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
('363312906', 'ELNCHS047', 'ELNCHS047', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Lightfoot', 'MD', 'Family Practice', '', '', NULL, 'O', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962441659', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS122', 'ELNCHS122', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Lightfoot', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962441659', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS003', 'ELNCHS003', 'ILCHIGSTD', 'Northwest Community Health Services', 'Susan', '', 'Elbaum', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972643633', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS078', 'ELNCHS078', 'ILCHIGSTD', 'Northwest Community Health Services', 'Susan', '', 'Elbaum', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972643633', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS028', 'ELNCHS028', 'ILCHIGSTD', 'Northwest Community Health Services', 'Maria', 'L', 'Savitt', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982603718', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS103', 'ELNCHS103', 'ILCHIGSTD', 'Northwest Community Health Services', 'Maria', 'L', 'Savitt', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982603718', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('000001002', 'W12027630', 'W12027630', 'TXHOUSTD', 'TMH Physician Organization', '', '', 'TMH Physician Organization', '', 'Clinics', '', '', NULL, 'O', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010026', 0, 'Y', 0, '2013-11-06', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('460500210', 'W12027673', 'W12027673', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Aziz', 'G', 'Munayirji', 'MD', 'General Surgery', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003869629', 0, 'Y', 0, '2013-11-22', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('271383837', 'W12027633', 'W12027633', 'ILCHIGSTD', 'Illinois Gastroenterology Group', '', '', 'Illinois Gastroenterology Group', '', 'Gastroenterology', '', '', NULL, 'O', '1415 S Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474391005', '8474397555', '1415 S Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474391005', '8474397555', 'CHIG16', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1316277817', 0, 'Y', 0, '2013-03-22', NULL, NULL, 42.0582, -87.9804, NULL, NULL),
('271383837', 'W12027634', 'W12027634', 'ILCHIGSTD', 'Illinois Gastroenterology Group', '', '', 'Illinois Gastroenterology Group', '', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 7630', 'Gurnee', 'Lake', 'IL', '60031', '8474391005', '8474397555', 'PO Box 7630', 'Gurnee', 'Lake', 'IL', '60031', '8474391005', '8474397555', 'CHIG16', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1316277817', 0, 'N', 0, '2013-03-22', NULL, NULL, 0, 0, NULL, NULL),
('760639329', 'W12027635', 'W12027635', 'TXHOUSTD', 'Pranav H Bhakta MD', 'Pranav', 'H', 'Bhakta', 'MD PA', 'Internal Medicine', '', '', NULL, 'O', '17448 Hwy 3 Ste 160', 'Webster', 'Harris', 'TX', '77598', '2813326650', '2813327588', '17448 Hwy 3 Ste 160', 'Webster', 'Harris', 'TX', '77598', '2813326650', '2813327588', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659485092', 0, 'N', 0, '2013-06-04', NULL, NULL, 29.5412, -95.1214, NULL, NULL),
('760639329', 'W12027636', 'W12027636', 'TXHOUSTD', 'Pranav H Bhakta MD', 'Pranav', 'H', 'Bhakta', 'MD PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 220', 'Seabrook', 'Harris', 'TX', '77586', '2813326650', '2813327588', 'PO Box 220', 'Seabrook', 'Harris', 'TX', '77586', '2813326650', '2813327588', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659485092', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('861064757', 'W12027637', 'W12027637', 'TX01', 'Hill Country Psycho Therapy Associates', 'Sabina', 'R', 'De Vries', 'PHD, LPC', 'Mental Health', '', '', NULL, 'O', '4538 Centerview Dr Ste 158', 'San Antonio', 'Bexar', 'TX', '78228', '2102158817', NULL, '4538 Centerview Dr Ste 158', 'San Antonio', 'Bexar', 'TX', '78228', '2102158817', '          ', 'TXPHD', '', '', '0.00', '100.00', '0.00', 6, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144419797', 0, 'N', 0, '2012-12-26', NULL, NULL, 29.4879, -98.5716, NULL, NULL),
('204043287', 'W12027639', 'W12027639', 'NM01', '', 'Tracy', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE     ', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', '601 Dr Martin Luther King Jr Ave NE     ', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447287362', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.0857, -106.64, NULL, NULL),
('204043287', 'W12027640', 'W12027640', 'NM01', '', 'Tracy', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'O', '5400 Gibson Blvd ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057276450', '5057278391', '5400 Gibson Blvd ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447287362', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('204043287', 'W12027641', 'W12027641', 'NM01', '', 'Tracy', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057276450', '5057278391', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447287362', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12027642', 'W12027642', 'NM01', 'ABQ Health Partners', 'Pamela', '', 'Chapman', 'MD', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417062373', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027643', 'W12027643', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Engleman', 'CNP', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528159100', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027644', 'W12027644', 'NM01', 'ABQ Health Partners', 'Michael', '', 'Lentz', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-02', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770597510', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027645', 'W12027645', 'NM01', 'ABQ Health Partners', 'Robert', '', 'Martz', 'MD', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627594', '5052627641', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627594', '5052627641', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-02', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', NULL, NULL, 'HCFA|UB|', '1780609446', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027646', 'W12027646', 'NM01', 'ABQ Health Partners', 'Gina', '', 'Waymire', 'MD', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275556375', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027647', 'W12027647', 'NM01', 'ABQ Health Partners', 'Sivakumar', '', 'Nagaraju', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '4801 McMahon Blvd NW Ste 250', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321190', '5052322355', '4801 McMahon Blvd NW Ste 250', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321190', '5052322355', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-04', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1952373235', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('204043287', 'W12027649', 'W12027649', 'NM01', 'ABQ Health Partners', 'Lance', '', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-11', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1750398707', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12027650', 'W12027650', 'NM01', 'ABQ Health Partners', 'Lance', '', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-11', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1750398707', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12027651', 'W12027651', 'NM01', 'ABQ Health Partners', 'Lance', '', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87144', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87144', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-11', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1750398707', 0, 'Y', 0, '2012-12-26', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12027652', 'W12027652', 'NM01', 'ABQ Health Partners', 'Lance', '', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '0000000000', '0000000000', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '0000000000', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-11', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1750398707', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12027654', 'W12027654', 'NM01', 'ABQ Health Partners', 'Lance', '', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-12-11', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1750398707', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('760046243', 'W12027656', 'W12027656', 'TXBEAUSTD', 'Physicians Eye Center', 'Chitra', 'V', 'Nadimpalli', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3000 39th St Ste 102', 'Port Arthur', 'Jefferson', 'TX', '77642', '4099852569', '4099852915', '3000 39th St Ste 102', 'Port Arthur', 'Jefferson', 'TX', '77642', '4099852569', '4099852915', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1306816616', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.9158, -93.9475, NULL, NULL),
('760046243', 'W12027657', 'W12027657', 'TXBEAUSTD', 'Physicians Eye Center', 'Chitra', 'V', 'Nadimpalli', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3385 Laurel Ave Ste 101', 'Beaumont', 'Jefferson', 'TX', '77707', '4098323120', '4098322085', '3385 Laurel Ave Ste 101', 'Beaumont', 'Jefferson', 'TX', '77707', '4098323120', '4098322085', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1306816616', 0, 'N', 0, '2013-06-03', NULL, NULL, 30.0826, -94.1376, NULL, NULL),
('942854057', 'W12027658', 'W12027658', 'UTIHC01', 'Dixie Regional Medical Center', 'Matthew', 'T', 'Sweney', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568581551', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12027660', 'W12027660', 'UTIHC02', 'Dixie Regional Medical Center', 'Matthew', 'T', 'Sweney', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568581551', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12027662', 'W12027662', 'UTIHC03', 'Dixie Regional Medical Center', 'Matthew', 'T', 'Sweney', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568581551', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12027663', 'W12027663', 'UTIHC04', 'Dixie Regional Medical Center', 'Matthew', 'T', 'Sweney', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568581551', 0, 'Y', 0, '2014-03-18', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12027666', 'W12027666', 'UTIHC01', 'Primary Childrens Medical Center', 'Mary', 'H', 'Martin', '', 'Pediatric Cardiology', '', '', 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, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033311071', 0, 'N', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
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('203845479', 'ELIBJ0161', 'ELIBJ0161', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013940782', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0163', 'ELIBJ0163', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013940782', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('203845479', 'ELIBJ0160', 'ELIBJ0160', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013940782', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0162', 'ELIBJ0162', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013940782', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('203845479', 'ELIBJ0159', 'ELIBJ0159', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013940782', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0218', 'ELIBJ0218', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erica', '', 'Falger', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033105572', 0, 'Y', 0, '2014-03-24', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0219', 'ELIBJ0219', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erica', '', 'Falger', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033105572', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0307', 'ELIBJ0307', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erica', '', 'Twarling', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033173356', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0308', 'ELIBJ0308', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erica', '', 'Twarling', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033173356', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0072', 'ELIBJ0072', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Theodore', 'J', 'Fisher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Our Lady Of The Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1043235781', 0, 'N', 0, '2012-12-26', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0074', 'ELIBJ0074', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Theodore', 'J', 'Fisher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', '2740 W Foster Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Our Lady Of The Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1043235781', 0, 'N', 0, '2012-12-26', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('203845479', 'ELIBJ0073', 'ELIBJ0073', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Theodore', 'J', 'Fisher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Our Lady Of The Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1043235781', 0, 'N', 0, '2012-12-26', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0071', 'ELIBJ0071', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Theodore', 'J', 'Fisher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Our Lady Of The Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1043235781', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0177', 'ELIBJ0177', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vaishali', '', 'Lafita', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053583633', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0178', 'ELIBJ0178', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vaishali', '', 'Lafita', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053583633', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0318', 'ELIBJ0318', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anand', 'M', 'Vora', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063466597', 0, 'N', 0, '2014-02-19', NULL, NULL, 42.3419, -87.9899, NULL, NULL),
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('203845479', 'ELIBJ0316', 'ELIBJ0316', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anand', 'M', 'Vora', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063466597', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0314', 'ELIBJ0314', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anand', 'M', 'Vora', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063466597', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
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('203845479', 'ELIBJ0226', 'ELIBJ0226', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joseph', '', 'Montalbano', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073541207', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0227', 'ELIBJ0227', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joseph', '', 'Montalbano', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073541207', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0228', 'ELIBJ0228', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joseph', '', 'Montalbano', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073541207', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0235', 'ELIBJ0235', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rebecca', '', 'Nishimoto', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073624664', 0, 'Y', 0, '2013-07-22', NULL, NULL, 42.0984, -87.8107, NULL, NULL),
