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', 'W12006677', 'W12006677', 'UTIHC01', 'Maternal Fetal Medicine', 'Heather', 'D', 'Major', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700860350', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006678', 'W12006678', 'UTIHC04', 'Maternal Fetal Medicine', 'Heather', 'D', 'Major', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700860350', 0, 'N', 0, '2011-06-23', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12006680', 'W12006680', 'UTIHC04', 'Emergency Room', 'Melville', 'S', 'Linscott', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679663280', 0, 'N', 0, '2010-12-08', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12006681', 'W12006681', 'UTIHC04', 'Emergency Room', 'Melville', 'S', 'Linscott', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679663280', 0, 'N', 0, '2010-12-08', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12006684', 'W12006684', 'UTIHC01', 'Primary Childrens Center for Counseling', 'Annie', 'M', 'Deming', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-10-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386945566', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006685', 'W12006685', 'UTIHC02', 'Primary Childrens Center for Counseling', 'Annie', 'M', 'Deming', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-10-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386945566', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006686', 'W12006686', 'UTIHC03', 'Primary Childrens Center for Counseling', 'Annie', 'M', 'Deming', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-10-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386945566', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006687', 'W12006687', 'UTIHC04', 'Primary Childrens Center for Counseling', 'Annie', 'M', 'Deming', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-10-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386945566', 0, 'N', 0, '2011-02-15', NULL, NULL, 40.6462, -111.934, NULL, NULL),
('942854057', 'W12006692', 'W12006692', 'UTIHC04', 'Emergency Room', 'Bruce', 'T', 'Taylor', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386684587', 0, 'N', 0, '2010-12-08', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12006694', 'W12006694', 'UTIHC01', 'Critical Care', 'Kenneth', 'W', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-12-15', '2011-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902879794', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006695', 'W12006695', 'UTIHC03', 'Critical Care', 'Kenneth', 'W', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-12-15', '2011-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902879794', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006696', 'W12006696', 'UTIHC04', 'Critical Care', 'Kenneth', 'W', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-12-15', '2011-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902879794', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006698', 'W12006698', 'UTIHC01', 'Emergency Room', 'Richard', 'A', 'Sorensen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184751547', 0, 'N', 0, '2010-12-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006699', 'W12006699', 'UTIHC03', 'Emergency Room', 'Richard', 'A', 'Sorensen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184751547', 0, 'N', 0, '2010-12-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006700', 'W12006700', 'UTIHC04', 'Emergency Room', 'Richard', 'A', 'Sorensen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184751547', 0, 'N', 0, '2010-12-08', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12006702', 'W12006702', 'UTIHC01', 'Physical Therapy', 'Kelly', 'J', 'Jackson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '652 S Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811191166', 0, 'N', 0, '2010-12-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006703', 'W12006703', 'UTIHC03', 'Physical Therapy', 'Kelly', 'J', 'Jackson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '652 S Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811191166', 0, 'N', 0, '2010-12-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006704', 'W12006704', 'UTIHC04', 'Physical Therapy', 'Kelly', 'J', 'Jackson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '652 S Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811191166', 0, 'N', 0, '2010-12-08', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('820533113', 'W12006804', 'W12006804', 'ID02', 'Health Quest Chiropractic', 'Jaren', 'L', 'Sayer', 'DC', 'Chiropractic', '', '', NULL, 'O', '1100 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083753500', '2083753716', '1100 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083753500', '2083753716', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942266317', 0, 'N', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870567253', 'W12006815', 'W12006815', 'UTDT01', 'Pediatric Dentistry', 'Ronald', '', 'French', 'DDS', 'Pedodontist', '', '', NULL, 'O', '2050 E Cotton Tree Ln', 'Beaver', 'Beaver', 'UT', '84713', '4354211298', NULL, '2050 E Cotton Tree Ln', 'Beaver', 'Beaver', 'UT', '84713', '4354211298', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006319', 0, 'N', 0, '2010-12-09', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12006837', 'W12006837', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Esther', '', 'Sears', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-22', '2012-07-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932137684', 0, 'N', 0, '2012-09-07', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('320084108', 'W12006823', 'W12006823', 'UT01', 'Andersen Chiropractic LLC', 'Kenneth', 'Raymond', 'Andersen', 'DC', 'Chiropractic', '', '', NULL, 'O', '9035 S 1300 E Ste 2B', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725696', '8015725753', '9035 S 1300 E Ste 2B', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725696', '8015725753', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760483986', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('208070290', 'W12006825', 'W12006825', 'UT01', 'ProHealth Chiropractic LLC', 'Mark', 'Frederic', 'Bentley', 'DC', 'Chiropractic', '', '', NULL, 'O', '523 E Sunland Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356287040', '4356742646', '523 E Sunland Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356287040', '4356742646', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144255431', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('364635100', 'W12006842', 'W12006842', 'UT01', 'Nephi Chiropractic', 'Brandon', 'D', 'Bradford', 'DC', 'Chiropractic', '', '', NULL, 'O', '45 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356237400', '4356237500', '45 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356237400', '4356237500', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790942365', 0, 'N', 0, '2014-05-16', NULL, NULL, 39.7114, -111.839, NULL, NULL),
('270175340', 'W12006826', 'W12006826', 'UT01', 'Active Life Chiropractic Health Center PC', 'Steven', 'E', 'Davis', 'DC', 'Chiropractic', '', '', NULL, 'O', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770735284', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('271898282', 'W12006828', 'W12006828', 'UT01', 'Integrated Wellness South Jordan', 'Scott', 'H', 'Frogley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790825388', 0, 'N', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('202823178', 'W12006829', 'W12006829', 'UT01', 'Goodman Chiropractic', 'Kenneth', 'Michael', 'Goodman', 'DC', 'Chiropractic', '', '', NULL, 'O', '85 E SR 73', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', '85 E SR 73', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700971587', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('528649254', 'W12006830', 'W12006830', 'UT01', 'SL Health Clinic', 'James', 'I', 'Grant', 'DC', 'Chiropractic', '', '', NULL, 'O', '2189 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014667122', '8014665541', '2189 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014667122', '8014665541', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316057466', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('271898282', 'W12006832', 'W12006832', 'UT01', 'Integrated Wellness South Jordan', 'Jon', '', 'McDonald', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265749774', 0, 'N', 0, '2012-08-29', NULL, NULL, 0, 0, NULL, NULL),
