', 'W11022410', 'UT01', 'Wasatch Therapy', 'Pamela', NULL, 'Frinkman', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8017748600', '8017748681', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1699873364', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870502207', 'W11022412', 'W11022412', 'UT01', 'Wasatch Therapy', 'Ryan', 'Scott', 'Webb', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8017748600', '8017748681', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1780755025', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870502207', 'W11022417', 'W11022417', 'UT01', 'Wasatch Therapy', 'Ryan', 'Scott', 'Webb', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014799865', '8014795846', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1780755025', 0, 'Y', 0, NULL, 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
('870395551', 'W11022464', 'W11022464', 'UT01', NULL, 'Jennifer', 'L', 'Kocour', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '745 Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8016121085', '4352830372', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-11-17', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841472610', 0, 'N', 0, '2009-12-02', NULL, NULL, 0, 0, NULL, NULL),
('742898805', 'W11022419', 'W11022419', 'TX01', 'Surgical Consultants of San Antonio', 'Dana', 'L', 'Reiss', 'MD', 'General Surgery', '', '', NULL, 'O', '2829 Babcock Rd Ste 415', 'San Antonio', 'Bexar', 'TX', '78229', '2106143370', NULL, '2833 Babcock Ste 415', 'San Antonio', 'Bexar', 'TX', '78229', '2106143370', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-12-01', '2010-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760470066', 0, 'N', 0, '2010-09-07', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('742898805', 'W11022420', 'W11022420', 'TX01', 'Surgical Consultants of San Antonio', 'Paul', 'M', 'Selinkoff', 'MD', 'General Surgery', '', '', NULL, 'O', '2833 Babcock Rd Ste 415', 'San Antonio', 'Bexar', 'TX', '78229', '2106143370', NULL, '2833 Babcock Ste 415', 'San Antonio', 'Bexar', 'TX', '78229', '2106143370', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-12-01', '2010-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023006335', 0, 'N', 0, '2010-09-07', NULL, NULL, 29.5133, -98.5912, NULL, NULL),
('870573947', 'W11022432', 'W11022432', 'UT01', 'Holladay Family Practice', 'Brian', 'C', 'Rasmussen', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', NULL, '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '          ', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-01', '2010-09-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1316058670', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11022430', 'W11022430', 'UT01', 'Standard Optical', 'Joshua', '', 'Randall', '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', '8015061111', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-11-30', '2010-02-12', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1922237197', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('261906096', 'W11022431', 'W11022431', 'UT01', 'Gut  Whisperer', 'Umaprasanna', 'S', 'Karnam', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015635121', '8015663926', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015635121', '8015663926', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689623852', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('870179340', 'W11022429', 'W11022429', 'UT01', 'Standard Optical', 'Joshua', '', 'Randall', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018862020', NULL, '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018862020', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-11-30', '2010-02-12', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1922237197', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
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('870665299', 'W11022463', 'W11022463', 'UT01', 'University of Utah Cardiothoracic Surgeons', 'Shelley', NULL, 'Treuhaft', 'APRN', 'Cardiovascular Disease', '', '', 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, '2009-10-21', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831422799', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11022465', 'W11022465', 'UT01', NULL, 'Joshua', 'R', 'Phelps', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '745 Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8016121085', '4352830372', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-11-17', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255513107', 0, 'N', 0, '2009-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11022466', 'W11022466', 'UT01', '', 'Carl', 'G', 'LeSueur', 'DC', 'Chiropractic', '', '', NULL, 'O', '1136 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015539691', '4352830372', '1136 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015539691', '4352830372', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-11-17', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770715831', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11022468', 'W11022468', 'UT01', 'University Health Care', 'Margaret', 'A', 'McKenzie', 'APRN', 'Hematology and Oncology', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-16', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699009282', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11022469', 'W11022469', 'ID02', 'Childrens Therapy Place Inc', 'Caren', 'A', 'De Angelis', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-12-01', '2010-04-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1437204922', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('205562511', 'W11022470', 'W11022470', 'UT01', 'Bountiful Internal Medicine', 'Holly', 'J', 'Green', 'APRN', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '520 N Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', NULL, '520 N Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205000718', 0, 'n', 0, '2013-12-23', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('205562511', 'W11022471', 'W11022471', 'UT01', 'Bountiful Internal Medicine', 'Holly', 'J', 'Green', 'APRN', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8012949333', NULL, 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8012949333', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205000718', 0, 'y', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W11022472', 'W11022472', 'UT01', 'Hoopes Vision Correction Center', 'Steven', 'H', 'Linn', 'OD', 'Optometry', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', '2012-11-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508006487', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'W11022473', 'W11022473', 'UT01', 'Foot and Ankle Institute', 'Leon', 'K', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '1811 W Royal Hunt Dr', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', NULL, '1811 W Royal Hunt Dr', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1336179886', 0, 'N', 0, '2011-12-16', NULL, NULL, 37.658, -113.086, NULL, NULL),
('161751617', 'W11022474', 'W11022474', 'TX01', 'Rheumatology Associates of South Texas', 'Gautam', '', 'Moorjani', 'MD', 'Rheumatology', '', '', NULL, 'O', '19272 Stone Oak Pkwy Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2102658851', NULL, '19272 Stone Oak Pkwy Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2102658851', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-12-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780617282', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6299, -98.4948, NULL, NULL),