('203845479', 'ELIBJ0236', 'ELIBJ0236', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rebecca', '', 'Nishimoto', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073624664', 0, 'Y', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0220', 'ELIBJ0220', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joel', '', 'Meyer', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083633424', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0221', 'ELIBJ0221', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joel', '', 'Meyer', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083633424', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0222', 'ELIBJ0222', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Joel', '', 'Meyer', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083633424', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0337', 'ELIBJ0337', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', '', 'Youderian', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083818173', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0339', 'ELIBJ0339', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', '', 'Youderian', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083818173', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0338', 'ELIBJ0338', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ari', '', 'Youderian', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083818173', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0265', 'ELIBJ0265', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffery', '', 'Rosengarten', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8475967640', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8475967640', '8473362537', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093792913', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0266', 'ELIBJ0266', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffery', '', 'Rosengarten', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093792913', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0140', 'ELIBJ0140', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stephen', '', 'Janas', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093795023', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0141', 'ELIBJ0141', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stephen', '', 'Janas', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093795023', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0305', 'ELIBJ0305', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Karen', '', 'Thompson', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8478708159', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8478708159', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104845874', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0306', 'ELIBJ0306', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Karen', '', 'Thompson', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104845874', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0123', 'ELIBJ0123', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'G', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1104871797', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0121', 'ELIBJ0121', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'G', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1104871797', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0117', 'ELIBJ0117', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'G', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1104871797', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0122', 'ELIBJ0122', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'G', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1104871797', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('203845479', 'ELIBJ0212', 'ELIBJ0212', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Philip', 'F', 'Ludkowski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', NULL, '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104879824', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1773, -88.076, NULL, NULL),
('203845479', 'ELIBJ0211', 'ELIBJ0211', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Philip', 'F', 'Ludkowski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104879824', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0210', 'ELIBJ0210', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Philip', 'F', 'Ludkowski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104879824', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0232', 'ELIBJ0232', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', 'E', 'Nemickas', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1124073838', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0230', 'ELIBJ0230', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', 'E', 'Nemickas', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1124073838', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0229', 'ELIBJ0229', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', 'E', 'Nemickas', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1124073838', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0231', 'ELIBJ0231', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', 'E', 'Nemickas', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8473363335', '8473363249', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1124073838', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('203845479', 'ELIBJ0013', 'ELIBJ0013', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', '', 'Bernfield', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144207416', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0014', 'ELIBJ0014', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', '', 'Bernfield', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144207416', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0016', 'ELIBJ0016', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', '', 'Bernfield', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144207416', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('203845479', 'ELIBJ0015', 'ELIBJ0015', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', '', 'Bernfield', 'MD', 'Radiology', '', '', NULL, 'O', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144207416', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0204', 'ELIBJ0204', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', '', 'Lewandowski', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144328741', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0205', 'ELIBJ0205', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Thomas', '', 'Lewandowski', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144328741', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0269', 'ELIBJ0269', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', 'A', 'Rubenstein', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1154374809', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0268', 'ELIBJ0268', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', 'A', 'Rubenstein', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1154374809', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0267', 'ELIBJ0267', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', 'A', 'Rubenstein', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1154374809', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0292', 'ELIBJ0292', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bruce', 'C', 'Summerville', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1164474979', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0291', 'ELIBJ0291', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bruce', 'C', 'Summerville', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 N Westmoreland Ste 100', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', '1200 N Westmoreland Ste 100', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1164474979', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2582, -87.8701, NULL, NULL),
('203845479', 'ELIBJ0290', 'ELIBJ0290', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bruce', 'C', 'Summerville', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1164474979', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0289', 'ELIBJ0289', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bruce', 'C', 'Summerville', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1164474979', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0035', 'ELIBJ0035', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0036', 'ELIBJ0036', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0033', 'ELIBJ0033', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0037', 'ELIBJ0037', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0032', 'ELIBJ0032', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0034', 'ELIBJ0034', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Dale', '', 'Charletta', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8477796021', '8479291170', '9000 Waukegan Rd Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8477796021', '8479291170', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164497731', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0108', 'ELIBJ0108', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Michael', '', 'Gorey', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174542518', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0109', 'ELIBJ0109', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Michael', '', 'Gorey', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174542518', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0050', 'ELIBJ0050', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Brian', 'J', 'Donahue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '8474382868', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '8474382868', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174574966', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.1773, -88.076, NULL, NULL),
('203845479', 'ELIBJ0049', 'ELIBJ0049', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Brian', 'J', 'Donahue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174574966', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0048', 'ELIBJ0048', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Brian', 'J', 'Donahue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174574966', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0031', 'ELIBJ0031', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Roger', 'N', 'Chams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8473243976', '8472342090', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8473243976', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184675944', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.3419, -87.9899, NULL, NULL),
('203845479', 'ELIBJ0030', 'ELIBJ0030', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Roger', 'N', 'Chams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184675944', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.4016, -88.0089, NULL, NULL),
('203845479', 'ELIBJ0028', 'ELIBJ0028', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Roger', 'N', 'Chams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184675944', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0029', 'ELIBJ0029', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Roger', 'N', 'Chams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr Ste 405', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', '720 Florsheim Dr Ste 405', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184675944', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0079', 'ELIBJ0079', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rajeev', '', 'Garapati', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184678823', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0080', 'ELIBJ0080', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rajeev', '', 'Garapati', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184678823', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0136', 'ELIBJ0136', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tamara', '', 'Jackson', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184771073', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0138', 'ELIBJ0138', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tamara', '', 'Jackson', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184771073', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0139', 'ELIBJ0139', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tamara', '', 'Jackson', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184771073', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0137', 'ELIBJ0137', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tamara', '', 'Jackson', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184771073', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0135', 'ELIBJ0135', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tamara', '', 'Jackson', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184771073', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0105', 'ELIBJ0105', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vladislav', '', 'Gorengaut', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772590', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0107', 'ELIBJ0107', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vladislav', '', 'Gorengaut', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772590', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0106', 'ELIBJ0106', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vladislav', '', 'Gorengaut', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772590', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0104', 'ELIBJ0104', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Vladislav', '', 'Gorengaut', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772590', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0002', 'ELIBJ0002', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Emilie', '', 'Allen', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205924868', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0001', 'ELIBJ0001', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Emilie', '', 'Allen', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205924868', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0099', 'ELIBJ0099', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Larry', '', 'Goldstein', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215976808', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0100', 'ELIBJ0100', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Larry', '', 'Goldstein', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215976808', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0252', 'ELIBJ0252', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Christ', 'J', 'Pavlatos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1255386785', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.3419, -87.9899, NULL, NULL),
('203845479', 'ELIBJ0250', 'ELIBJ0250', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Christ', 'J', 'Pavlatos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-07-21', 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1255386785', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('203845479', 'ELIBJ0251', 'ELIBJ0251', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Christ', 'J', 'Pavlatos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-07-21', 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1255386785', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.4016, -88.0089, NULL, NULL),