('204348971', 'W12006835', 'W12006835', 'UT01', 'Advanced Spinal Care', 'Brent', 'Nephi', 'Wall', 'DC', 'Chiropractic', '', '', NULL, 'O', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346263100', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('271898282', 'W12006834', 'W12006834', 'UT01', 'Integrated Wellness South Jordan', 'Randy', '', 'Woodward', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770721128', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870665180', 'W12006827', 'W12006827', 'UT01', 'Draney Chiropractic', 'Elizabeth', 'C', 'Draney', 'DC', 'Chiropractic', '', '', NULL, 'O', '7211 Plaza Ctr Dr Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012802548', '8012802658', '7211 Plaza Ctr Dr Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012802548', '8012802658', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063512580', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('263373277', 'W12006845', 'W12006845', 'UTPEHP', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'O', '1011 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', '1011 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('263373277', 'W12006847', 'W12006847', 'UTPEHP', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'O', '575 Rivergate Ln Ste 106', 'Durango', 'La Plata', 'CO', '81301', '9702470937', '9702479579', '575 Rivergate Ln Ste 106', 'Durango', 'La Plata', 'CO', '81301', '9702470937', '9702479579', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('263373277', 'W12006846', 'W12006846', 'UTPEHP', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'B', 'PO Box 876', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'PO Box 876', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('820477112', 'W12006848', 'W12006848', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Ralph', '', 'Campanale, II', 'MD', 'General Surgery', '', '', NULL, 'O', '180 W 1st St', 'Ketchum', 'Blaine', 'ID', '83340', '2087263707', NULL, '180 W 1st St', 'Ketchum', 'Blaine', 'ID', '83340', '2087263707', '          ', 'IDSINCLAIRE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972566727', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('272612740', 'W12006850', 'W12006850', 'WY01', '', 'Kris', 'A', 'Canfield', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 967', 'Gillette', 'Campbell', 'WY', '82717', '3076827500', '3076827585', 'PO Box 967', 'Gillette', 'Campbell', 'WY', '82717', '3076827500', '3076827585', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-02-12', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366441131', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870581690', 'W12006886', 'W12006886', 'UTDT01', '', 'Clayton M', NULL, 'Hansen', 'DDS', 'Dentist', '', '', NULL, 'O', '366 S 500 E', 'American Fork', 'Utah', 'UT', '84003', '8017562809', NULL, '366 S 500 E', 'American Fork', 'Utah', 'UT', '84003', '8017562809', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006564', 0, 'N', 0, '2008-08-25', NULL, NULL, 0, 0, NULL, NULL),
('870681797', 'W12006892', 'W12006892', 'UTDT01', '', 'Stephen', NULL, 'Johansen', 'DDS', 'Dentist', '', '', NULL, 'O', '7370 S Creek Rd Ste 202', 'Sandy', 'Salt Lake', 'UT', '84093', '8016761234', NULL, '7370 S Creek Rd Ste 202', 'Sandy', 'Salt Lake', 'UT', '84093', '8016761234', '          ', 'UT000C', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006953', 0, 'N', 0, '2008-08-25', NULL, NULL, 0, 0, NULL, NULL),
('556598155', 'W12006900', 'W12006900', 'UTDT01', '', 'Daniel', '', 'Ormsby', 'DDS', 'Dentist', '', '', NULL, 'O', '5801 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8014249031', NULL, '5801 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8014249031', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007984', 0, 'Y', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12006903', 'W12006903', 'UTDT01', 'The Center of Dental Professionals', 'Kris', 'H', 'Rosander', 'DDS', 'Dentist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1558422279', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006916', 'W12006916', 'UTDT01', 'Professional Dental', 'David', '', 'Blackhurst', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', NULL, '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002024', 0, 'N', 0, '2011-01-25', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006918', 'W12006918', 'UTDT01', 'Professional Dental', 'David', '', 'Faerber', 'DMD', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', NULL, '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004019', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006919', 'W12006919', 'UTDT01', 'Professional Dental', 'Brody', '', 'Hart', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', NULL, '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002035', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006920', 'W12006920', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', NULL, '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006924', 'W12006924', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', NULL, '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002061', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('340743218', 'W12006925', 'W12006925', 'UTMH1', 'Psychological Assessment and Treatment Specialists', 'Jennifer', 'A', 'Cannon', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', NULL, '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104127869', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870340605', 'W12006927', 'W12006927', 'UT01', 'Southwest Internal Medicine', 'Joseph', 'H', 'Woolley', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '1404 W Sun River Pkwy Ste 100', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356745763', '1404 W Sun River Pkwy Ste 100', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356745763', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-02-12', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780800813', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('870340605', 'W12006926', 'W12006926', 'UT01', 'Southwest Internal Medicine', 'Joseph', 'H', 'Woolley', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '1490 E Foremaster Dr Ste 210', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356745763', '1490 E Foremaster Dr Ste 210', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356745763', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-02-12', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780800813', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('711032839', 'W12006928', 'W12006928', 'ID01', '', 'Amy', '', 'Miles', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '300 W Main St Ste 108', 'Boise', 'Ada', 'ID', '83702', '2084291609', '2083388932', '300 W Main St Ste 108', 'Boise', 'Ada', 'ID', '83702', '2084291609', '2083388932', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114057528', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'W12006929', 'W12006929', 'WY01', 'Big Horn Urgent Care', 'Paula', 'S', 'Giovanini-Morris', 'NP', 'Family Practice', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '          ', NULL, '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '          ', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932116803', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'W12006931', 'W12006931', 'WY01', 'Big Horn Urgent Care', 'Sylvia', 'A', 'Rife', 'ARNP', 'Urgent Care', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245292242', 0, 'N', 0, '2014-07-22', NULL, NULL, 44.8053, -106.973, NULL, NULL),
('820397963', 'W12006934', 'W12006934', 'Sinclair', 'Shoshone Family Medical', 'Stephanie', '', 'Roberts', 'PA (Sinclair Health  Services Provider)', 'Family Practice', '', '', NULL, 'O', '113 S Apple St', 'Shoshone', 'Lincoln', 'ID', '83352', '2088862224', NULL, '113 S Apple St', 'Shoshone', 'Lincoln', 'ID', '83352', '2088862224', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144393257', 0, 'N', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12006935', 'W12006935', 'UT01', 'Utah Valley Urgent Care', 'Bryan', 'K', 'Adams', 'APRN', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-18', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578654224', 0, 'N', 0, '2010-11-01', NULL, NULL, 40.312, -111.719, NULL, NULL),
('870639748', 'W12006936', 'W12006936', 'UT01', 'Hoopes Vision Correction Center', 'O Claron', '', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8015680200', NULL, '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8015680200', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1780685412', 0, 'N', 0, '2011-10-05', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('870639748', 'W12004637', 'W12004637', 'UT01', 'Hoopes Vision Correction Center', 'O Claron', '', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'B', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1780685412', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12006941', 'W12006941', 'UT01', 'Rock Run Medical', 'Kara', '', 'Barber', 'PA-C', 'Family Practice', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083948970', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12006939', 'W12006939', 'UT01', 'Rock Run Medical', 'Kara', '', 'Barber', 'PA-C', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', NULL, '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', '2011-11-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083948970', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12006940', 'W12006940', 'UT01', 'Rock Run Medical', 'Kara', '', 'Barber', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8017732838', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8017732838', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083948970', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12006942', 'W12006942', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 100B', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '5405 S 500 E Ste 100B', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12006944', 'W12006944', 'UT01', 'Utah Valley Urgent Care', 'Jennifer', 'L', 'Butcher', 'APRN', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013230598', 0, 'N', 0, '2010-09-20', NULL, NULL, 40.312, -111.719, NULL, NULL),
('261488477', 'W12006951', 'W12006951', 'UT01', 'Family Surgical Suite (Oral Surgery Only)', '', '', 'Family Surgical Suite ', 'GROUP', 'Oral Surgery Center', 'Ambulatory Surgery Center', '', NULL, 'O', '8822 S Redwood Rd Ste C113', 'West Jordan', 'Salt Lake', 'UT', '84088', '8014951064', '8015231139', '8822 S Redwood Rd Ste C113', 'West Jordan', 'Salt Lake', 'UT', '84088', '8014951064', '8015231139', '', '', '2', '0.00', '0.00', '0.00', 6, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083861165', 0, 'N', 0, '2011-03-30', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('271398252', 'W12006952', 'W12006952', 'UT01', 'Utah Valley Urgent Care', 'Bradford', 'A', 'Gale', 'PA', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1932126976', 0, 'N', 0, '2012-11-26', NULL, NULL, 40.312, -111.719, NULL, NULL),