('161751617', 'W11022475', 'W11022475', 'TX01', 'Rheumatology Associates of South Texas', 'Gautam', '', 'Moorjani', 'MD', 'Rheumatology', '', '', NULL, 'O', '8527 Village Park Dr Ste 207', 'San Antonio', 'Bexar', 'TX', '78217', '2106563926', NULL, '8527 Village Park Dr Ste 207', 'San Antonio', 'Bexar', 'TX', '78217', '2106563926', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-12-01', '2009-12-31', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780617282', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022476', 'W11022476', 'WY01', 'Western Medical', '', '', 'Western Medical Associates', '', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009580', 0, 'Y', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022477', 'W11022477', 'WY01', 'Western Medical', 'Jeremy', '', 'Morse', '', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007708', 0, 'Y', 0, '2010-09-30', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022478', 'W11022478', 'WY01', 'Western Medical', 'Joe', '', 'Schoeber', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1740233071', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022479', 'W11022479', 'WY01', 'Western Medical', 'Werner', '', 'Studer', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1356349054', 0, 'Y', 0, '2011-01-17', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022480', 'W11022480', 'WY01', 'Western Medical', 'Joseph', '', 'Mickelson', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1467448043', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022481', 'W11022481', 'WY01', 'Western Medical', 'Jay', '', 'Swedberg', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1467450163', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W11022482', 'W11022482', 'WY01', 'Western Medical', 'Sherrill', '', 'Fox', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', '', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2010-09-29', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1124034566', 0, 'Y', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022483', 'W11022483', 'WY01', 'Dubois Med ical Clinic', 'Vaughn (Recognized PPO but not contracted)', '', 'Morgan', '', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy  26', 'Dubois', '', 'WY', '82513', '3074552516', NULL, '5647 US Hwy  26', 'Dubois', '', 'WY', '82513', '3074552516', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007698', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'W11022484', 'W11022484', 'WY01', 'Family Clinic', 'Dana', 'R', 'Ideen', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 E  A  St', 'Casper', '', 'WY', '82601', '3072358552', NULL, '1315 E  A  St', 'Casper', '', 'WY', '82601', '3072358552', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2009-12-15', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1558375477', 0, 'Y', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'W11022485', 'W11022485', 'WY01', 'Family Clinic', 'Marjorie', 'L', 'Wells', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 E  A  St', 'Casper', '', 'WY', '82601', '3072358552', NULL, '1315 E  A  St', 'Casper', '', 'WY', '82601', '3072358552', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2009-12-15', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1780698431', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('201328719', 'W11022486', 'W11022486', 'WY01', 'Urgent Care Now', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2546 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072651110', NULL, '2546 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '          ', '', '', '', '0.00', '8.00', '0.00', 3, '2009-12-15', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'Y', 0, '2013-02-05', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12029313', 'W12029313', 'UT01', 'Lakeview Behavioral Health', 'Heather', '', 'Bernard', 'NP', 'Mental Health', 'Counseling', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', '0000000000', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1104846781', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('830326307', 'W11022487', 'W11022487', 'WY01', 'Community Health Ctr', 'Trent (Recognized PPO but not contracted)', '', 'Batty', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005222', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022488', 'W11022488', 'WY01', 'Community Health Ctr', 'Vincent (Recognized PPO but not contracted)', '', 'Hinshaw', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006726', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022489', 'W11022489', 'WY01', 'Community Health Ctr', 'Michele (Recognized PPO but not contracted)', '', 'Mohr', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007660', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022490', 'W11022490', 'WY01', 'Community Health Ctr', 'Jamie (Recognized PPO but not contracted)', '', 'Baum', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005226', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022491', 'W11022491', 'WY01', 'Community Health Ctr', 'Brandon (Recognized PPO but not contracted)', '', 'Isaacs', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006873', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022492', 'W11022492', 'WY01', 'Community Health Ctr', 'Thomas (Recognized PPO but not contracted)', '', 'Radosevich', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008303', 0, 'Y', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022493', 'W11022493', 'WY01', 'Community Health Ctr', 'Sharon (Recognized PPO but not contracted)', '', 'Kames', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007032', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022494', 'W11022494', 'WY01', 'Community Health Ctr', 'Andrew (Recognized PPO but not contracted)', '', 'Roberts', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008421', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022495', 'W11022495', 'WY01', 'Community Health Ctr', 'Beth (Recognized PPO but not contracted)', '', 'Robitaille', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008433', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022496', 'W11022496', 'WY01', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Kooiker-Brostoski', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007140', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022497', 'W11022497', 'WY01', 'Community Health Ctr', 'Dale (Recognized PPO but not contracted)', '', 'Ross', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008486', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022498', 'W11022498', 'WY01', 'Community Health Ctr', 'David (Recognized PPO but not contracted)', '', 'Butters', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005504', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022499', 'W11022499', 'WY01', 'Community Health Ctr', 'Paul (Recognized PPO but not contracted)', '', 'Langevin', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007191', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022500', 'W11022500', 'WY01', 'Community Health Ctr', 'Eric (Recognized PPO but not contracted)', '', 'Lawrence', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007218', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022501', 'W11022501', 'WY01', 'Community Health Ctr', 'Stephan (Recognized PPO but not contracted)', '', 