('203845479', 'ELIBJ0248', 'ELIBJ0248', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Christ', 'J', 'Pavlatos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-07-21', 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1255386785', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0249', 'ELIBJ0249', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Christ', 'J', 'Pavlatos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1255386785', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0145', 'ELIBJ0145', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476706100', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476706100', '8474540521', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0146', 'ELIBJ0146', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0143', 'ELIBJ0143', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0147', 'ELIBJ0147', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0142', 'ELIBJ0142', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0144', 'ELIBJ0144', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Surekha', '', 'Jani', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265407829', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0091', 'ELIBJ0091', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kenneth', '', 'Goldberg', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265451603', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0093', 'ELIBJ0093', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kenneth', '', 'Goldberg', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265451603', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0092', 'ELIBJ0092', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kenneth', '', 'Goldberg', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265451603', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0176', 'ELIBJ0176', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrea', 'R', 'Kramer', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1275588089', 0, 'Y', 0, '2014-02-04', NULL, NULL, 42.1898, -87.826, NULL, NULL),
('203845479', 'ELIBJ0173', 'ELIBJ0173', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrea', 'R', 'Kramer', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1275588089', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0175', 'ELIBJ0175', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrea', 'R', 'Kramer', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1275588089', 0, 'Y', 0, '2014-02-04', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0174', 'ELIBJ0174', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrea', 'R', 'Kramer', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1275588089', 0, 'Y', 0, '2014-02-04', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0182', 'ELIBJ0182', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Don', '', 'Larson', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275697534', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0183', 'ELIBJ0183', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Don', '', 'Larson', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275697534', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0283', 'ELIBJ0283', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Lori', '', 'Siegel', 'MD', 'Rheumatology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479149009', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '8479149009', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1300144882', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0282', 'ELIBJ0282', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Lori', '', 'Siegel', 'MD', 'Rheumatology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1300144882', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0131', 'ELIBJ0131', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Peter', 'E', 'Hoepfner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306876297', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3419, -87.9899, NULL, NULL),
('203845479', 'ELIBJ0129', 'ELIBJ0129', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Peter', 'E', 'Hoepfner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306876297', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('203845479', 'ELIBJ0130', 'ELIBJ0130', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Peter', 'E', 'Hoepfner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', '3021 Falling Waters Blvd Ste C', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453670', '8472342090', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306876297', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4016, -88.0089, NULL, NULL),
('203845479', 'ELIBJ0127', 'ELIBJ0127', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Peter', 'E', 'Hoepfner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306876297', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0128', 'ELIBJ0128', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Peter', 'E', 'Hoepfner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr Ste 405', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', '720 Florsheim Dr Ste 405', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306876297', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0247', 'ELIBJ0247', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rhutav', '', 'Parikh', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1316150121', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0246', 'ELIBJ0246', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rhutav', '', 'Parikh', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1316150121', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0045', 'ELIBJ0045', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Serafin', 'M', 'De Leon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1326091414', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0043', 'ELIBJ0043', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Serafin', 'M', 'De Leon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1326091414', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0042', 'ELIBJ0042', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Serafin', 'M', 'De Leon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1326091414', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0044', 'ELIBJ0044', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Serafin', 'M', 'De Leon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1326091414', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('203845479', 'ELIBJ0051', 'ELIBJ0051', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anne', '', 'Doppenberg', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356360796', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0053', 'ELIBJ0053', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anne', '', 'Doppenberg', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356360796', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0052', 'ELIBJ0052', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Anne', '', 'Doppenberg', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356360796', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0068', 'ELIBJ0068', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Garo', 'J', 'Emerzian', 'DPM', 'Podiatry', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1356392906', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0065', 'ELIBJ0065', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Garo', 'J', 'Emerzian', 'DPM', 'Podiatry', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1356392906', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
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('203845479', 'ELIBJ0264', 'ELIBJ0264', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'E', 'Quinn', 'Regan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', NULL, '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356395222', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1773, -88.076, NULL, NULL),
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('203845479', 'ELIBJ0262', 'ELIBJ0262', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'E', 'Quinn', 'Regan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356395222', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0157', 'ELIBJ0157', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Frank', '', 'Kalmar', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8475967640', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8475967640', '8473362537', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376520783', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0158', 'ELIBJ0158', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Frank', '', 'Kalmar', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376520783', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0237', 'ELIBJ0237', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kristina', '', 'Olsen', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376576538', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0238', 'ELIBJ0238', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kristina', '', 'Olsen', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376576538', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0239', 'ELIBJ0239', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kristina', '', 'Olsen', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376576538', 0, 'Y', 0, '2012-12-26', 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
('203845479', 'ELIBJ0322', 'ELIBJ0322', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Daniel', '', 'Wenzke', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376704395', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0324', 'ELIBJ0324', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Daniel', '', 'Wenzke', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376704395', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0323', 'ELIBJ0323', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Daniel', '', 'Wenzke', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376704395', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0008', 'ELIBJ0008', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Laura', '', 'Bade', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60005', '7737779900', '7737775927', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60005', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386875680', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('203845479', 'ELIBJ0009', 'ELIBJ0009', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Laura', '', 'Bade', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386875680', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0209', 'ELIBJ0209', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'J', 'Logue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1396797270', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0207', 'ELIBJ0207', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'J', 'Logue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1396797270', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0206', 'ELIBJ0206', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'J', 'Logue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1396797270', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0208', 'ELIBJ0208', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'J', 'Logue', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8473363335', '8473363249', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1396797270', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('203845479', 'ELIBJ0284', 'ELIBJ0284', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jessica', '', 'Silgalis', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396799441', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0285', 'ELIBJ0285', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jessica', '', 'Silgalis', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396799441', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0169', 'ELIBJ0169', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jesse', '', 'Kong', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396879672', 0, 'Y', 0, '2014-07-23', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0170', 'ELIBJ0170', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jesse', '', 'Kong', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396879672', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0038', 'ELIBJ0038', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rakesh', '', 'Chaudhari', 'MD', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396938148', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0039', 'ELIBJ0039', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Rakesh', '', 'Chaudhari', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396938148', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0017', 'ELIBJ0017', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Aimee', '', 'Brasher', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396991378', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0019', 'ELIBJ0019', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Aimee', '', 'Brasher', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396991378', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0018', 'ELIBJ0018', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Aimee', '', 'Brasher', 'MD', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396991378', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0275', 'ELIBJ0275', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ritesh', '', 'Shah', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407019953', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0277', 'ELIBJ0277', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ritesh', '', 'Shah', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407019953', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0276', 'ELIBJ0276', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Ritesh', '', 'Shah', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407019953', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0187', 'ELIBJ0187', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alan', 'C', 'League', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1407938186', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0190', 'ELIBJ0190', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alan', 'C', 'League', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '8816 W Dempster', 'Niles', 'Cook', 'IL', '60714', '8477237052', '8478270671', '8816 W Dempster', 'Niles', 'Cook', 'IL', '60714', '8477237052', '8478270671', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1407938186', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0399, -87.8448, NULL, NULL),
('203845479', 'ELIBJ0189', 'ELIBJ0189', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alan', 'C', 'League', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1407938186', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0188', 'ELIBJ0188', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alan', 'C', 'League', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1407938186', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0153', 'ELIBJ0153', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Yazan', '', 'Kaakaji', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437106929', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.067, -87.9665, NULL, NULL),