('942854057', 'W12006954', 'W12006954', 'UTIHCPHY', 'Bountiful KidsCare', 'Enrique', 'P', 'Baires', 'MD', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-10-09', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1548373400', 0, 'Y', 0, '2013-03-27', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('271398252', 'W12006955', 'W12006955', 'UT01', 'Utah Valley Urgent Care', 'Orrin', 'B', 'Hansen', 'NP', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-18', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1104916543', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.312, -111.719, NULL, NULL),
('271398252', 'W12006956', 'W12006956', 'UT01', 'Utah Valley Urgent Care', 'Kevin', 'A', 'Hough', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-18', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174581870', 0, 'N', 0, '2010-12-15', NULL, NULL, 40.312, -111.719, NULL, NULL),
('271398252', 'W12006957', 'W12006957', 'UT01', 'Utah Valley Urgent Care', 'Judd', 'D', 'Hunter', 'APRN', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831428705', 0, 'N', 0, '2010-12-15', NULL, NULL, 40.312, -111.719, NULL, NULL),
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('271398252', 'W12006959', 'W12006959', 'UT01', 'Utah Valley Urgent Care', 'William', 'E', 'Hough', 'DO', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-18', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386737633', 0, 'N', 0, '2014-05-21', NULL, NULL, 40.312, -111.719, NULL, NULL),
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('201030213', 'W12007017', 'W12007017', 'UT01', '', 'Ronald', 'Eric', 'Sanders', '', 'Chiropractic', '', '', NULL, 'O', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.45', 3, '2011-01-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619044179', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12007021', 'W12007021', 'UTIHC04', 'Park City Medical Center', 'S', 'Marlene', 'Hatch', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205918240', 0, 'N', 0, '2009-09-05', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('942854057', 'W12007023', 'W12007023', 'UTIHC04', 'Park City Medical Center', 'Gary', 'M', 'Watts', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528014792', 0, 'N', 0, '2010-01-12', NULL, NULL, 40.6876, -111.468, 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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('870687050', 'W12007397', 'W12007397', 'UT01', 'Iron Mission Dialysis Center', '', '', 'Iron Mission Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', NULL, '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', '          ', '', '', '', '0.00', '38.00', '0.00', 6, '2011-01-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336248855', 0, 'N', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('870687050', 'W12007400', 'W12007400', 'UT01', 'Iron Mission Dialysis Center', '', '', 'Iron Mission Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336248855', 0, 'Y', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870687050', 'W12007401', 'W12007401', 'UT01', 'Iron Mission Dialysis Center', '', '', 'Iron Mission Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '38.00', '0.00', 6, '2011-01-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336248855', 0, 'Y', 0, '2011-01-10', 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
('870687050', 'W12007402', 'W12007402', 'UT01', 'Iron Mission Dialysis Center', '', '', 'Iron Mission Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '36.00', '0.00', 6, '2012-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336248855', 0, 'Y', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542583', 'W12007403', 'W12007403', 'UT01', 'Dixie Dialysis Center', '', '', 'Dixie Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326147844', 0, 'Y', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542583', 'W12007404', 'W12007404', 'UT01', 'Dixie Dialysis Center', '', '', 'Dixie Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '38.00', '0.00', 3, '2011-01-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326147844', 0, 'Y', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542583', 'W12007405', 'W12007405', 'UT01', 'Dixie Dialysis Center', '', '', 'Dixie Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326147844', 0, 'Y', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542583', 'W12007406', 'W12007406', 'UT01', 'Dixie Dialysis Center', '', '', 'Dixie Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '720 S River Rd', 'St George', 'Washington', 'UT', '84791', '4356560857', NULL, '720 S River Rd', 'St George', 'Washington', 'UT', '84791', '4356560857', '          ', '', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326147844', 0, 'N', 0, '2011-01-10', NULL, NULL, 37.0958, -113.557, NULL, NULL),
('870542583', 'W12007407', 'W12007407', 'UT01', 'Dixie Dialysis Center', '', '', 'Dixie Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '720 S River Rd', 'St George', 'Washington', 'UT', '84791', '4356560857', NULL, '720 S River Rd', 'St George', 'Washington', 'UT', '84791', '4356560857', '          ', '', '', '', '0.00', '38.00', '0.00', 3, '2011-01-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326147844', 0, 'N', 0, '2011-01-10', 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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('260553931', 'W12007529', 'W12007529', 'ID01', 'Saint Alphonsus Medical Group Heart Care Emmett', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('260553931', 'W12007528', 'W12007528', 'ID01', 'Saint Alphonsus Medical Group Heart Care', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '520 S Eagle Rd Ste 2205', 'Meridian', 'Ada', 'ID', '83642', '2088840036', '2088843805', '520 S Eagle Rd Ste 2205', 'Meridian', 'Ada', 'ID', '83642', '2088840036', '2088843805', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-01-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820200895', 'W12007530', 'W12007530', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center Reading Only', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '          ', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12007531', 'W12007531', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Marcel', 'A', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801837141', 0, 'N', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12007532', 'W12007532', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Austin', 'J', 'Graham', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2011-07-31', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1548228844', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12007534', 'W12007534', 'ID01', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Brigitta', 'S', 'Lavergne', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-20', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1164596557', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W12007535', 'W12007535', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-02-10', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12007536', 'W12007536', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-02-10', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W12007537', 'W12007537', 'ID01', 'Saint Alphonsus Medical GroupMHP Family Medicine', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-02-10', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12007538', 'W12007538', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-02-10', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('260553931', 'W12007539', 'W12007539', 'ID01', 'Saint Alphonsus Medical Group Heart Care Boise', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-10-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('260553931', 'W12007541', 'W12007541', 'ID01', 'Saint Alphonsus Medical Group Heart Care Emmett', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-10-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2012-06-26', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('260553931', 'W12007540', 'W12007540', 'ID01', 'Saint Alphonsus Medical Group Heart Care', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '520 S Eagle Rd Ste 2205', 'Meridian', 'Ada', 'ID', '83642', '2088840036', '2088843805', '520 S Eagle Rd Ste 2205', 'Meridian', 'Ada', 'ID', '83642', '2088840036', '2088843805', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2012-06-26', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820200895', 'W12007542', 'W12007542', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2012-11-20', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12007543', 'W12007543', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2012-11-20', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W12007544', 'W12007544', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2012-11-20', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W12007545', 'W12007545', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12007546', 'W12007546', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12007547', 'W12007547', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W12007548', 'W12007548', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12007549', 'W12007549', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W12007550', 'W12007550', 'ID01', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'N', 0, '2013-02-13', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('352329743', 'W12007551', 'W12007551', 'UT01', 'Mountain Star Pediatrics', '', '', 'Mountain Star Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8014790174', NULL, 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8014790174', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007723', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('261322751', 'W12007552', 'W12007552', 'PEHP', 'Therapeutic Milestones ', 'Jay', '', 'Langford', 'PT', 'Physical Therapy', '', '', NULL, 'O', '26 E 1000 N Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', '26 E 1000 N Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2011-02-01', '2011-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043539497', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('261322751', 'W12007553', 'W12007553', 'PEHP', 'Therapeutic Milestones ', 'Jay', '', 'Langford', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 833', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'PO Box 833', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2011-02-01', '2011-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043539497', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('820463458', 'W41015840', 'W41015840', 'ID02', NULL, 'Jon', 'W', 'Glick', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '200 Forest St', 'McCall', 'Valley', 'ID', '83638', '2086304248', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922039262', 0, 'n', 0, '2013-03-01', NULL, NULL, 0, 0, NULL, NULL),