'Trent', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009174', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022502', 'W11022502', 'WY01', 'Community Health Ctr', 'Biran (Recognized PPO but not contracted)', '', 'Veauthier', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009433', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022503', 'W11022503', 'WY01', 'Community Health Ctr', 'Karen (Recognized PPO but not contracted)', '', 'Wildman', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009619', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022504', 'W11022504', 'WY01', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Miller', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007622', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022505', 'W11022505', 'WY01', 'Community Health Ctr', 'Lonnie (Recognized PPO but not contracted)', '', 'Teague', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009026', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022506', 'W11022506', 'WY01', 'Community Health Ctr', 'Cynthia (Recognized PPO but not contracted)', '', 'Works', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009677', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W11022507', 'W11022507', 'WY01', 'Community Health Ctr', 'Coleen (Recognized PPO but not contracted)', '', 'Haynes', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-03-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006622', 0, 'Y', 0, '2012-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830274249', 'W11022508', 'W11022508', 'WY01', '', 'Anne (Recognized PPO but not contracted)', '', 'MacGuire', '', 'Rheumatology', '', '', NULL, 'O', '940 E 3rd St', 'Casper', '', 'WY', '82601', '3075770445', NULL, '940 E 3rd St', 'Casper', '', 'WY', '82601', '3075770445', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007377', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830324127', 'W11022509', 'W11022509', 'WY01', 'Platte Valley Medical Clinic', 'Diane ', '', 'Noton', '', 'Family Practice', '', '', NULL, 'O', '1208 S River St', 'Saratoga', NULL, 'WY', '82331', '3073268381', NULL, '1208 S River St', 'Saratoga', '', 'WY', '82331', '3073268381', '', '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2009-12-15', '2009-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007913', 0, 'N', 0, '2010-07-01', NULL, NULL, 0, 0, NULL, NULL),
('830248812', 'W11022510', 'W11022510', 'WY01', '', 'Michael (Recognized PPO but not contracted)', '', 'Garnum', '', 'Pediatrics', '', '', NULL, 'O', '940 E  3rd ST Ste 205', 'Casper', '', 'WY', '82601', '3075774260', NULL, '940 E  3rd ST Ste 205', 'Casper', '', 'WY', '82601', '3075774260', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006372', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830239998', 'W11022511', 'W11022511', 'WY01', '(Recognized PPO but not Contracted)', 'Johnny', '', 'Tooke', 'MD', 'Family Practice', '', '', NULL, 'O', '2241  Farnum St', 'Casper', '', 'WY', '82609', '3072661263', NULL, '2241  Farnum St', 'Casper', '', 'WY', '82609', '3072661263', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2013-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053426759', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830332882', 'W11022512', 'W11022512', 'WY01', '', 'Steve (Recognized PPO but not contracted)', '', 'Larson', '', 'Optometrist', '', '', NULL, 'O', '204  S Durbin St', 'Casper', '', 'Wy', '82601', '3072350505', NULL, '204  S Durbin St', 'Casper', '', 'Wy', '82601', '3072350505', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007207', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('061666516', 'W11022513', 'W11022513', 'WY01', 'Allergy & Asthma', 'Karmish (Recognized PPO but not contracted)', '', 'Shaw', '', 'Allergy and Immunology', '', '', NULL, 'O', '2222 E  2nd St', 'Casper', '', 'WY', '82609', '3075775222', NULL, '2222 E  2nd St', 'Casper', '', 'WY', '82609', '3075775222', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008686', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('202765815', 'W11022514', 'W11022514', 'WY01', 'Sage Medical Group', 'Marian (Recognized PPO but not contracted)', '', 'Bursten', '', 'Family Practice', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005496', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('202765815', 'W11022515', 'W11022515', 'WY01', 'Sage Medical Group', 'Jason', '', 'Lloyd', 'MD', 'Family Practice', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1841298536', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('202765815', 'W11022516', 'W11022516', 'WY01', 'Sage Medical Group', 'David ', '', 'Erk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1396713046', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W11022517', 'W11022517', 'WY01', 'Int Med Group (Cheyenne)', 'Geraldine (Recognized PPO but not contracted)', '', 'Gardner', '', 'Cardiovascular Disease', '', 'Internal Medicine', NULL, 'O', '2301  House Ave', 'Cheyenne', '', 'WY', '82001', '3076354141', NULL, '2301  House Ave', 'Cheyenne', '', 'WY', '82001', '3076354141', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006361', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'W11022518', 'W11022518', 'WY01', 'WY  OtolaryngologyJoseph Vigneri MD', 'Joseph (Recognized PPO but not contracted)', '', 'Vigneri', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009446', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'W11022519', 'W11022519', 'WY01', 'WY  OtolaryngologyJoseph Vigneri MD', 'Eugene (Recognized PPO but not contracted)', '', 'Podrazik', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008226', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'W11022520', 'W11022520', 'WY01', 'WY  OtolaryngologyJoseph Vigneri MD', 'Cope (Recognized PPO but not contracted)', '', 'Norcross', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007892', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830326365', 'W11022521', 'W11022521', 'WY01', 'Rocky Mt Infections Disease', 'Mark (Recognized PPO but not contracted)', '', 'Dowell', '', 'Infectious Disease', '', '', NULL, 'O', '5810  E  2nd St', 'Casper', '', 'WY', '82601', '3072348700', NULL, '5810  E  2nd St', 'Casper', '', 'WY', '82601', '3072348700', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006019', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W11022522', 'W11022522', 'WY01', 'Wyoming Surgical Associates', 'James', '', 'Anderson', 'MD', 'Colon and Rectal Surgery', 'General Surgery', 'Vascular Surgery', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-06-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1205822442', 0, 'Y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('520629656', 'W11022523', 'W11022523', 'WY01', 'David Elbogen', 'David (Recognized PPO but not contracted)', '', 'Elbogen', '', 'Pediatrics', '', '', NULL, 'O', '1720 Poplar Dr Ste 1', 'Casper', '', 'WY', '82601', '3074731427', NULL, '1720 Poplar Dr Ste 1', 'Casper', '', 'WY', '82601', '3074731427', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006102', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11022525', 'W11022525', 'ID03', NULL, 'Daryl', 'A', 'Moss', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1278 Woodruff', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085243018', NULL, NULL, NULL, 'Bonneville', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-11-01', '2009-12-01', NULL, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255494977', 0, 'N', 0, '2009-12-08', NULL, NULL, 0, 0, NULL, NULL),