('203845479', 'ELIBJ0155', 'ELIBJ0155', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Yazan', '', 'Kaakaji', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437106929', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.191, -87.8573, NULL, NULL),
('203845479', 'ELIBJ0156', 'ELIBJ0156', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Yazan', '', 'Kaakaji', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437106929', 0, 'Y', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0154', 'ELIBJ0154', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Yazan', '', 'Kaakaji', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437106929', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.0568, -87.9018, NULL, NULL),
('203845479', 'ELIBJ0152', 'ELIBJ0152', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Yazan', '', 'Kaakaji', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437106929', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.0445, -87.7999, NULL, NULL),
('203845479', 'ELIBJ0150', 'ELIBJ0150', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrew', 'J', 'Johanek', 'DO', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437187366', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0151', 'ELIBJ0151', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Andrew', 'J', 'Johanek', 'DO', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437187366', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0319', 'ELIBJ0319', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Walker', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447276129', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0321', 'ELIBJ0321', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Walker', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447276129', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0320', 'ELIBJ0320', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Walker', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447276129', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0003', 'ELIBJ0003', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'William', '', 'Ankenbrandt', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447279880', 0, 'Y', 0, '2014-02-14', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0005', 'ELIBJ0005', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'William', '', 'Ankenbrandt', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447279880', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0004', 'ELIBJ0004', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'William', '', 'Ankenbrandt', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447279880', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0225', 'ELIBJ0225', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Chris', 'R', 'Miller', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '          ', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477507382', 0, 'N', 0, '2014-04-08', NULL, NULL, 42.1773, -88.076, NULL, NULL),
('203845479', 'ELIBJ0224', 'ELIBJ0224', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Chris', 'R', 'Miller', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477507382', 0, 'N', 0, '2014-04-08', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0223', 'ELIBJ0223', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Chris', 'R', 'Miller', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477507382', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0148', 'ELIBJ0148', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'John', '', 'Jeske', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence St. Francis Hospital', 'Presence St. Joseph Hospital', '', 'HCFA|UB|', '1487693131', 0, 'Y', 0, '2014-01-30', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0149', 'ELIBJ0149', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'John', '', 'Jeske', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence St. Francis Hospital', 'Presence St. Joseph Hospital', '', 'HCFA|UB|', '1487693131', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0334', 'ELIBJ0334', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Doris', '', 'Yip', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497714869', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0336', 'ELIBJ0336', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Doris', '', 'Yip', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497714869', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0335', 'ELIBJ0335', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Doris', '', 'Yip', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497714869', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0253', 'ELIBJ0253', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Sasan', '', 'Payvar', 'MD', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548325897', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0254', 'ELIBJ0254', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Sasan', '', 'Payvar', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548325897', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0297', 'ELIBJ0297', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stanford', 'R', 'Tack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', '1275 E Belvidere Rd Ste 150', 'Grayslake', 'Lake', 'IL', '60030', '8477352896', '2472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558314013', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3419, -87.9899, NULL, NULL),
('203845479', 'ELIBJ0295', 'ELIBJ0295', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stanford', 'R', 'Tack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558314013', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('203845479', 'ELIBJ0296', 'ELIBJ0296', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stanford', 'R', 'Tack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3021 Falling Waters Blvd Ste A', 'Lindenhurst', 'Lake', 'IL', '60046', '8473569300', '8472342090', '3021 Falling Waters Blvd Ste A', 'Lindenhurst', 'Lake', 'IL', '60046', '8473569300', '8472342090', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558314013', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4016, -88.0089, NULL, NULL),
('203845479', 'ELIBJ0293', 'ELIBJ0293', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stanford', 'R', 'Tack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558314013', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0294', 'ELIBJ0294', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stanford', 'R', 'Tack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8472342090', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558314013', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0287', 'ELIBJ0287', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Charles', 'M', 'Slack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1558316893', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0288', 'ELIBJ0288', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Charles', 'M', 'Slack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '3124441145', '7735612925', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '3124441145', '7735612925', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1558316893', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('203845479', 'ELIBJ0286', 'ELIBJ0286', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Charles', 'M', 'Slack', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1558316893', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0086', 'ELIBJ0086', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jonathan', '', 'Garrett', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558367482', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0085', 'ELIBJ0085', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jonathan', '', 'Garrett', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558367482', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0084', 'ELIBJ0084', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jonathan', '', 'Garrett', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558367482', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0165', 'ELIBJ0165', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tony', '', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558384115', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.067, -87.9665, NULL, NULL),
('203845479', 'ELIBJ0167', 'ELIBJ0167', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tony', '', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558384115', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.191, -87.8573, NULL, NULL),
('203845479', 'ELIBJ0168', 'ELIBJ0168', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tony', '', 'Kim', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558384115', 0, 'Y', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0166', 'ELIBJ0166', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tony', '', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558384115', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.0568, -87.9018, NULL, NULL),
('203845479', 'ELIBJ0164', 'ELIBJ0164', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Tony', '', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558384115', 0, 'Y', 0, '2013-09-25', NULL, NULL, 42.0445, -87.7999, NULL, NULL),
('203845479', 'ELIBJ0257', 'ELIBJ0257', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bojan', '', 'Petrovic', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609032549', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0258', 'ELIBJ0258', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bojan', '', 'Petrovic', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609032549', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0259', 'ELIBJ0259', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Bojan', '', 'Petrovic', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609032549', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0120', 'ELIBJ0120', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1609068386', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0118', 'ELIBJ0118', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1609068386', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0116', 'ELIBJ0116', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1609068386', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0119', 'ELIBJ0119', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Hamming', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', '900 N Westmoreland Ste LL 72', 'Lake Forest', 'Lake', 'IL', '60045', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1609068386', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('203845479', 'ELIBJ0024', 'ELIBJ0024', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Shireesha', '', 'Carse', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609928415', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0026', 'ELIBJ0026', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Shireesha', '', 'Carse', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '9479453370', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609928415', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0027', 'ELIBJ0027', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Shireesha', '', 'Carse', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609928415', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0025', 'ELIBJ0025', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Shireesha', '', 'Carse', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609928415', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0023', 'ELIBJ0023', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Shireesha', '', 'Carse', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8477796021', '8479291170', '9000 Waukegan Rd Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8477796021', '8479291170', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609928415', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0256', 'ELIBJ0256', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Keely', '', 'Pedersen', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619228624', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0255', 'ELIBJ0255', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Keely', '', 'Pedersen', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619228624', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0020', 'ELIBJ0020', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Marc', 'J', 'Breslow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1619961927', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0022', 'ELIBJ0022', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Marc', 'J', 'Breslow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1619961927', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0021', 'ELIBJ0021', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Marc', 'J', 'Breslow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1619961927', 0, 'Y', 0, '2014-01-30', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0078', 'ELIBJ0078', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'S', 'Forman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1150 N State St', 'Chicago', 'Cook', 'IL', '60610', '7735612600', '7733278490', '1150 N State St', 'Chicago', 'Cook', 'IL', '60610', '7735612600', '7733278490', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1639122955', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.9033, -87.6286, NULL, NULL),
('203845479', 'ELIBJ0077', 'ELIBJ0077', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'S', 'Forman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', '2740 W Foster Ave Ste 301', 'Chicago', 'Cook', 'IL', '60625', '7735612600', '7735612925', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1639122955', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('203845479', 'ELIBJ0076', 'ELIBJ0076', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'S', 'Forman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1639122955', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0075', 'ELIBJ0075', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Edward', 'S', 'Forman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1639122955', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0010', 'ELIBJ0010', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Taizoon', 'H', 'Baxamusa', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659322535', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0012', 'ELIBJ0012', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Taizoon', 'H', 'Baxamusa', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659322535', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0011', 'ELIBJ0011', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Taizoon', 'H', 'Baxamusa', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659322535', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.043, -87.7992, 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
('203845479', 'ELIBJ0060', 'ELIBJ0060', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Robert', 'C', 'Dugan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', '1025 Red Oak Ln Ste 100', 'Lindenhurst', 'Lake', 'IL', '60046', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1659324085', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.4143, -88.0569, NULL, NULL),