('010894077', 'W42005244', 'W42005244', 'UTMH1', 'Kara Heugly Counseling', 'Kara', 'L', 'Heugly', 'LPC', 'Mental Health', '', '', NULL, 'O', '375 S Carbon Ave Ste 128', 'Price', 'Carbon', 'UT', '84501', '4356370171', '4356371265', '375 S Carbon Ave Ste 128', 'Price', 'Carbon', 'UT', '84501', '4356370171', '4356371265', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-12-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902953623', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('050538349', 'W12007569', 'W12007569', 'ID01', 'Treasure Valley Emergency Physicians', '', '', 'Treasure Valley Emergency Physicians', 'Group', 'Emergency Medicine', '', '', NULL, 'M', '1000 River Rd Ste 100', 'Conshohocken', 'Montgomery', 'PA', '19428', '2084671171', NULL, '1000 River Rd Ste 100', 'Conshohocken', 'Montgomery', 'PA', '19428', '2084671171', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053360065', 0, 'Y', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('050538349', 'W12007568', 'W12007568', 'ID01', 'Treasure Valley Emergency Physicians', '', '', 'Treasure Valley Emergency Physicians', 'Group', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053360065', 0, 'Y', 0, '2012-02-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('050538349', 'W12007570', 'W12007570', 'ID01', 'Treasure Valley Emergency Physicians', '', '', 'Treasure Valley Emergency Physicians', 'Group', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 13309', 'Philadelphia', 'Philadelphia', 'PA', '19101', '2084671171', NULL, 'PO Box 13309', 'Philadelphia', 'Philadelphia', 'PA', '19101', '2084671171', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053360065', 0, 'Y', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('271026940', 'W12007572', 'W12007572', 'UT01', 'Canyon Crest Heart and Health', 'Mark', 'H', 'Keep', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '11762 S State Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8015716364', '8015712778', '11762 S State Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8015716364', '8015712778', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609859297', 0, 'Y', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('271026940', 'W12007573', 'W12007573', 'UT01', 'Canyon Crest Heart and Health', 'Mark', 'H', 'Keep', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 9230', 'Belfast', 'Waldo', 'ME', '04915', '8015716364', '8015712778', 'PO Box 9230', 'Belfast', 'Waldo', 'ME', '04915', '8015716364', '8015712778', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609859297', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'W12007577', 'W12007577', 'UT01', 'Utah Valley Pediatrics', 'Sarah', 'L', 'Ashby', 'MD', 'Pediatrics', '', '', NULL, 'O', '1159 E 200 Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565609', NULL, '1159 E 200 Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565609', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-17', '2011-03-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1306855978', 0, 'N', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
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('260093564', 'W12007607', 'W12007607', '', 'Riverwoods Anesthesia', '', '', 'Riverwoods Anesthesia', '', 'Anesthesia', '', '', NULL, '', 'Change', 'Provo', 'Utah', 'UT', '84604', '          ', NULL, 'Change', 'Provo', 'Utah', 'UT', '84604', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002081', 0, 'Y', 0, '2011-03-14', NULL, NULL, 0, 0, NULL, NULL),
('000002079', 'W12007604', 'W12007604', '', 'Total Dental Administrators', '', '', 'Total Dental Administrators', '', 'Dentist', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2005-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002079', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
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('870609595', 'W12007613', 'W12007613', 'UT01', 'Utah County Medical Associates', 'William', 'D', 'Voss', 'DO', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1447246244', 0, 'Y', 0, '2014-04-07', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12007612', 'W12007612', 'UT01', 'Utah County Medical Associates', 'William', 'D', 'Voss', 'DO', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1447246244', 0, 'Y', 0, '2014-04-07', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870516264', 'W12007593', 'W12007593', 'UT01', 'Utah County Surgical Associates', '', '', 'Utah County Surgical Associates', '', 'General Surgery', '', '', NULL, '', 'Change', 'Provo', 'Utah', 'UT', '84604', '          ', '8013749690', 'Change', 'Provo', 'Utah', 'UT', '84604', '          ', '8013749690', 'UTCTYSURG', '', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1851450720', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('528626191', 'W12005893', 'W12005893', 'UTDT01', '', 'Michael', '', 'Lorscheider', 'DMD', 'Dentist', '', '', NULL, 'O', '2476 N University Pkwy Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013770990', NULL, '2476 N University Pkwy Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013770990', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004091', 0, 'N', 0, '2011-01-21', NULL, NULL, 0, 0, NULL, NULL),
('204840137', 'W12005895', 'W12005895', 'UTDT01', 'Advanced Family Dental', 'Brian', '', 'Harward', 'DDS', 'Dentist', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', NULL, '1760 N Main St Ste 103', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004092', 0, 'N', 0, '2011-01-21', NULL, NULL, 0, 0, NULL, NULL),
('262040977', 'W12005898', 'W12005898', 'UTDT01', '', 'Steven', '', 'Facer', 'DMD', 'Endodontist', '', '', NULL, 'O', '7138 S Highland Dr', 'Salt Lake', 'Salt Lake', 'UT', '84181', '8019428686', NULL, '7138 S Highland Dr', 'Salt Lake', 'Salt Lake', 'UT', '84181', '8019428686', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004093', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('260342681', 'W12005900', 'W12005900', 'UTDT01', '', 'Chase', '', 'Williams', 'DDS', 'Dentist', '', '', NULL, 'O', '510 S Mains St', 'Cedar City', 'Iron', 'UT', '84720', '4355869543', NULL, '510 S Mains St', 'Cedar City', 'Iron', 'UT', '84720', '4355869543', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004094', 0, 'N', 0, '2011-01-21', NULL, NULL, 0, 0, NULL, NULL),
('529786122', 'W12005905', 'W12005905', 'UTDT01', '', 'Stephen', '', 'Davis', 'DDS', 'Dentist', '', '', NULL, 'O', '3950 S 700 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012632236', NULL, '3950 S 700 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012632236', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004096', 0, 'N', 0, '2011-01-21', NULL, NULL, 0, 0, NULL, NULL),
('273142372', 'W12005891', 'W12005891', 'UTDT01', 'South Temple Dental', 'Spencer', '', 'Updike', 'DDS', 'Dentist', '', '', NULL, 'O', '34 S 500 E Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015218188', NULL, '34 S 500 E Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015218188', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004090', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12007617', 'W12007617', 'UT01', 'Wasatch Medical Center', 'Thomas', 'R', 'Carn', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1194774588', 0, 'N', 0, '2013-11-21', NULL, NULL, 40.2865, -111.69, NULL, NULL),
('830333437', 'W12007618', 'W12007618', 'WY01', 'Teton Therapy', 'Virginia', 'J', 'Holcomb', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932432101', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.0246, -108.401, NULL, NULL),
('830333437', 'W12007620', 'W12007620', 'WY01', 'Teton Therapy', 'Jeffrey ', 'L', 'McMenamy', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740215227', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.0246, -108.401, NULL, NULL),
('870471479', 'W12007621', 'W12007621', 'UT01', 'Wasatch Medical Center', 'Maynard', 'R', 'Olsen', 'MD', 'Family Practice', '', '', NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1518067347', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.2865, -111.69, NULL, NULL),
('870471479', 'W12007622', 'W12007622', 'UT01', 'Wasatch Medical Center', 'David', 'N', 'Peterson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659321990', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.2865, -111.69, NULL, NULL),