('200392269', 'W11022526', 'W11022526', 'ID01', 'Access Life Resource Inc', 'Julene', 'B', 'Knapp', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '960 Broadway Ave Ste 115', 'Boise', 'Ada', 'ID', '83706', '2083381227', NULL, '960 Broadway Ave Ste 115', 'Boise', 'Ada', 'ID', '83706', '2083381227', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952487407', 0, 'n', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11022527', 'W11022527', 'ID01', NULL, 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1710190665', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11022528', 'W11022528', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Donald', 'K', 'Stott', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649264003', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11022529', 'W11022529', 'ID01', '', 'Mark', NULL, 'McConnell', NULL, 'Pulmonary', '', '', NULL, 'O', '1055 N Curtis', 'Boise', '', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', '', 'ID', '83706', '2083672121', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-12-12', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007496', 0, 'Y', 0, '2012-12-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11022530', 'W11022530', 'ID01', '', 'Patrick', '', 'Weis', '', 'Pulmonary', '', '', NULL, 'O', '1055 N Curtis', 'Boise', '', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', '', 'ID', '83706', '2083672121', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-02-01', 0, 0, 0, '', '', '', '', 'HCFA|', '0000009560', 0, 'Y', 0, '2011-03-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11022531', 'W11022531', 'ID01', '', 'Kenneth', 'E', 'Chandler', 'CADC', 'Mental Health', 'Counseling', '', NULL, 'O', '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083673553', NULL, '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1629205570', 0, 'N', 0, '2009-12-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11022532', 'W11022532', 'ID01', '', 'Robert', 'G', 'Ingram', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083676238', NULL, '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083676238', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1427074384', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11022533', 'W11022533', 'ID01', '', 'Kevin', 'A', 'Clifford', 'MD', 'Emergency Medicine', 'Hospice', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083672121', '          ', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083672121', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2014-06-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1568500700', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W11022534', 'W11022534', 'ID01', '', 'Jill', NULL, 'Anderson', 'CCNS', 'Clinical Nurse Specialist', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', '', 'ID', '83706', '2083674278', NULL, '6140 W Curtisian Ste 200', 'Boise', '', 'ID', '83706', '2083674278', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063696979', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('460500210', 'W11022535', 'W11022535', 'ID01', '', 'Jennifer', 'T', 'Shalz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-10-05', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1245346303', 0, 'N', 0, '2012-07-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('820200895', 'W11022557', 'W11022557', 'ID01', 'Saint Alphonsus Express Care', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'B', '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675178', NULL, '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675178', '', '', '', '', '0.00', '0.00', '0.00', 6, '2009-12-21', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1033304886', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('870572252', 'W11022566', 'W11022566', 'UT01', 'Hidden Valley Family Medicine', 'Pascale', '', 'Stephani', 'CNM', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8015723750', NULL, 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8015723750', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811935430', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('261888030', 'W11022567', 'W11022567', 'UTMH1', 'Brighter Future Counseling', 'Tyler', 'C', 'Goddard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '203 E Cobblecreek Dr Ste 210', 'Cedar City', 'Iron', 'UT', '84721', '4355862182', NULL, '203 E Cobblecreek Dr Ste 210', 'Cedar City', 'Iron', 'UT', '84721', '4355862182', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-12-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821161738', 0, 'n', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W11022568', 'W11022568', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Debra', 'L', 'Walker', 'PA', 'Orthopaedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-12-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912993015', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W11022569', 'W11022569', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-12-31', 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W11022570', 'W11022570', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Joseph', 'F', 'Allegretto', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '109 W Lakeway', 'Gillette', 'Campbell', 'WY', '82718', '3076826222', NULL, '109 W Lakeway', 'Gillette', 'Campbell', 'WY', '82718', '3076826222', '', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA|UB|', '1508823964', 0, 'N', 0, '2014-04-28', NULL, NULL, 44.269, -105.504, NULL, NULL),
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('810587644', 'W11022601', 'W11022601', 'UT01', 'Bear Lake Community Health Center', 'Julie', '', 'Patterson', 'PAC', 'Family Practice', 'Orthopedic Surgery', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', NULL, '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2011-12-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275866139', 0, 'N', 0, '2014-03-11', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('264247415', 'W11022602', 'W11022602', 'UT01', NULL, 'Kathleen', NULL, 'Rodman', 'NP', 'Gynecologic Oncology', NULL, NULL, NULL, 'O', '255 Douglas St', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015839639', NULL, '255 Douglas St', 'Salt Lake City', 'Salt Lake', 'UT', '84102', NULL, NULL, 'WISESTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760439574', 0, 'n', 0, '2006-10-19', NULL, NULL, 40.7639, -111.855, NULL, NULL),
('820525090', 'W11022603', 'W11022603', 'ID01', 'Boise Orthopedic Clinic', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-12-15', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11022604', 'W11022604', 'ID01', 'Boise Orthopedic Clinic', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-11-17', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('810587644', 'W11022605', 'W11022605', 'UT01', 'Bear Lake Community Health Center', 'Jeffrey', '', 'Pulley', 'PAC', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', NULL, '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912233305', 0, 'N', 0, '2012-10-23', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('810587644', 'W11022606', 'W11022606', 'UT01', 'Cache Valley Community Health Ctr', 'Jeffrey', '', 'Pulley', 'PAC', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84321', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84321', '4357556061', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912233305', 0, 'N', 0, '2012-10-23', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('202630141', 'W11022607', 'W11022607', 'ID02', 'Primary Health Medical Group', 'Rachel', '', 'Levitch', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089398200', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089398200', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-12-15', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740515287', 0, 'y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11022608', 'W11022608', 'ID02', 'Primary Health Medical Group', 'Rachel', '', 'Levitch', 'PA', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', NULL, '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-12-15', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740515287', 0, 'N', 0, '2014-05-09', NULL, NULL, 43.6915, -116.355, NULL, NULL),