('203845479', 'ELIBJ0059', 'ELIBJ0059', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Robert', 'C', 'Dugan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363248', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363248', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1659324085', 0, 'N', 0, '2014-01-30', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0058', 'ELIBJ0058', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Robert', 'C', 'Dugan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1659324085', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0181', 'ELIBJ0181', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Frances', 'J', 'Lamberta', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', NULL, '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425377', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1773, -88.076, NULL, NULL),
('203845479', 'ELIBJ0180', 'ELIBJ0180', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Frances', 'J', 'Lamberta', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425377', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0179', 'ELIBJ0179', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Frances', 'J', 'Lamberta', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425377', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0203', 'ELIBJ0203', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Susanne', '', 'Lewandowski', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425674', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0202', 'ELIBJ0202', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Susanne', '', 'Lewandowski', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425674', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0201', 'ELIBJ0201', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Susanne', '', 'Lewandowski', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669425674', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0312', 'ELIBJ0312', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', 'L', 'Visotsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', '1450 Busch Pkwy Ste 115', 'Buffalo Grove', 'Lake', 'IL', '60089', '2246767920', '2246767994', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1669428538', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('203845479', 'ELIBJ0313', 'ELIBJ0313', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', 'L', 'Visotsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1669428538', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1898, -87.826, NULL, NULL),
('203845479', 'ELIBJ0309', 'ELIBJ0309', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', 'L', 'Visotsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1669428538', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0311', 'ELIBJ0311', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', 'L', 'Visotsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1669428538', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0310', 'ELIBJ0310', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Jeffrey', 'L', 'Visotsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1669428538', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0047', 'ELIBJ0047', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Luke', '', 'Dillon', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669707170', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0046', 'ELIBJ0046', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Luke', '', 'Dillon', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669707170', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0041', 'ELIBJ0041', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Angi', '', 'Courtney', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679536346', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0040', 'ELIBJ0040', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Angi', '', 'Courtney', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679536346', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0198', 'ELIBJ0198', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', '', 'Lee', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679596241', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0200', 'ELIBJ0200', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', '', 'Lee', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679596241', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0199', 'ELIBJ0199', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', '', 'Lee', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679596241', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0197', 'ELIBJ0197', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Scott', '', 'Lee', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679596241', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0328', 'ELIBJ0328', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Craig', 'S', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', '1919 Skokie Valley', 'Highland Park', 'Lake', 'IL', '60035', '2247655500', '2247655501', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1689629859', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1898, -87.826, NULL, NULL),
('203845479', 'ELIBJ0325', 'ELIBJ0325', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Craig', 'S', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1689629859', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0327', 'ELIBJ0327', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Craig', 'S', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', '900 Rand Rd Ste 200', 'Des Plaines', 'Cook', 'IL', '60016', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1689629859', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0326', 'ELIBJ0326', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Craig', 'S', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', 'Presence Holy Family Medical Center', NULL, NULL, 'HCFA|UB|', '1689629859', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0172', 'ELIBJ0172', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Julia', '', 'Koziol', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700153954', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0171', 'ELIBJ0171', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Julia', '', 'Koziol', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', '720 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8472474000', '8475732430', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700153954', 0, 'Y', 0, '2014-04-15', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0061', 'ELIBJ0061', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Eisenstein', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '9479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700863925', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0062', 'ELIBJ0062', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Eisenstein', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700863925', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0064', 'ELIBJ0064', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Eisenstein', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700863925', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0063', 'ELIBJ0063', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Matthew', '', 'Eisenstein', 'MD', 'Radiology', '', '', NULL, 'O', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700863925', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0184', 'ELIBJ0184', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Martin', '', 'Lazarus', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1708815123', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0185', 'ELIBJ0185', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Martin', '', 'Lazarus', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1708815123', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0186', 'ELIBJ0186', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Martin', '', 'Lazarus', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1708815123', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0006', 'ELIBJ0006', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stephen', '', 'Aydt', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8478708159', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8478708159', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710997911', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0007', 'ELIBJ0007', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stephen', '', 'Aydt', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710997911', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0113', 'ELIBJ0113', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0114', 'ELIBJ0114', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'O', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', '1717 N Ashland', 'Chicago', 'Cook', 'IL', '60622', '7737724203', '7737729989', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.9128, -87.6676, NULL, NULL),
('203845479', 'ELIBJ0111', 'ELIBJ0111', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0115', 'ELIBJ0115', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0110', 'ELIBJ0110', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0112', 'ELIBJ0112', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', '', 'Granato', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720055320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0298', 'ELIBJ0298', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kiran', '', 'Thakrar', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730208448', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0300', 'ELIBJ0300', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kiran', '', 'Thakrar', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730208448', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0299', 'ELIBJ0299', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Kiran', '', 'Thakrar', 'MD', 'Radiology', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8478321460', '8478321467', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730208448', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('203845479', 'ELIBJ0126', 'ELIBJ0126', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'James', 'M', 'Hill', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '8474382868', '1253 S Rand Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383041', '8474382868', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740234848', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.1773, -88.076, NULL, NULL),
('203845479', 'ELIBJ0125', 'ELIBJ0125', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'James', 'M', 'Hill', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8478706100', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740234848', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0124', 'ELIBJ0124', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'James', 'M', 'Hill', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740234848', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0213', 'ELIBJ0213', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erich', '', 'Lussnig', 'MD', 'Radiology', '', '', NULL, 'O', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', '2350 Ravine Way Ste 600', 'Glenview', 'Cook', 'IL', '60025', '8477244470', '8477244597', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750366050', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.101, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0214', 'ELIBJ0214', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erich', '', 'Lussnig', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750366050', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0215', 'ELIBJ0215', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Erich', '', 'Lussnig', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750366050', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0242', 'ELIBJ0242', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Satnam', '', 'Papa', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '9479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479149096', '9479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760404958', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0243', 'ELIBJ0243', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Satnam', '', 'Papa', 'MD', 'Radiology', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473362344', '8473362537', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760404958', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0245', 'ELIBJ0245', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Satnam', '', 'Papa', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760404958', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0244', 'ELIBJ0244', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Satnam', '', 'Papa', 'MD', 'Radiology', '', '', NULL, 'O', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', '718 Florsheim Dr', 'Libertyville', 'Lake', 'IL', '60048', '8473624483', '8473624920', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760404958', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.2584, -87.9455, NULL, NULL),
('203845479', 'ELIBJ0082', 'ELIBJ0082', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', 'H', 'Garelick', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811980618', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0083', 'ELIBJ0083', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', 'H', 'Garelick', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811980618', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('203845479', 'ELIBJ0081', 'ELIBJ0081', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'David', 'H', 'Garelick', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811980618', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0096', 'ELIBJ0096', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Gregory', '', 'Goldstein', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821063496', 0, 'Y', 0, '2014-02-11', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
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('203845479', 'ELIBJ0102', 'ELIBJ0102', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alexander', 'C', 'Gordon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932153103', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0330', 'ELIBJ0330', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alice', '', 'Yao Lee', 'MD', 'Radiology', '', '', NULL, 'O', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', '1300 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8474540520', '8474540521', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932426327', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0665, -87.9672, NULL, NULL),
('203845479', 'ELIBJ0332', 'ELIBJ0332', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alice', '', 'Yao Lee', 'MD', 'Radiology', '', '', NULL, 'O', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '8479453370', '2101 Waukegan Rd Ste 110', 'Bannockburn', 'Lake', 'IL', '60015', '8479453340', '8479453370', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932426327', 0, 'Y', 0, '2013-01-16', NULL, NULL, 42.1948, -87.8605, NULL, NULL),
('203845479', 'ELIBJ0333', 'ELIBJ0333', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alice', '', 'Yao Lee', 'MD', 'Radiology', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932426327', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0331', 'ELIBJ0331', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alice', '', 'Yao Lee', 'MD', 'Radiology', '', '', NULL, 'O', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', '900 Rand Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60016', '8479547600', '8479547624', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932426327', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('203845479', 'ELIBJ0329', 'ELIBJ0329', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Alice', '', 'Yao Lee', 'MD', 'Radiology', '', '', NULL, 'O', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', '9000 Waukegan Rd Ste 200', 'Morton Grove', 'Cook', 'IL', '60053', '8473753000', '8479291190', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932426327', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.043, -87.7992, NULL, NULL),