('870471479', 'W12007623', 'W12007623', 'UT01', 'Wasatch Medical Center', 'Scott', 'D', 'Peterson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '8012292420', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1427008812', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.2865, -111.69, NULL, NULL),
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('274361726', 'W12007625', 'W12007625', 'UT01', 'Aspen Foot and Ankle ', 'David ', 'T', 'Savage', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8014651345', '8014651354', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8014651345', '8014651354', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891789491', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12007626', 'W12007626', 'WY01', 'Teton Therapy', 'Grant', 'A', 'Basko', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', '2011-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255666137', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007627', 'W12007627', 'UT01', 'Tri City Medical Clinic M-F 8am-9pm  Sat 9am-9pm', '', '', 'Premier Family Medical', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834776', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('272907339', 'W12007631', 'W12007631', 'UT01', 'Ames Eye Care', 'Derek', 'B', 'Ames', 'OD', 'Optometry', '', '', NULL, 'O', '2610 Pioneer Rd', 'St George', 'Washington', 'UT', '84790', '4356749770', '4356749771', '2610 Pioneer Rd', 'St George', 'Washington', 'UT', '84790', '4356749770', '4356749771', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2012-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174836431', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870657473', 'W12006608', 'W12006608', 'UT01', 'Skaggs Chiropractic', 'Daniel', 'S', 'Skaggs', 'DC', 'Chiropractic', '', '', NULL, 'O', '2721 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84404', '8017824454', '8017824455', '2721 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84404', '8017824454', '8017824455', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477684884', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('260721125', 'W12007632', 'W12007632', 'UTMH1', 'Competence Inc', 'Kayleen', 'M', 'Fuller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1631 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8016522720', '8018787312', '1631 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8016522720', '8018787312', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-03-01', '2012-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073552402', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12007633', 'W12007633', 'UT01', 'Utah Surgical Associates Inc', 'Christy', '', 'Anderson', 'APRN', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', '', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083869101', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870679270', 'W12007634', 'W12007634', 'UT01', 'Kaysville Clinic', 'Douglas', 'P', 'Barney', 'MD', 'Wound Care', 'Hyperbaric Wound', 'Family Practice', NULL, 'O', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', '2011-07-13', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013081801', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('273178383', 'W12007635', 'W12007635', 'ID02', 'Borron Family Medicine', 'Brookney', 'R', 'Borron', 'FNP', 'Family Practice', '', '', NULL, 'O', '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '2089393315', '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '2089393315', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-01', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053543660', 0, 'N', 0, '2013-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007639', 'W12007639', 'UT01', 'Tri City Medical Clinic', '', '', 'Premier Family Medical', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-24', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834776', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007640', 'W12007640', 'UT01', 'Tri City Medical Clinic', '', '', 'Premier Family Medical', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '8017561705', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-25', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834776', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007643', 'W12007643', 'UT01', 'Central Utah Clinic', 'John', 'F', 'Boyle', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2011-02-28', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1154489698', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007644', 'W12007644', 'UT01', 'Central Utah Clinic', 'John', 'F', 'Boyle', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2011-02-28', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1154489698', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007642', 'W12007642', 'UT01', 'Central Utah Clinic', 'John', 'F', 'Boyle', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '230 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356370474', '4356375052', '230 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356370474', '4356375052', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2011-02-28', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1154489698', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12006947', 'W12006947', 'UT01', '', 'Alan', 'N', 'Bybee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', NULL, '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033184940', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12006499', 'W12006499', 'UTMH1', 'LDS Family Services', 'Dwight', 'D', 'Hurst', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043474620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('800405814', 'W12007650', 'W12007650', 'ID01', 'Boise Spine Center', 'Noah', 'B', 'Edvalson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', NULL, '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-01-24', '2014-03-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275767519', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.5921, -116.294, NULL, NULL),
('870281299', 'W12007651', 'W12007651', 'UT01', 'American Fork Clinic', '', '', 'American Fork Clinic', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '8018553854', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '8018553854', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942311006', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12007652', 'W12007652', 'UT01', 'Lehi Medical Clinic', '', '', 'American Fork Clinic', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942311006', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('202499373', 'W12007653', 'W12007653', 'UT01', 'South Valley OB/GYN', 'Cameron', 'D', 'Anderson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '39 S Professional Way Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014653201', '8014652889', '39 S Professional Way Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014653201', '8014652889', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629096870', 0, 'N', 0, '2013-06-17', NULL, NULL, 40.0442, -111.712, 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
('870347187', 'W12007654', 'W12007654', 'UT01', 'Utah Valley Eye Center', 'L', 'T', 'Cook', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-07-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1801893375', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870347187', 'W12007655', 'W12007655', 'UT01', 'Utah Valley Eye Center', 'Loran', 'D', 'Cook', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-26', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396741948', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870638632', 'W12007656', 'W12007656', 'UT01', 'Mountain Peaks Family Practice', 'Robert', 'G', 'Durrans', 'MD', 'Family Practice', '', '', NULL, 'O', '501E 770 N', 'Orem', 'Utah', 'UT', '84097', '8017249840', '8012351509', '501E 770 N', 'Orem', 'Utah', 'UT', '84097', '8017249840', '8012351509', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-03-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1447332465', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('870347187', 'W12007657', 'W12007657', 'UT01', 'Utah Valley Eye Center', 'Franklin', 'M', 'Edmunds', 'OD', 'Optometry', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-26', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578560165', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('262653132', 'W12007658', 'W12007658', 'UT01', 'Alpine Family Medicine', 'Daniel', 'W', 'Egan', 'MD', 'Family Practice', '', '', NULL, 'O', '155 W Canyon Crest Rd', 'Alpine', 'Utah', 'UT', '84004', '8017639851', '8017639852', '155 W Canyon Crest Rd', 'Alpine', 'Utah', 'UT', '84004', '8017639851', '8017639852', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066564', 0, 'N', 0, '2013-08-13', NULL, NULL, 40.4491, -111.781, NULL, NULL),
('870347187', 'W12007659', 'W12007659', 'UT01', 'Utah Valley Eye Center', 'Joe', 'R', 'Haggard', 'OD', 'Optometry', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508863978', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870627216', 'W12007660', 'W12007660', 'UT01', '', 'Heidi', 'A', 'Heras', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '482 W 50 N Ste 14', 'American Fork', 'Utah', 'UT', '84003', '8014927662', '8014927663', '482 W 50 N Ste 14', 'American Fork', 'Utah', 'UT', '84003', '8014927662', '8014927663', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1619910684', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.378, -111.811, NULL, NULL),