('200961076', 'W11022609', 'W11022609', 'UT01', 'Summit Pain Management', 'Katrina', '', 'Lewis', 'MD', 'Pain Management', '', '', NULL, 'O', '5250 S 320 W Ste 305', 'Murray', 'Salt Lake', 'UT', '84107', '8012627246', NULL, '5250 S 320 W Ste 305', 'Murray', 'Salt Lake', 'UT', '84107', '8012627246', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841491529', 0, 'N', 0, '2013-08-26', NULL, NULL, 40.6564, -111.899, NULL, NULL),
('200961076', 'W11022610', 'W11022610', 'UT01', 'Summit Pain Management', 'Katrina', '', 'Lewis', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012627246', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012627246', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841491529', 0, 'y', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11022611', 'W11022611', 'UT01', 'Granger Medical Clinic', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', 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', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-01-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11022612', 'W11022612', 'UT01', 'Granger Medical Clinic', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', 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', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-01-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870284475', 'W11022613', 'W11022613', 'UT01', 'Granger Medical Clinic', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8013021700', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8013021700', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-01-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W11022614', 'W11022614', 'WY01', 'Lander Medical Clinic', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'n', 0, '2013-08-27', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('826000428', 'W11022615', 'W11022615', 'UT01', 'Oneida County Clinic', NULL, NULL, 'Oneida County Clinic', NULL, 'Family Practice', NULL, NULL, NULL, 'B', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087662600', NULL, '220 Bannock St', 'Malad City', 'Oneida', 'UT', '83252', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007973', 0, 'Y', 0, '2009-12-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11022616', 'W11022616', 'UTPEHP', 'Primary Childrens Medical Center', 'Lara', 'A', 'Leishman', 'PhD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626755', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626755', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-01-01', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215197264', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11022617', 'W11022617', 'UT01', NULL, 'John', 'T', 'McPhie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2530 W 4700 S Ste B4', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018849126', '8013999807', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-11-17', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598995763', 0, 'N', 0, '2009-12-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11022618', 'W11022618', 'WYBILLINGS', 'Billings Clinic - Rehab', 'Nicole', 'M', 'Schad', 'SLP', 'Speech Therapy', NULL, 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, '2010-01-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437488723', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742715684', 'W11022619', 'W11022619', 'UT01', 'Rocky Mountain Care-Clearfield', NULL, NULL, 'Rocky Mountain Care-Clearfield', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '1450 S 1500 E', 'Clearfield', 'Davis', 'UT', '84015', '8013974300', NULL, '1450 S 1500 E', 'Clearfield', 'Davis', 'UT', '84015', NULL, NULL, '', NULL, '7', '0.00', '100.00', '0.00', 3, '2009-12-16', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629075361', 0, 'N', 0, '2009-12-28', NULL, NULL, 41.093, -111.997, NULL, NULL),
('264093211', 'W11022620', 'W11022620', 'UTMH1', 'Destination Hope Counseling', 'Karen', 'M', 'DeBirk', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1190 N Spring Creek Pl Ste D2', 'Springville', 'Utah', 'UT', '84663', '8018064226', NULL, '1190 N Spring Creek Pl Ste D2', 'Springville', 'Utah', 'UT', '84663', '8018064226', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-12-21', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568796522', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('208004030', 'W11022621', 'W11022621', 'UTDT01', 'Aspen Dental of Cache Valley', 'Brandon', '', 'Priebe', 'DDS', 'Dentist', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', NULL, '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1427213594', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('263079602', 'W11022622', 'W11022622', 'UTDT01', 'Falling Creek Dental', 'Chad', NULL, 'Goeckeritz', 'DDS', 'Dentist', '', '', NULL, 'O', '112 E 12450 S Ste 101', 'Draper', 'Salt Lake', 'UT', '84020', '8014953567', NULL, '112 E 12450 S Ste 101', 'Draper', 'Salt Lake', 'UT', '84020', '8014953567', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', '2010-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006428', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('260187799', 'W11022623', 'W11022623', 'UTDT01', 'South Mountain Dental', 'Christopher', '', 'Johnson', 'DO', 'Dentist', '', '', NULL, 'O', '12288 S 900 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015010209', NULL, '12288 S 900 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015010209', '', 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1043224116', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('201933509', 'W11022624', 'W11022624', 'UTDT01', 'Horizon Dental', 'David', NULL, 'Iroz', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014653111', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006869', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('870281464', 'W11022625', 'W11022625', 'UTDT01', 'Highland Dental Center', 'Darin', '', 'Knudson', 'DDS', 'Dentist', 'Pedodontist', '', NULL, 'O', '1955 S 1300 E Ste 1 ', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014875755', NULL, '1955 S 1300 E Ste 1 ', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014875755', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007122', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('010778442', 'W11022626', 'W11022626', 'UTDT01', 'Genesis Dental of Tooele', 'Edgar Alan', NULL, 'Stewart', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', NULL, NULL, NULL, 'Tooele', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000008915', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('529441031', 'W11022627', 'W11022627', 'UTDT01', NULL, 'Glen', NULL, 'Eliason', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste A111', 'Ogden', 'Weber', 'UT', '84403', '8013937781', NULL, NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006106', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('260816943', 'W11022628', 'W11022628', 'UTDT01', NULL, 'Gerald', NULL, 'Torgeson', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '164 E 5900 S ', 'Murray', 'Salt Lake', 'UT', '84107', '8012621181', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000009142', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('208004030', 'W11022629', 'W11022629', 'UTDT01', 'Aspen Dental of Cache Valley', 'Justin', '', 'Carter', 'DDS', 'Dentist', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', NULL, '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005593', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('261315012', 'W11022630', 'W11022630', 'UTDT01', NULL, 'John', NULL, 'Rich', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '2180 E 4500 S Ste 170', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012782941', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000008378', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('529800177', 'W11022631', 'W11022631', 'UTDT01', NULL, 'Jeffrey', '', 'Sperry', 'DMD', 'Dentist', '', '', NULL, 'O', '2000 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014848893', NULL, '2000 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014848893', '', 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008863', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('270252868', 'W11022632', 'W11022632', 'UTDT01', NULL, 'John Josh', '', 'Smith', 'DMD', 'Dentist', '', '', NULL, 'O', '2180 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', NULL, '2180 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', '', 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008764', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('262779410', 'W11022633', 'W11022633', 'UTDT01', '', 'Jared', '', 'Weaver', 'DDS', 'Dentist', '', '', NULL, 'O', '2011 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014840792', '          ', '2011 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014840792', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'DEN|', '1851555650', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('528354560', 'W11022634', 'W11022634', 'UTDT01', NULL, 'Kyle', NULL, 'Morgan', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '47 E Crestwood Rd Ste 5', 'Kaysville', 'Davis', 'UT', '84037', '8015462439', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007696', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('141855048', 'W11022635', 'W11022635', 'UTDT01', 'Canyon Dental', 'R Joseph', '', 'Magness', 'DDS', 'Dentist', '', '', NULL, 'O', '3961 W 9000 S Ste I', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012601131', NULL, '3961 W 9000 S Ste I', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012601131', '', 'UT000A', NULL, '', '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1720248586', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('261160336', 'W11022636', 'W11022636', 'UTDT01', NULL, 'Stephen', NULL, 'Haslam', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '6065 S Fashion Blvd Ste 275', 'Murray', 'Salt Lake', 'UT', '84107', '8012624628', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006608', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('263425508', 'W11022637', 'W11022637', 'UTDT01', 'Lakeside Dental', 'Spencer', '', 'Luke', 'DDS', 'Dentist', '', '', NULL, 'O', '1011 N Catherine St', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8015963000', NULL, '1011 N Catherine St', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8015963000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'DEN|', '0000007361', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('529420831', 'W11022638', 'W11022638', 'UTDT01', '', 'Stephen', '', 'Morgan', 'DDS', 'Dentist', '', '', NULL, 'O', '47 E Crestwood Rd', 'Kaysville', 'Davis', 'UT', '84037', '8015462439', NULL, '47 E Crestwood Rd', 'Kaysville', 'Davis', 'UT', '84037', '8015462439', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', '2009-06-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000007697', 0, 'N', 0, '2010-10-01', NULL, NULL, 0, 0, NULL, NULL),
('260316630', 'W11022639', 'W11022639', 'UTDT01', NULL, 'Cameron', NULL, 'Workman', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '150 E 200 N Ste B2', 'Logan', 'Cache', 'UT', '84321', '4357529225', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000009675', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('870624803', 'W11022640', 'W11022640', 'UTDT01', NULL, 'Larry', NULL, 'Braithwaite', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '1675 N 200 W Ste 12A', 'Provo', 'Utah', 'UT', '84604', '8013754600', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005398', 0, 'N', 0, '2009-12-29', NULL, NULL, 0, 0, NULL, NULL),
('261494084', 'W11022641', 'W11022641', 'UTDT01', 'Hyde Park Dental', 'Monte', NULL, 'Carlson', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '3125 N Main Ste 104', 'North Logan', 'Cache', 'UT', '84341', '4357874444', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005577', 0, 'N', 0, '2009-12-29', 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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('820514419', 'W11022796', 'W11022796', 'ID02', 'Horizon Health', 'Katherine', '', 'Laible', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '311 W Idaho St', 'Boise', NULL, 'ID', '83702', '2088468616', '2088884296', '311 W Idaho St', 'Boise', '', 'ID', '83702', '2088468616', '2088884296', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083739049', 0, 'N', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
('680624385', 'W11022793', 'W11022793', 'ID02', 'Eagle Creek Family Medicine', 'Vicki', '', 'Wooll', 'MD', 'Family Practice', '', '', NULL, 'O', '1281 E Iron Eagle Dr', 'Eagle', NULL, 'ID', '83616', '2089395535', '2089395536', '1281 E Iron Eagle Dr', 'Eagle', '', 'ID', '83616', '2089395535', '2089395536', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-12-17', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1922053172', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11022797', 'W11022797', 'UT01', 'Jordan Valley Surgical Specialists', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8016014423', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Fulton', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-12-30', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'y', 0, '2009-12-30', NULL, NULL, 0, 0, NULL, NULL),