('203845479', 'ELIBJ0240', 'ELIBJ0240', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Courtney', '', 'Paison', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962455980', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
('203845479', 'ELIBJ0241', 'ELIBJ0241', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Courtney', '', 'Paison', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962455980', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0216', 'ELIBJ0216', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'John', '', 'Marogol', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962458208', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0217', 'ELIBJ0217', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'John', '', 'Marogol', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962458208', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0134', 'ELIBJ0134', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Michael', '', 'Jablon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982658084', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0133', 'ELIBJ0133', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Michael', '', 'Jablon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982658084', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('203845479', 'ELIBJ0132', 'ELIBJ0132', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Michael', '', 'Jablon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982658084', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0194', 'ELIBJ0194', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'O', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', '150 N Michigan Ave Ste 1400', 'Chicago', 'Cook', 'IL', '60601', '3124441145', '3124441954', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.8843, -87.6245, NULL, NULL),
('203845479', 'ELIBJ0193', 'ELIBJ0193', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'O', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', '2860 N Broadway Ste 202', 'Chicago', 'Cook', 'IL', '60657', '7733278300', '7733278490', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.934, -87.6445, NULL, NULL),
('203845479', 'ELIBJ0192', 'ELIBJ0192', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'O', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', '4801 W Peterson Ave Ste 314', 'Chicago', 'Cook', 'IL', '60646', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('203845479', 'ELIBJ0191', 'ELIBJ0191', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'ELIBJ0196', 'ELIBJ0196', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'O', '5140 N California Ave Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7737779900', '7737775927', '5140 N California Ave Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9752, -87.6989, NULL, NULL),
('203845479', 'ELIBJ0195', 'ELIBJ0195', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Megan', 'R', 'Leahy', 'DPM', 'Podiatry', '', '', NULL, 'O', '5600 W Addison St Ste 400', 'Chicago', 'Cook', 'IL', '60634', '7737779900', '7737775927', '5600 W Addison St Ste 400', 'Chicago', 'Cook', 'IL', '60634', '7737779900', '7737775927', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1982828190', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('203845479', 'ELIBJ0273', 'ELIBJ0273', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stacy', '', 'Schmitz', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', '350 S Greenleaf Ste 405', 'Gurnee', 'Lake', 'IL', '60031', '8473363335', '8473363249', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982835740', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.3565, -87.9022, NULL, NULL),
('203845479', 'ELIBJ0274', 'ELIBJ0274', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Stacy', '', 'Schmitz', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8477207133', '', 'CHIG3', 'ORTHOHCPC1', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982835740', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('760046243', 'W12027671', 'W12027671', 'TXHOUSTD', 'Physicians Eye Center', 'Raj', '', 'Singla', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3000 39th St Ste 102', 'Port Arthur', 'Jefferson', 'TX', '77642', '4099852569', '4099852915', '3000 39th St Ste 102', 'Port Arthur', 'Jefferson', 'TX', '77642', '4099852569', '4099852915', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1003984873', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.9158, -93.9475, NULL, NULL),
('760046243', 'W12027672', 'W12027672', 'TXHOUSTD', 'Physicians Eye Center', 'Raj', '', 'Singla', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3385 Laurel Ave Ste 101', 'Beaumont', 'Jefferson', 'TX', '77707', '4098323120', '4098322085', '3385 Laurel Ave Ste 101', 'Beaumont', 'Jefferson', 'TX', '77707', '4098323120', '4098322085', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1003984873', 0, 'N', 0, '2013-05-10', NULL, NULL, 30.0826, -94.1376, NULL, NULL),
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('000001002', 'W12027683', 'W12027683', 'TXHOUSTD', 'TMH Physician Organization', '', '', 'TMH Physician Organization', '', 'Clinics', '', '', NULL, 'O', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010026', 0, 'Y', 0, '2013-11-06', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('000001002', 'W12027684', 'W12027684', 'TXHOUSTD', 'TMH Physician Organization', '', '', 'TMH Physician Organization', '', 'Clinics', '', '', NULL, 'O', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2030-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010026', 0, 'Y', 0, '2013-11-06', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('000001002', 'W12027685', 'W12027685', 'TXHOUSTD', 'TMH Physician Organization', '', '', 'TMH Physician Organization', '', 'Clinics', '', '', NULL, 'O', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', '6550 Fannin St Ste 447', 'Houston', 'Harris', 'TX', '77030', '7134417963', '7137937012', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 6, '2030-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010026', 0, 'Y', 0, '2013-11-06', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('820200895', 'W12027687', 'W12027687', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity', 'Kevin', '', 'Chicoine', 'MD', 'Occupational Medicine', 'Family Practice', 'Urgent Care', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-27', '2013-06-01', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1730121740', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12027688', 'W12027688', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Kevin', '', 'Chicoine', 'MD', 'Occupational Medicine', 'Family Practice', 'Urgent Care', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-27', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1730121740', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('010708714', 'W12027689', 'W12027689', 'ID02', 'Diagnostic Pathology Services Inc', 'Thomas', 'M', 'Donndelinger', 'MD', 'Pathology', '', '', NULL, 'O', '9850 W St Lukes Dr', 'Nampa', 'Canyon', 'ID', '83687', '2083812378', '2083814762', '9850 W St Lukes Dr', 'Nampa', 'Canyon', 'ID', '83687', '2083812378', '2083814762', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1255372009', 0, 'N', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('010708714', 'W12027690', 'W12027690', 'ID02', 'Diagnostic Pathology Services Inc', 'Joseph', 'D', 'Kronz', 'MD', 'Pathology', '', '', NULL, 'O', '9850 W St Lukes Dr', 'Nampa', 'Canyon', 'ID', '83687', '2083812378', '2083814762', '9850 W St Lukes Dr', 'Nampa', 'Canyon', 'ID', '83687', '2083812378', '2083814762', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831135581', 0, 'N', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027693', 'W12027693', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '1 Clinic Rd', 'Challis', 'Custer', 'ID', '83226', '2087883434', '2087882025', '1 Clinic Rd', 'Challis', 'Custer', 'ID', '83226', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027679', 'W12027679', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '100 Hospital Dr Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2087278600', '2087278601', '100 Hospital Dr Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2087278600', '2087278601', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('452715973', 'W12027681', 'W12027681', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '110 Niece Ave', 'Stanley', 'Custer', 'ID', '83278', '2087883434', '2087882025', '110 Niece Ave', 'Stanley', 'Custer', 'ID', '83278', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027680', 'W12027680', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087882025', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027695', 'W12027695', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027697', 'W12027697', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '21 E Maple', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '2087883386', '21 E Maple', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '2087883386', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027696', 'W12027696', 'Sinclair', 'St Lukes Clinic Wood River', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'O', '738 N College Rd Ste C', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2088147100', '2087372731', '738 N College Rd Ste C', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2088147100', '2087372731', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027699', 'W12027699', 'Sinclair', 'St Lukes Clinic Wood River LLC', '', '', 'St Lukes Clinic Wood River LLC', '', 'Clinic', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972891604', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0022', 'ELCSA0022', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'Y', 0, '2013-07-02', NULL, NULL, 40.1174, -88.2271, NULL, NULL),
('363819436', 'ELCSA0021', 'ELCSA0021', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363819436', 'ELCSA0008', 'ELCSA0008', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247927', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247927', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0024', 'ELCSA0024', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '6303247900', '6302711813', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363819436', 'ELCSA0025', 'ELCSA0025', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363819436', 'ELCSA0020', 'ELCSA0020', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '801 S Washington St', 'Naperville', 'Dupage', 'IL', '60566', '6303247900', '6302711813', '801 S Washington St', 'Naperville', 'Dupage', 'IL', '60566', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('363819436', 'ELCSA0034', 'ELCSA0034', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6308015700', '6302711813', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6308015700', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7856, -88.3289, NULL, NULL),
('363819436', 'ELCSA0031', 'ELCSA0031', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'Y', 0, '2013-07-02', NULL, NULL, 40.1174, -88.2271, NULL, NULL),
('363819436', 'ELCSA0033', 'ELCSA0033', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363819436', 'ELCSA0011', 'ELCSA0011', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0032', 'ELCSA0032', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363819436', 'ELCSA0030', 'ELCSA0030', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', 'One Ingalls Dr', 'Harvery', 'Cook', 'IL', '60426', '6303247900', '6302711813', 'One Ingalls Dr', 'Harvery', 'Cook', 'IL', '60426', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.6068, -87.6594, NULL, NULL),
('363819436', 'ELCSA0017', 'ELCSA0017', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6308015700', '6302711813', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6308015700', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7856, -88.3289, NULL, NULL),
('363819436', 'ELCSA0016', 'ELCSA0016', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', '1400 W Park Ave', 'Urbana', 'Champaign', 'IL', '61801', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'Y', 0, '2013-07-02', NULL, NULL, 40.1174, -88.2271, NULL, NULL),
('363819436', 'ELCSA0014', 'ELCSA0014', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363819436', 'ELCSA0007', 'ELCSA0007', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0018', 'ELCSA0018', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '6303247900', '6302711813', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363819436', 'ELCSA0019', 'ELCSA0019', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363819436', 'ELCSA0013', 'ELCSA0013', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', '801 S Washington St', 'Naperville', 'Dupage', 'IL', '60566', '6303247900', '6302711813', '801 S Washington St', 'Naperville', 'Dupage', 'IL', '60566', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('363819436', 'ELCSA0015', 'ELCSA0015', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'O', 'One Ingalls Dr', 'Harvery', 'Cook', 'IL', '60426', '6303247900', '6302711813', 'One Ingalls Dr', 'Harvery', 'Cook', 'IL', '60426', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.6068, -87.6594, NULL, NULL),
('363819436', 'ELCSA0038', 'ELCSA0038', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0545, -87.8881, NULL, NULL),
('363819436', 'ELCSA0009', 'ELCSA0009', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0036', 'ELCSA0036', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363819436', 'ELCSA0035', 'ELCSA0035', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.7123, -88.0234, NULL, NULL),
('363819436', 'ELCSA0037', 'ELCSA0037', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363819436', 'ELCSA0042', 'ELCSA0042', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0545, -87.8881, NULL, NULL),
('363819436', 'ELCSA0012', 'ELCSA0012', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0040', 'ELCSA0040', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363819436', 'ELCSA0039', 'ELCSA0039', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.7123, -88.0234, NULL, NULL),
('363819436', 'ELCSA0041', 'ELCSA0041', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0666, -87.993, NULL, NULL),
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('850481490', 'W12031212', 'W12031212', 'Test', 'Testing Associates', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', '', '', 'OP1', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'UB|HCFA|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12027702', 'W12027702', 'Sinclair', 'St Lukes Clinic Wood River LLC', 'Joseph', 'A', 'Rodriguez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104916394', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
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('300520570', 'ELTMH0116', 'ELTMH0116', 'TXHOUSTD', 'TMH Physician Associates', 'Kimberly', '', 'Byrum', 'FNP', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1003162454', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'ELTMH0153', 'ELTMH0153', 'TXHOUSTD', 'TMH Physician Associates', 'Sherilyn', '', 'Gordon Burroughs', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003841990', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0067', 'ELTMH0067', 'TXHOUSTD', 'TMH Physician Associates', 'Earl', '', 'Mangin', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1003874371', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.6948, -95.5233, NULL, NULL),