('870347187', 'W12007661', 'W12007661', 'UT01', 'Utah Valley Eye Center', 'Michael', 'J', 'Lloyd', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-26', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124239009', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('203620216', 'W12007662', 'W12007662', 'UT01', 'Foot and Ankle Clinic of Utah', 'Scott', 'R', 'McKell', 'DPM', 'Podiatry', '', '', NULL, 'O', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8017651718', '8012263869', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8017651718', '8012263869', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497820054', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.2999, -111.705, NULL, NULL),
('870619968', 'W12007664', 'W12007664', 'UTDT01', '', 'Daniel', '', 'Ormsby', 'DDS', 'Dentist', '', '', NULL, 'O', '5801 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8014249031', NULL, '5801 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8014249031', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007984', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870619968', 'W12007663', 'W12007663', 'UTDT01', '', 'Daniel', '', 'Ormsby', 'DDS', 'Dentist', '', '', NULL, 'O', '4578 S Highland Dr Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014249031', NULL, '4578 S Highland Dr Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014249031', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '1997-04-14', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007984', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12007645', 'W12007645', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870525682', 'W12007646', 'W12007646', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-09-11', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12007647', 'W12007647', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 41.7366, -111.835, NULL, NULL),
('870525682', 'W12007648', 'W12007648', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 40.659, -111.894, NULL, NULL),
('273723626', 'W12007681', 'W12007681', 'WY01', 'Family Circle Counseling', 'Janae', 'B', 'Harman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'M', '1508 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', NULL, '1508 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851627210', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('273723626', 'W12007680', 'W12007680', 'WY01', 'Family Circle Counseling', 'Janae', 'B', 'Harman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '801 Robertson Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', NULL, '801 Robertson Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851627210', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12007682', 'W12007682', 'UT01', 'Retina Associates of Utah', 'James', 'G', 'Howard', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033110119', 0, 'N', 0, '2013-08-01', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870525682', 'W12007683', 'W12007683', 'UT01', 'Retina Associates of Utah', 'James', 'G', 'Howard', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017558222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017558222', '8017758223', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-09-13', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033110119', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12007684', 'W12007684', 'UT01', 'Retina Associates of Utah', 'James', 'G', 'Howard', 'MD', 'Ophthalmology', '', '', NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033110119', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.7366, -111.835, NULL, NULL),
('870525682', 'W12007685', 'W12007685', 'UT01', 'Retina Associates of Utah', 'James', 'G', 'Howard', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033110119', 0, 'N', 0, '2013-08-01', NULL, NULL, 40.659, -111.894, NULL, NULL),
('870525682', 'W12007686', 'W12007686', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870525682', 'W12007687', 'W12007687', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870525682', 'W12007688', 'W12007688', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 41.7366, -111.835, NULL, NULL),
('870525682', 'W12007689', 'W12007689', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 40.659, -111.894, NULL, NULL),
('263510730', 'W12007690', 'W12007690', 'UTMH1', 'Autism Assessment and Treatment Center', 'Lori', '', 'Lichte-Brill', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', NULL, '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902139603', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('528723936', 'W12007691', 'W12007691', 'UT01', '', 'Steven', 'G', 'Nance', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-30', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1376645887', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870347187', 'W12007692', 'W12007692', 'UT01', 'Utah Valley Eye Center', 'Duane', 'J', 'Nelson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'UVEC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841296498', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('203620216', 'W12007693', 'W12007693', 'UT01', 'Foot and Ankle Clinic of Utah', 'Matthew', 'G', 'Ollerton', 'DPM', 'Podiatry', '', '', NULL, 'B', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8014913663', NULL, '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8014913663', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518959733', 0, 'Y', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('203620216', 'W12007694', 'W12007694', 'UT01', 'Foot and Ankle Clinic of Utah', 'Matthew', 'G', 'Ollerton', 'DPM', 'Podiatry', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014913668', '8014896378', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014913668', '8014896378', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518959733', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.1723, -111.61, NULL, NULL),
('820505891', 'W12007695', 'W12007695', 'ID01', 'Audiology & Hearing Aid Center', 'Cynthia', 'K', 'Olsen', 'CCC-A', 'Audiology', '', '', NULL, 'O', '1740 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2086580238', '2086580302', '1740 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2086580238', '2086580302', 'IDAUDIO', '', '', '0.00', '15.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588732325', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6208, -116.284, NULL, NULL),
('203620216', 'W12007696', 'W12007696', 'UT01', 'Foot and Ankle Clinic of Utah', 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', '8017363887', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', '8017363887', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, '', '', 'HCFA|UB|', '1841202397', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.3784, -111.766, NULL, NULL),
('203620216', 'W12007697', 'W12007697', 'UT01', 'Foot and Ankle Clinic of Utah', 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', '', '', NULL, 'B', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8012262421', NULL, '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8012262421', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, '', '', 'HCFA|UB|', '1841202397', 0, 'Y', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('203620216', 'W12007698', 'W12007698', 'UT01', 'Foot and Ankle Clinic of Utah', 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', '', '', NULL, 'O', '680 E Main Ste 200', 'Lehi', 'Utah', 'UT', '84043', '8017660606', '8017633887', '680 E Main Ste 200', 'Lehi', 'Utah', 'UT', '84043', '8017660606', '8017633887', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, '', '', 'HCFA|UB|', '1841202397', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.3882, -111.838, NULL, NULL),
('203620216', 'W12007699', 'W12007699', 'UT01', 'Foot and Ankle Clinic of Utah', 'Gary', 'R', 'Ridge', 'DPM', 'Podiatry', '', '', NULL, 'O', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8012262421', '8012263869', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8012262421', '8012263869', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144267089', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.2999, -111.705, NULL, NULL),
('870235759', 'W12007700', 'W12007700', 'UT01', 'Central Utah Foot Clinic', 'Thomas', 'G', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720069446', 0, 'N', 0, '2014-04-07', NULL, NULL, 40.379, -111.765, NULL, NULL),
('870235759', 'W12007701', 'W12007701', 'UT01', 'Central Utah Foot Clinic', 'Thomas', 'G', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '150 W 800 N', 'Provo', 'Utah', 'UT', '84601', '8013755353', '8013755395', '150 W 800 N', 'Provo', 'Utah', 'UT', '84601', '8013755353', '8013755395', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720069446', 0, 'N', 0, '2014-04-07', NULL, NULL, 40.2443, -111.661, NULL, NULL),
('262653132', 'W12007702', 'W12007702', 'UT01', 'Alpine Family Medicine', 'Peter', 'V', 'Sundwall', 'MD', 'Family Practice', '', '', NULL, 'O', '155 W Canyon Crest Rd', 'Alpine', 'Utah', 'UT', '84004', '8017639851', '8017639582', '155 W Canyon Crest Rd', 'Alpine', 'Utah', 'UT', '84004', '8017639851', '8017639582', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1558470641', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.4491, -111.781, NULL, NULL),
('870525682', 'W12007703', 'W12007703', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870525682', 'W12007704', 'W12007704', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870525682', 'W12007705', 'W12007705', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 41.7366, -111.835, NULL, NULL),
('870525682', 'W12007706', 'W12007706', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 40.659, -111.894, NULL, NULL),
('830333437', 'W12007707', 'W12007707', 'WY01', 'Teton Therapy', '', '', 'Teton Therapy', 'Group', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275564122', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.0246, -108.401, NULL, NULL),