('529941285', 'W11022798', 'W11022798', 'UTMH1', NULL, 'Brad', '', 'Benson', 'LSCW', 'Mental Health', 'Social Worker', '', NULL, 'O', '290 W 100 S', 'Vernal', 'Uintah', 'UT', '84078', '4356216142', NULL, '290 W 100 S', 'Vernal', 'Uintah', 'UT', '84078', '4356216142', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528141827', 0, 'n', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('529941285', 'W11022799', 'W11022799', 'UTMH1', NULL, 'Brad', '', 'Benson', 'LSCW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 790007', 'Vernal', 'Uintah', 'UT', '84079', '4356216142', NULL, 'PO Box 790007', 'Vernal', 'Uintah', 'UT', '84079', '4356216142', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528141827', 0, 'y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022800', 'W11022800', 'UT01', 'St George Clinic', 'Nancy', 'R', 'Davis', 'NP', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821101288', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022801', 'W11022801', 'UT01', 'St George Clinic', 'Gus', 'C', 'Pendleton', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649361874', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022802', 'W11022802', 'UT01', 'St George Clinic', 'Clark', 'J', 'Staheli', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568505691', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022803', 'W11022803', 'UT01', 'St George Clinic', 'C', 'K', 'Stratford', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275688228', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022804', 'W11022804', 'UT01', 'St George Clinic', 'Howard', 'L', 'Chamberlain', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306951504', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022805', 'W11022805', 'UT01', 'St George Clinic', 'Scott', 'D', 'Barton', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376690180', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022806', 'W11022806', 'UT01', 'St George Clinic', 'Mckay', 'D', 'Christian', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760528897', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022807', 'W11022807', 'UT01', 'St George Clinic M-F 9am-9pm  Sat 9am-2pm ', '', '', 'St George Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829281', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022808', 'W11022808', 'UT01', 'St George Clinic', 'Jonathan', 'P', 'Hubbard', 'DO', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609894922', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022809', 'W11022809', 'UT01', 'St George Clinic', 'Curtis', '', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245225325', 0, 'N', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022810', 'W11022810', 'UT01', 'St George Clinic', 'Nancy', 'R', 'Davis', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821101288', 0, 'Y', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022811', 'W11022811', 'UT01', 'St George Clinic', 'Gus', 'C', 'Pendleton', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649361874', 0, 'Y', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022812', 'W11022812', 'UT01', 'St George Clinic', 'Clark', 'J', 'Staheli', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568505691', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022813', 'W11022813', 'UT01', 'St George Clinic', 'C', 'K', 'Stratford', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275688228', 0, 'Y', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022814', 'W11022814', 'UT01', 'St George Clinic', 'Howard', 'L', 'Chamberlain', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306951504', 0, 'Y', 0, '2014-01-17', 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
('870281028', 'W11022815', 'W11022815', 'UT01', 'St George Clinic', 'Scott', 'D', 'Barton', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376690180', 0, 'Y', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022816', 'W11022816', 'UT01', 'St George Clinic', 'Mckay', 'D', 'Christian', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760528897', 0, 'Y', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022817', 'W11022817', 'UT01', 'St George Clinic', '', '', 'St George Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829281', 0, 'Y', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022818', 'W11022818', 'UT01', 'St George Clinic', 'Jonathan', 'P', 'Hubbard', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609894922', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11022819', 'W11022819', 'UT01', 'St George Clinic', 'Curtis', '', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245225325', 0, 'Y', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('870558462', 'W11022820', 'W11022820', 'UTMH1', 'Canyon Counseling Group', 'F', 'Ann', 'Nielsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1361 N Hwy 89 Ste 11', 'Farmington', 'Davis', 'UT', '84025', '8016731005', NULL, '1361 N Hwy 89 Ste 11', 'Farmington', 'Davis', 'UT', '84025', '8016731005', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366638405', 0, 'n', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870558462', 'W11022821', 'W11022821', 'UTMH1', 'Canyon Counseling Group', 'F', 'Ann', 'Nielsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 54197', 'North Salt Lake', 'Davis', 'UT', '84054', '8016731005', NULL, 'PO Box 54197', 'North Salt Lake', 'Davis', 'UT', '84054', '8016731005', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366638405', 0, 'y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W11022822', 'W11022822', 'TX01', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', NULL, '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742915297', 'W11022824', 'W11022824', 'TX01', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', NULL, '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'W11022823', 'W11022823', 'TX01', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6171, -98.4927, 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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('942854057', 'W11023000', 'W11023000', 'UTPEHP2', 'Neonatology DRMC', 'Erick', 'B', 'Gerday', 'MD', 'Neonatology', '', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538172606', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023001', 'W11023001', 'UTPEHP2', 'DRMC Rehab Ctr', 'Daniel', 'Scott', 'Gillespie', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568473577', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023002', 'W11023002', 'UTPEHP2', 'Maternal Fetal Medicine', 'Frederick', 'A', 'Gonzalez', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', '', 'UT', '84770', '4356884000', NULL, '544 S 400 E', 'St George', '', 'UT', '84770', '4356884000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-07-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841211265', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023003', 'W11023003', 'UTPEHP2', 'DRMC Rehab Ctr', 'Gary', 'L', 'Gottfredson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356357339', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023004', 'W11023004', 'UTPEHP2', 'Rehab', 'Jerold', 'L', 'Hagen', 'MD', 'Internal Medicine', '', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2011-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639102635', 0, 'Y', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023005', 'W11023005', 'UTPEHP2', 'Neonatology DRMC', 'Jennifer', 'L', 'Hall', 'APRN', 'Neonatology', 'Neonatal Nurse Practitioner', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2011-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689848160', 0, 'Y', 0, '2011-05-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023006', 'W11023006', 'UTPEHP2', 'DRMC Rehab Ctr', 'Shalyse', 'S', 'Heaton', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '1380 E Medical Ctr Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194731125', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023007', 'W11023007', 'UTPEHP2', 'Inpatient Behavioral Medicine Unit', 'Raymond', 'K', 'Hinton', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', '2009-10-26', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609978345', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023008', 'W11023008', 'UTPEHP2', 'Dixie Regional Medical Center', 'Terri', 'L', 'Hoffman', 'MD', 'Internal Medicine', 'Pulmonology', '', NULL, 