('371520288', 'ELTMH0380', 'ELTMH0380', 'TXHOUSTD', 'Methodist Pathology Associates', 'Geoffrey', '', 'Land', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003958554', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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('300520570', 'ELTMH0125', 'ELTMH0125', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Miclat', 'FNP', 'Family Practice', '', '', NULL, 'O', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1013105733', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
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('300520570', 'ELTMH0238', 'ELTMH0238', 'TXHOUSTD', 'TMH Physician Associates', 'Saleem', '', 'Zaidi', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013947316', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'ELTMH0367', 'ELTMH0367', 'TXHOUSTD', 'Methodist Pathology Associates', 'Donna', '', 'Coffey', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1013975416', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0108', 'ELTMH0108', 'TXHOUSTD', 'TMH Physician Associates', 'Willa', '', 'Hsueh', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1023036076', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, 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
('300520570', 'ELTMH0425', 'ELTMH0425', 'TXHOUSTD', 'TMH Physician Associates', 'M. Danelle', '', 'McLain', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023048428', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0207', 'ELTMH0207', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Masud', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023054525', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0208', 'ELTMH0208', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Masud', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023054525', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0071', 'ELTMH0071', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Passmore', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1023076205', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6948, -95.5233, NULL, NULL),
('371520288', 'ELTMH0396', 'ELTMH0396', 'TXHOUSTD', 'Methodist Pathology Associates', 'Hidehiro', '', 'Takei', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023104528', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0151', 'ELTMH0151', 'TXHOUSTD', 'TMH Physician Associates', 'Craig', '', 'Fischer', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906472', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906472', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033109475', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0488', 'ELTMH0488', 'TXHOUSTD', 'TMH Physician Associates', 'Wade', '', 'Fischer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1033116710', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('550892748', 'ELTMH0323', 'ELTMH0323', 'TXHOUSTD', 'TMH Physician Organization', 'Jaime', '', 'Gateno', 'MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '6560 Fannin St Ste 1280', 'Houston', 'Harris', 'TX', '77030', '7134415577', '7137931869', '6560 Fannin St Ste 1280', 'Houston', 'Harris', 'TX', '77030', '7134415577', '7137931869', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033144209', 0, 'Y', 0, '2013-05-31', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('371520288', 'ELTMH0376', 'ELTMH0376', 'TXHOUSTD', 'Methodist Pathology Associates', 'Abida', '', 'Haque', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1033167549', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0424', 'ELTMH0424', 'TXHOUSTD', 'TMH Physician Associates', 'Kadian', '', 'McIntosh', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033298401', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0415', 'ELTMH0415', 'TXHOUSTD', 'TMH Physician Associates', 'Danielle', '', 'Comeaux', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033300686', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('571201170', 'ELTMH0298', 'ELTMH0298', 'TXHOUSTD', 'TMH Physician Organization', 'Nelly', '', 'Heiman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 100', 'Houston', 'Harris', 'TX', '77070', '2817371320', '2817371321', '18220 Tomball Pkwy Ste 100', 'Houston', 'Harris', 'TX', '77070', '2817371320', '2817371321', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033326103', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('300520570', 'ELTMH0129', 'ELTMH0129', 'TXHOUSTD', 'TMH Physician Associates', 'Dalbir', '', 'Purewal', 'MD', 'Family Practice', '', '', NULL, 'O', '16740 Champions Forest Dr', 'Spring', 'Harris', 'TX', '77379', '2813762828', '2813208143', '16740 Champions Forest Dr', 'Spring', 'Harris', 'TX', '77379', '2813762828', '2813208143', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043241441', 0, 'N', 0, '2012-12-27', NULL, NULL, 30.0122, -95.538, NULL, NULL),
('300520570', 'ELTMH0324', 'ELTMH0324', 'TXHOUSTD', 'TMH Physician Associates', 'William', '', 'Bryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', '6550 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043247208', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('371520288', 'ELTMH0387', 'ELTMH0387', 'TXHOUSTD', 'Methodist Pathology Associates', 'Thu Huy', '', 'Ngo', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043268576', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'ELTMH0354', 'ELTMH0354', 'TXHOUSTD', 'Methodist Pathology Associates', 'Mojghan', '', 'Amrikachi', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1043278302', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0123', 'ELTMH0123', 'TXHOUSTD', 'TMH Physician Associates', 'Vijay', '', 'Jotwani', 'MD', 'Family Practice', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043364839', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7366, -95.4371, NULL, NULL),
('300520570', 'ELTMH0259', 'ELTMH0259', 'TXHOUSTD', 'TMH Physician Associates', 'Jose', '', 'Perez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053346379', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0211', 'ELTMH0211', 'TXHOUSTD', 'TMH Physician Associates', 'Rani', '', 'Nanda', 'DO', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053574913', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0212', 'ELTMH0212', 'TXHOUSTD', 'TMH Physician Associates', 'Rani', '', 'Nanda', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053574913', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0255', 'ELTMH0255', 'TXHOUSTD', 'TMH Physician Associates', 'Nicoline', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 130', 'Houston', 'Harris', 'TX', '77070', '8329121188', '2816408806', '18220 Tomball Pkwy Ste 130', 'Houston', 'Harris', 'TX', '77070', '8329121188', '2816408806', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1053614636', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0179', 'ELTMH0179', 'TXHOUSTD', 'TMH Physician Associates', 'Swaminathan', '', 'Iyer', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063493229', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7123, -95.4002, NULL, NULL),
('300520570', 'ELTMH0508', 'ELTMH0508', 'TXHOUSTD', 'TMH Physician Associates', 'Hosam', '', 'El Sayed', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063598977', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0187', 'ELTMH0187', 'TXHOUSTD', 'TMH Physician Associates', 'Surya Prakash Deepa', '', 'Bangalore', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134410005', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134410005', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063671600', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0188', 'ELTMH0188', 'TXHOUSTD', 'TMH Physician Associates', 'Surya Prakash Deepa', '', 'Bangalore', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063671600', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0256', 'ELTMH0256', 'TXHOUSTD', 'TMH Physician Associates', 'Heidi', '', 'Matus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063674851', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0009', 'ELTMH0009', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'DeGarmo', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134416148', '7137906489', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134416148', '7137906489', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063727485', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0010', 'ELTMH0010', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'DeGarmo', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063727485', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0493', 'ELTMH0493', 'TXHOUSTD', 'TMH Physician Associates', 'Mahesh', '', 'Ramchandani', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073513693', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0152', 'ELTMH0152', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Gaber', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073579835', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'ELTMH0265', 'ELTMH0265', 'TXHOUSTD', 'TMH Physician Organization', 'David', '', 'Chiu', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1073594537', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0178', 'ELTMH0178', 'TXHOUSTD', 'TMH Physician Associates', 'Monisha', '', 'Singh', 'MD', 'Hematology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073655965', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7123, -95.4002, NULL, NULL),
('371520288', 'ELTMH0382', 'ELTMH0382', 'TXHOUSTD', 'Methodist Pathology Associates', 'Joyce', '', 'Maldonado', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '          ', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083619316', 0, 'Y', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('412152284', 'ELTMH0290', 'ELTMH0290', 'TXHOUSTD', 'TMH Physician Organization', 'Yi', 'Jonathan', 'Zhang', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1083666978', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('383768845', 'ELTMH0098', 'ELTMH0098', 'TXHOUSTD', 'Methodist Radiology Associates', 'Amy', '', 'Powitzky', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083691562', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0099', 'ELTMH0099', 'TXHOUSTD', 'Methodist Radiology Associates', 'Amy', '', 'Powitzky', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083691562', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0466', 'ELTMH0466', 'TXHOUSTD', 'TMH Physician Associates', 'Babith', '', 'Mankidy', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1083769194', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0022', 'ELTMH0022', 'TXHOUSTD', 'TMH Physician Associates', 'Marilyn', '', 'Jose', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083802441', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0433', 'ELTMH0433', 'TXHOUSTD', 'TMH Physician Associates', 'Layne', '', 'Opersteny', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083942007', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'ELTMH0341', 'ELTMH0341', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Moseley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', '13802 Centerfield Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093745390', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'ELTMH0499', 'ELTMH0499', 'TXHOUSTD', 'TMH Physician Associates', 'Sophie', '', 'Fletcher', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', '6560 Fannin Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1093924714', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0345', 'ELTMH0345', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Seaberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104009042', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('571201170', 'ELTMH0402', 'ELTMH0402', 'TXHOUSTD', 'TMH Physician Organization', 'Purvi', '', 'Desai', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '6560 Fannin St Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', '6560 Fannin Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104013481', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0414', 'ELTMH0414', 'TXHOUSTD', 'TMH Physician Associates', 'Hue', '', 'Cao', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104046697', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0346', 'ELTMH0346', 'TXHOUSTD', 'TMH Physician Associates', 'Timothy', '', 'Sitter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813252', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('571201170', 'ELTMH0274', 'ELTMH0274', 'TXHOUSTD', 'TMH Physician Organization', 'Milvia', '', 'Pleitez', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137902059', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137902059', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1104846583', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0185', 'ELTMH0185', 'TXHOUSTD', 'TMH Physician Associates', 'Mirza', '', 'Baig', 'MD', 'Hospitalist', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104846922', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0186', 'ELTMH0186', 'TXHOUSTD', 'TMH Physician Associates', 'Mirza', '', 'Baig', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104846922', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0043', 'ELTMH0043', 'TXHOUSTD', 'TMH Physician Organization', 'Donald', '', 'Bledsoe', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137906468', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137906468', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104864628', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('371520288', 'ELTMH0398', 'ELTMH0398', 'TXHOUSTD', 'Methodist Pathology Associates', 'Luan', '', 'Truong', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104874650', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0318', 'ELTMH0318', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Key', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', '6560 Fannin Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1104881010', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('371520288', 'ELTMH0372', 'ELTMH0372', 'TXHOUSTD', '', 'Yimin', '', 'Ge', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '          ', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104912500', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'ELTMH0379', 'ELTMH0379', 'TXHOUSTD', 'Methodist Pathology Associates', 'Ognjen', '', 'Kosarac', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1114172632', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0016', 'ELTMH0016', 'TXHOUSTD', 'TMH Physician Associates', 'Karen', '', 'Hollenberg', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114198173', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('571201170', 'ELTMH0411', 'ELTMH0411', 'TXHOUSTD', 'TMH Physician Organization', 'Brent', '', 'Bell', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste AX 121B', 'Houston', 'Harris', 'TX', '77030', '7137902637', '7137931300', '6565 Fannin Ste AX 121B', 'Houston', 'Harris', 'TX', '77030', '7137902637', '7137931300', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114242856', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('134298938', 'ELTMH0457', 'ELTMH0457', 'TXHOUSTD', 'Aldona Spiegel MD', 'Aldona', '', 'Spiegel', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137902085', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137902085', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114956778', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0065', 'ELTMH0065', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Mahmarian', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114957511', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0075', 'ELTMH0075', 'TXHOUSTD', 'TMH Physician Associates', 'Dipan', '', 'Shah', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114966470', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'ELTMH0264', 'ELTMH0264', 'TXHOUSTD', 'TMH Physician Organization', 'Stanley', '', 'Appel', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1124009113', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('412152284', 'ELTMH0284', 'ELTMH0284', 'TXHOUSTD', 'TMH Physician Organization', 'Jerry', '', 'Blacklock', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137901015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137901015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124053392', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0254', 'ELTMH0254', 'TXHOUSTD', 'TMH Physician Associates', 'Julie', '', 'Hung', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124053863', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.5909, -95.6296, NULL, NULL),