('870609595', 'W12007708', 'W12007708', 'UT01', 'Utah County Medical Associates', 'William', 'D', 'Voss', 'DO', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1447246244', 0, 'N', 0, '2014-04-07', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870525682', 'W12007709', 'W12007709', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870525682', 'W12007710', 'W12007710', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8018738462', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8018738462', '8017758223', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870525682', 'W12007712', 'W12007712', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 41.7366, -111.835, NULL, NULL),
('870525682', 'W12007711', 'W12007711', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 40.659, -111.894, NULL, NULL),
('870503202', 'W12007716', 'W12007716', 'UT01', 'Mountain West Ear Nose and Throat', 'Tel', 'S', 'Boman', 'AUD', 'Audiology', '', '', NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1972531028', 0, 'N', 0, '2014-05-08', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('870516264', 'W12007717', 'W12007717', 'UT01', 'Utah Surgical Associates Inc', 'David', 'W', 'Brock', 'PAC', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205024122', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('274412746', 'W12007718', 'W12007718', 'UT01', 'Olympus Eye Associates', 'David', 'T', 'Brockbank', 'MD', 'Ophthalmology', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-15', '2011-07-17', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093822561', 0, 'N', 0, '2011-12-15', NULL, NULL, 0, 0, NULL, NULL),
('272265113', 'W12007719', 'W12007719', 'UTMH1', '', 'Jennifer', 'E', 'JAMES', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1404 W State Rd Ste 207', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017177494', '8883899859', '1404 W State Rd Ste 207', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017177494', '8883899859', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720131899', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('870283830', 'W12007722', 'W12007722', 'UT01', 'Intermountain Allergy', 'Eric ', 'C', 'Chenworth', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '6065 Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', '8012664138', '6065 Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', '8012664138', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2013-03-25', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700859907', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007723', 'W12007723', 'UT01', 'Tri City Medical Clinic', 'Steven', 'B', 'Cherrington', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871608893', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870679270', 'W12007724', 'W12007724', 'UT01', 'Kaysville Clinic', 'Layne', 'K', 'Kamalu', 'MD', 'Family Practice', '', '', NULL, 'O', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104987916', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.0329, -111.938, NULL, NULL),
('870679270', 'W12007725', 'W12007725', 'UT01', 'Kaysville Clinic M-F 9am-5pm', '', '', 'Kaysville Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', '120 S Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015444227', '8015443724', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013047521', 0, 'N', 0, '2013-06-12', NULL, NULL, 41.0329, -111.938, NULL, NULL),
('870516264', 'W12007728', 'W12007728', 'UT01', 'Utah Surgical Associates Inc', 'Craig', 'S', 'Cook', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851347090', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870546501', 'W12007752', 'W12007752', 'UT01', 'Alpine Pediatrics', '', '', 'Alpine Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8017630517', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8017630517', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004989', 0, 'Y', 0, '2013-08-09', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12007753', 'W12007753', 'UT01', 'Alpine Pediatrics', '', '', 'Alpine Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004989', 0, 'Y', 0, '2013-08-09', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870546501', 'W12007755', 'W12007755', 'UT01', 'Alpine Pediatrics', '', '', 'Alpine Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', NULL, '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004989', 0, 'Y', 0, '2013-08-09', NULL, NULL, 40.3848, -111.914, NULL, NULL),
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('870400988', 'W12007757', 'W12007757', 'UT01', '', 'Gary', '', 'Behrmann', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 246', 'Payson', 'Utah', 'UT', '84651', '8014654877', '8014654879', 'PO Box 246', 'Payson', 'Utah', 'UT', '84651', '8014654877', '8014654879', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1871680579', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12007797', 'W12007797', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'N', 0, '2011-02-16', NULL, NULL, 40.659, -111.894, NULL, NULL),
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('942854057', 'W12007810', 'W12007810', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', 'Jared', 'B', 'Hains', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780750091', 0, 'N', 0, '2011-02-15', NULL, NULL, 40.6557, -111.905, NULL, NULL),
('942854057', 'W12007813', 'W12007813', 'UTIHCPHY', 'Heber Valley Clinic', 'Kim', 'T', 'Heaton', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225051089', 0, 'Y', 0, '2012-02-29', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12007816', 'W12007816', 'UTIHCPHY', 'Heart Rhythm Specialists Logan', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007815', 'W12007815', 'UTIHCPHY', 'Heart Rhythm Specialists', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12007817', 'W12007817', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007818', 'W12007818', 'UTIHCPHY', 'Dixie Neonatology', 'Garry', 'G', 'Lipsey', 'APRN', 'Neonatology', 'Neonatal Nurse Practitioner', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477737583', 0, 'N', 0, '2011-02-15', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12007820', 'W12007820', 'UTIHCPHY', 'Heart Rhythm Specialists Logan', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-05-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007821', 'W12007821', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12007822', 'W12007822', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.6557, -111.905, NULL, NULL),
('942854057', 'W12007823', 'W12007823', 'UTIHCPHY', 'Dixie Neonatology', 'Amiee', '', 'Mitchell', 'APRN', 'Neonatology', '', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457679284', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007825', 'W12007825', 'UTIHCPHY', 'Park City Specialty Clinic', 'G David', '', 'Munday', 'MD', 'Urology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-05-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108432', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007827', 'W12007827', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', 'Joanne', '', 'Nam', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861583692', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007829', 'W12007829', 'UTIHCPHY', 'Heart Rhythm Specialists Logan', 'Joanne', '', 'Nam', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861583692', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007828', 'W12007828', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Joanne', '', 'Nam', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861583692', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007830', 'W12007830', 'UTIHCPHY', 'Sunset Family Practice', 'Martin', 'J', 'Nygaard', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659305688', 0, 'N', 0, '2011-06-23', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12007833', 'W12007833', 'UTIHCPHY', 'Southwest Spine and Pain-Cedar', 'Rick', 'W', 'Obray', 'MD', 'Radiology', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-03-01', '2011-09-10', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1316087372', 0, 'N', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007834', 'W12007834', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12007835', 'W12007835', 'UTIHCPHY', 'Heart Rhythm Specialists Panguitch', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '8015073513', '8015073584', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('942854057', 'W12007836', 'W12007836', 'UTIHCPHY', 'Utah Heart-Riverton', 'Rex', 'A', 'Outtrim', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558355313', 0, 'N', 0, '2012-06-04', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12007838', 'W12007838', 'UTIHCPHY', 'Dixie Neonatology', 'Rebecca', 'L', 'Pitts', 'NP', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912182692', 0, 'N', 0, '2011-02-15', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12007839', 'W12007839', 'UTIHCPHY', 'Dixie Neonatology', 'Robert', 'E', 'Ridout', 'MD', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407847239', 0, 'N', 0, '2011-02-16', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12007840', 'W12007840', 'UTIHCPHY', 'Heber Valley Clinic', 'Marc', 'S', 'Robins', 'DO', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780671453', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12007841', 'W12007841', 'UTIHCPHY', 'Dixie Neonatology', 'Sheila', 'D', 'Sakraida', 'APRN', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821284100', 0, 'N', 0, '2011-02-15', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12007843', 'W12007843', 'UTIHCPHY', 'Park City Specialty Clinic', 'Andrew', 'P', 'Talbott', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-05-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619932761', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007846', 'W12007846', 'UTIHCPHY', 'Park City Specialty Clinic', 'Mary Jean', '', 'Walker', 'APRN', 'Pain Management', NULL, NULL, NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2011-05-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851890', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007847', 'W12007847', 'UTIHCPHY', 'Heart Rhythm Specialists', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528036654', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12007850', 'W12007850', 'UTIHCPHY', 'Heart Rhythm Specialists Logan', 'Daniel', 'J', 'Young', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902095631', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007851', 'W12007851', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Daniel', 'J', 'Young', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902095631', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007849', 'W12007849', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', 'Daniel', 'J', 'Young', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902095631', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