'B', '1380 E Medical Ctr Dr Ste 1400', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr Ste 1400', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871512137', 0, 'Y', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023009', 'W11023009', 'UTPEHP2', 'Summit Physical Therapy', 'Jane', 'A', 'Hugunin', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1532 E 1450 S', 'St George', NULL, 'UT', '84790', '4352514545', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295740074', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023010', 'W11023010', 'UTPEHP2', 'DRMC Rehab Ctr', 'Ted', 'A', 'Hugunin', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891700613', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023011', 'W11023011', 'UTPEHP2', 'DRMC Rehab Ctr', 'Kerry', 'Ann', 'Humphrey', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306062914', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023012', 'W11023012', 'UTPEHP2', 'Maternal Fetal Medicine', 'Gilbert', 'M', 'Jackson', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356421259', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023013', 'W11023013', 'UTPEHP2', 'Critical Care/Pulmonary', 'Charlie', 'R', 'Jacques', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', 'Pulmonary', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336162890', 0, 'Y', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023014', 'W11023014', 'UTPEHP2', 'Dixie Regional Medical Center', 'Gary', 'L', 'Jones', 'MD', 'Neurology', '', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356344300', '          ', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356344300', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2014-02-25', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1770540619', 0, 'Y', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023015', 'W11023015', 'UTPEHP2', 'Neonatology DRMC', 'Tracy', 'B', 'Karp', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306052360', 0, 'Y', 0, '2011-06-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023016', 'W11023016', 'UTPEHP2', 'SW ER Phys Grp', 'Kathleen', 'R', 'Killian', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, NULL, NULL, 'Washington', NULL, NULL, '4352511000', '          ', 'PEHPLCSW', '', '', '0.00', '30.00', '0.00', 8, '2008-07-01', '2009-09-04', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007084', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023017', 'W11023017', 'UTPEHP2', 'Dixie Regional Medical Center', 'Michael', 'R', 'Kline', 'MD', 'Pulmonary', 'Family Practice', 'Internal Medicine', NULL, 'B', '1380 E Medical Ctr Dr Ste 1400', 'St George', 'Washington', 'UT', '84790', '4352512355', NULL, '1380 E Medical Ctr Dr Ste 1400', 'St George', 'Washington', 'UT', '84790', '4352512355', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1073531331', 0, 'Y', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023018', 'W11023018', 'UTPEHP2', 'Emergency Room', 'Aaron', 'O', 'Klomp', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512134', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611602', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023019', 'W11023019', 'UTPEHP2', 'Neuro-Psychology DRMC', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', '          ', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2008-07-01', '2008-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023020', 'W11023020', 'UTPEHP2', 'SW ER Phys Grp', 'Gordon', 'L', 'Larsen', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', NULL, 'UT', '84790', '4352511000', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760479083', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023021', 'W11023021', 'UTPEHP2', 'Wound Care', 'Jana', 'M', 'Leany', 'APRN', 'Mental Health', 'Family Practice', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861488900', 0, 'Y', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023022', 'W11023022', 'UTPEHP2', 'SW Phys Group', 'Jana', 'M', 'Leany', 'APRN', 'Mental Health', 'Family Practice', '', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861488900', 0, 'Y', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023023', 'W11023023', 'UTPEHP2', 'Dixie Regional Medical Center', 'Steven', 'W', 'Lewis', 'MD', 'Pulmonary', 'Pulmonary Disease', NULL, NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255354437', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023024', 'W11023024', 'UTPEHP2', 'Dixie Regional Medical Center', 'Steven', 'W', 'Lewis', 'MD', 'Pulmonary', 'Pulmonary Disease', NULL, NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255354437', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023025', 'W11023025', 'UTPEHP2', 'Neonatology DRMC', 'Garry', 'G', 'Lipsey', 'APRN', 'Neonatology', 'Neonatal Nurse Practitioner', '', NULL, 'B', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477737583', 0, 'Y', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023026', 'W11023026', 'UTPEHP2', 'Dixie Cardiology', 'Daniel', 'B', 'Madsen', 'MD', 'Internal Medicine', '', '', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497749451', 0, 'Y', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023027', 'W11023027', 'UTPEHP2', 'Critical Care', 'Mark', 'L', 'Martinez', 'MD', 'Hospitalist', '', '', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512250', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512250', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508861964', 0, 'Y', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023028', 'W11023028', 'UTPEHP2', 'Dixie Cardiology', 'Kent', 'B', 'McDonald', 'MD', 'Hospitalist', '', '', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093794554', 0, 'Y', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023029', 'W11023029', 'UTPEHP2', 'Dixie Cardiology', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '1380 E Medical Ctr Dr', 'St George', NULL, 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', '', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'Y', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023030', 'W11023030', 'UTPEHP2', 'DRMC Rehab Ctr', 'Michael', 'B', 'Meek', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '385 N 3050 E', 'St George', NULL, 'UT', '84790', '4352512643', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891911418', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023031', 'W11023031', 'UTPEHP2', 'DRMC Rehab Ctr', 'Mark', 'A', 'Mills', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366538126', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023032', 'W11023032', 'UTPEHP2', 'Neonatology DRMC', 'Lonnie', 'J', 'Miner', 'MD', 'Neonatology', 'Pediatric Infectious Diseases', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1942220645', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023033', 'W11023033', 'UTPEHP2', 'DRMC Rehab Ctr', 'Lorraine', 'G', 'Moe', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', '', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-07-01', '2010-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538177993', 0, 'N', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023034', 'W11023034', 'UTPEHP2', 'DRMC Rehab Ctr', 'Scott', 'S', 'Munson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', NULL, 'UT', '84737', '4356356480', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104035112', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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