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('870656811', 'W12007857', 'W12007857', 'UT01', 'ProRehab', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2010-12-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'N', 0, '2011-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12007858', 'W12007858', 'UT01', 'ProRehab', 'Clayton', 'Lloyd', 'Taylor', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '220 Park Place', 'East Carbon', 'Carbon', 'UT', '84520', '4356131500', '4356131501', '220 Park Place', 'East Carbon', 'Carbon', 'UT', '84520', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2011-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1093995292', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12007859', 'W12007859', 'UT01', 'ProRehab', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '590 E 100 N Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', '590 E 100 N Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2011-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
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('876000528', 'W12007870', 'W12007870', 'UT01', 'Utah State University Dept of Communication Disorders', 'Maria', 'P', 'Houston', 'SLP', 'Speech Therapy', '', '', NULL, 'O', ' 1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '4357970221', ' 1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568778744', 0, 'N', 1, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
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('841380939', 'W12007881', 'W12007881', 'UT01', '', 'Kipp', '', 'Robins', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2230 N University Pkwy Ste 9B', 'Provo', 'Utah', 'UT', '84604', '8013753175', '8013752818', '2230 N University Pkwy Ste 9B', 'Provo', 'Utah', 'UT', '84604', '8013753175', '8013752818', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396741476', 0, 'N', 0, '2013-04-16', NULL, NULL, 40.2621, -111.666, NULL, NULL),
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('870507858', 'W12007883', 'W12007883', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', '8012214656', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', '8012214656', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
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('870609595', 'W12007890', 'W12007890', 'UT01', 'Utah County Medical Associates', '', '', 'Utah County Medical Associates', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009347', 0, 'Y', 0, '2011-11-14', NULL, NULL, 40.044, -111.716, NULL, NULL),
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('870609595', 'W12007888', 'W12007888', 'UT01', 'Utah County Medical Associates', '', '', 'Utah County Medical Associates', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009347', 0, 'Y', 0, '2011-11-14', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007891', 'W12007891', 'UT01', 'Utah County Medical Associates', '', '', 'Utah County Medical Associates', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009347', 0, 'Y', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('092782607', 'W12007892', 'W12007892', 'ID01', 'Cafferty Counseling Services', 'Camilla', '', 'Cafferty', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1552 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83646', '2089943599', '2084614510', '1552 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83646', '2089943599', '2084614510', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-01-03', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063569796', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('092782607', 'W12007893', 'W12007893', 'ID01', 'Cafferty Counseling Services', 'Camilla', '', 'Cafferty', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '192 Holly St', 'Nampa', 'Canyon', 'ID', '83686', '2084679117', '2084614510', '192 Holly St', 'Nampa', 'Canyon', 'ID', '83686', '2084679117', '2084614510', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-01-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063569796', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007901', 'W12007901', 'UTIHCPHY', 'Dixie Neonatology', '', '', 'Southwest Regional Cancer Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447420401', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007905', 'W12007905', 'UTIHC04', 'Orthopedic Surgery', 'Bryce', 'W', 'Millar', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-03-01', '2014-05-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831133248', 0, 'N', 0, '2014-05-27', NULL, NULL, 42.5342, -113.783, NULL, NULL),
('942854057', 'W12007908', 'W12007908', 'UTIHC04', 'Emergency Room', 'Jenifer', 'K', 'Lingeman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-12-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467650119', 0, 'N', 0, '2011-02-02', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12007909', 'W12007909', 'UTIHC01', 'Pediatrics', 'Raoul', 'D', 'Nelson', 'MD, PHD', 'Pediatric Nephrology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-07', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972682540', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12007914', 'W12007914', 'UTIHC04', 'Emergency Room', 'John', 'M', 'Pabers', 'MD', 'Family Practice', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-01-19', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750321378', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12007926', 'W12007926', 'UTIHC01', 'Physical Therapy', 'Ronald', 'Kolby', 'Daniels', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962567602', 0, 'N', 0, '2011-02-02', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12007929', 'W12007929', 'UTIHC01', 'PCMC Rehab South', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007930', 'W12007930', 'UTIHC02', 'PCMC Rehab South', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007931', 'W12007931', 'UTIHC03', 'PCMC Rehab South', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12007932', 'W12007932', 'UTIHC04', 'PCMC Residential Treatment', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '5770 S 1500 W Ste Bldg C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137954', NULL, '5770 S 1500 W Ste Bldg C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137954', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.6462, -111.934, NULL, NULL),
('273858690', 'W12007933', 'W12007933', 'UT01', 'Bariatric Medicine Institute', 'Daniel', 'R', 'Cottam', 'MD', 'General Surgery', 'Bariatric Surgery', '', NULL, 'O', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760574776', 0, 'N', 0, '2014-03-06', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('273858690', 'W12007934', 'W12007934', 'UT01', 'Bariatric Medicine Institute', 'Christina', 'G', 'Richards', 'MD', 'General Surgery', 'Bariatric Surgery', '', NULL, 'O', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1922123694', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('273858690', 'W12007935', 'W12007935', 'UT01', 'Bariatric Medicine Institute', 'Irma', 'M', 'Garzon-Asosta', 'PA', 'Family Practice', '', '', NULL, 'O', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', '1046 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '8017462886', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-03-07', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1649462383', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('263829375', 'W12007936', 'W12007936', 'UT01', '', 'Benjamin', 'E', 'Adams', 'DO', 'Dermatology', '', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4358651477', NULL, '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4358651477', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1376769943', 0, 'N', 0, '2011-11-17', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('611572907', 'W12007937', 'W12007937', 'UT01', 'South Ogden Center for Family Medicine', 'Natalie ', '', 'Ahrenstorff', 'PA-C', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659568293', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12007938', 'W12007938', 'UT01', 'South Ogden Center for Family Medicine', 'Natalie ', '', 'Ahrenstorff', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659568293', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12007939', 'W12007939', 'UT01', 'Alpine Pediatrics', 'Jesse', 'A', 'Alba', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932386711', 0, 'N', 0, '2011-02-02', NULL, NULL, 40.3848, -111.914, NULL, NULL);