('300520570', 'ELTMH0063', 'ELTMH0063', 'TXHOUSTD', 'TMH Physician Associates', 'Karla', '', 'Kurrelmeyer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124063631', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0311', 'ELTMH0311', 'TXHOUSTD', 'TMH Physician Associates', 'Bridget', '', 'Fahy', 'MD', 'Oncology', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137926470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137926470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124066824', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0462', 'ELTMH0462', 'TXHOUSTD', '', 'Liliana', '', 'Diaz', 'MD', 'Pulmonary', '', '', NULL, 'O', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134114499', 0, 'N', 0, '2013-04-11', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
('300520570', 'ELTMH0120', 'ELTMH0120', 'TXHOUSTD', 'TMH Physician Associates', 'Debra', '', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', '6550 Fannin Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134142961', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('371520288', 'ELTMH0355', 'ELTMH0355', 'TXHOUSTD', 'Methodist Pathology Associates', 'Rose', '', 'Anton', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1134177611', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0160', 'ELTMH0160', 'TXHOUSTD', 'TMH Physician Associates', 'Lee', '', 'Morris', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134300387', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'ELTMH0028', 'ELTMH0028', 'TXHOUSTD', 'TMH Physician Organization', 'Peggy', '', 'Phillips', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 489', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', '6550 Fannin Ste 489', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134429046', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'ELTMH0385', 'ELTMH0385', 'TXHOUSTD', 'Methodist Pathology Associates', 'Seema', '', 'Mullick', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144288424', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0138', 'ELTMH0138', 'TXHOUSTD', 'TMH Physician Associates', 'Christian', '', 'Schupp', 'MD', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144378084', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'ELTMH0443', 'ELTMH0443', 'TXHOUSTD', 'TMH Physician Associates', 'Erin', '', 'Wickliff', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144406729', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0444', 'ELTMH0444', 'TXHOUSTD', 'TMH Physician Associates', 'Erin', '', 'Wickliff', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144406729', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0437', 'ELTMH0437', 'TXHOUSTD', 'TMH Physician Associates', 'Sean', '', 'Townsend', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817970926', '13802 Centerfield Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817970926', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144591082', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'ELTMH0438', 'ELTMH0438', 'TXHOUSTD', 'TMH Physician Associates', 'Sean', '', 'Townsend', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414838', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414838', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144591082', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0110', 'ELTMH0110', 'TXHOUSTD', 'TMH Physician Associates', 'Mary', '', 'Ruppe', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154354173', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0248', 'ELTMH0248', 'TXHOUSTD', 'TMH Physician Associates', 'Thomas', '', 'Baxter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154480689', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0142', 'ELTMH0142', 'TXHOUSTD', 'TMH Physician Associates', 'Anupam', '', 'Sidhu', 'MD', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154523488', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('571201170', 'ELTMH0299', 'ELTMH0299', 'TXHOUSTD', 'TMH Physician Organization', 'Christopher', '', 'Hobday', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6550 Fannin St Ste 901', 'Houston', 'Harris', 'TX', '77030', '7134411026', '7137902986', '6550 Fannin Ste 901', 'Houston', 'Harris', 'TX', '77030', '7134411026', '7137902986', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154597888', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'ELTMH0479', 'ELTMH0479', 'TXHOUSTD', 'TMH Physician Organization', 'Bin', '', 'Teh', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '6565 Fannin St Ste DB1 077', 'Houston', 'Harris', 'TX', '77030', '7134414800', '7134414493', '6565 Fannin Ste DB1 077', 'Houston', 'Harris', 'TX', '77030', '7134414800', '7134414493', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164414439', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
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('371520288', 'ELTMH0364', 'ELTMH0364', 'TXHOUSTD', 'Methodist Pathology Associates', 'Lauri Brozo', '', 'Campagna', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1194705004', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('412152284', 'ELTMH0287', 'ELTMH0287', 'TXHOUSTD', 'TMH Physician Organization', 'Robert', 'G', 'Parrish', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194743773', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0017', 'ELTMH0017', 'TXHOUSTD', 'TMH Physician Associates', 'Sarah', '', 'Krinock', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205851896', 0, 'Y', 0, '2013-08-01', NULL, NULL, 29.7098, -95.3999, 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
('300520570', 'ELTMH0343', 'ELTMH0343', 'TXHOUSTD', 'TMH Physician Associates', 'Vincent', '', 'Phan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2816904608', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2816904608', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205948296', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'ELTMH0199', 'ELTMH0199', 'TXHOUSTD', 'TMH Physician Associates', 'Matt', '', 'Khoshnevis', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215032305', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0200', 'ELTMH0200', 'TXHOUSTD', 'TMH Physician Associates', 'Matt', '', 'Khoshnevis', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215032305', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0269', 'ELTMH0269', 'TXHOUSTD', 'TMH Physician Organization', 'Makoto', '', 'Kawai', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137906468', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137906468', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1215175856', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0180', 'ELTMH0180', 'TXHOUSTD', 'TMH Physician Associates', 'Tejal', '', 'Patel', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '6445 Main St Ste 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137921642', '6445 Main St Ste 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137921642', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1215910237', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7123, -95.4002, NULL, NULL),
('412152284', 'ELTMH0283', 'ELTMH0283', 'TXHOUSTD', 'TMH Physician Organization', 'David', '', 'Baskin', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1215962485', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('134298938', 'ELTMH0455', 'ELTMH0455', 'TXHOUSTD', 'Klebuc Michael MD', 'Michael', '', 'Klebuc', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416108', '7137902088', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416108', '7137902088', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225067887', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0408', 'ELTMH0408', 'TXHOUSTD', 'TMH Physician Associates', 'Heather', '', 'Ashford', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902202', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902202', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225105836', 0, 'Y', 0, '2013-05-30', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0163', 'ELTMH0163', 'TXHOUSTD', 'TMH Physician Associates', 'Timothy', '', 'Oppermann', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1225118748', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0500', 'ELTMH0500', 'TXHOUSTD', 'TMH Physician Associates', 'Alvin', '', 'Goh', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', '6560 Fannin Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225279169', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0217', 'ELTMH0217', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad Umair', '', 'Qamar', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', '6565 Fannin Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235148370', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0218', 'ELTMH0218', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad Umair', '', 'Qamar', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235148370', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0509', 'ELTMH0509', 'TXHOUSTD', '', 'Tam', '', 'Huynh', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134416201', '7137944901', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134416201', '7137944901', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235177098', 0, 'N', 0, '2013-04-11', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0154', 'ELTMH0154', 'TXHOUSTD', 'TMH Physician Associates', 'Melanie', '', 'Hafford', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1235339037', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0007', 'ELTMH0007', 'TXHOUSTD', 'TMH Physician Associates', 'Aaron', '', 'Cohn', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235376682', 0, 'Y', 0, '2013-05-30', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0157', 'ELTMH0157', 'TXHOUSTD', 'TMH Physician Associates', 'Rafael', '', 'Lugo', 'MD', 'General Surgery', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1245224492', 0, 'N', 0, '2013-03-22', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('371520288', 'ELTMH0357', 'ELTMH0357', 'TXHOUSTD', 'Methodist Pathology Associates', 'Alberto', '', 'Ayala', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1245286111', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0447', 'ELTMH0447', 'TXHOUSTD', 'TMH Physician Associates', 'Joan', '', 'Zampieri', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245329549', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0448', 'ELTMH0448', 'TXHOUSTD', 'TMH Physician Associates', 'Joan', '', 'Zampieri', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245329549', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('571201170', 'ELTMH0046', 'ELTMH0046', 'TXHOUSTD', 'TMH Physician Organization', 'Debra', '', 'Nelson', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 260', 'Houston', 'Harris', 'TX', '77070', '2818904448', '2818904237', '18220 Tomball Pkwy Ste 260', 'Houston', 'Harris', 'TX', '77070', '2818904448', '2818904237', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Willowbrook Hospital', NULL, NULL, 'HCFA|UB|', '1245470095', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('300520570', 'ELTMH0344', 'ELTMH0344', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Pyle', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4201 Garth Rd Ste 107', 'Baytown', 'Harris', 'TX', '77521', '2814277400', '2814278750', '4201 Garth Rd Ste 107', 'Baytown', 'Harris', 'TX', '77521', '2814277400', '2814278750', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1255329686', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
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('371520288', 'ELTMH0399', 'ELTMH0399', 'TXHOUSTD', 'Methodist Pathology Associates', 'Ping', '', 'Wang', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306002092', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('300520570', 'ELTMH0039', 'ELTMH0039', 'TXHOUSTD', 'TMH Physician Associates', 'Todd', '', 'Williams', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306117585', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('412152284', 'ELTMH0458', 'ELTMH0458', 'TXHOUSTD', 'TMH Physician Organization', 'Brenda', '', 'Garza', 'NP', 'Psychiatry', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316296338', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
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('300520570', 'ELTMH0336', 'ELTMH0336', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Lintner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316982929', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7366, -95.4371, NULL, NULL),
('300520570', 'ELTMH0445', 'ELTMH0445', 'TXHOUSTD', 'TMH Physician Associates', 'Bonnie', '', 'Woeltjen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', '6550 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316983794', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0446', 'ELTMH0446', 'TXHOUSTD', 'TMH Physician Associates', 'Bonnie', '', 'Woeltjen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134418691', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134418691', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316983794', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('300520570', 'ELTMH0427', 'ELTMH0427', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Mucha', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326086778', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('383768845', 'ELTMH0088', 'ELTMH0088', 'TXHOUSTD', 'Methodist Radiology Associates', 'Andrew', '', 'Crane', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326241126', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0089', 'ELTMH0089', 'TXHOUSTD', 'Methodist Radiology Associates', 'Andrew', '', 'Crane', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326241126', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0261', 'ELTMH0261', 'TXHOUSTD', 'TMH Physician Associates', 'Sheena', '', 'Stubbers', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', '6560 Fannin Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336125954', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('571201170', 'ELTMH0304', 'ELTMH0304', 'TXHOUSTD', 'TMH Physician Organization', 'Jonathan', '', 'Russell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '10130 Louetta Rd Ste G', 'Houston', 'Harris', 'TX', '77070', '8326985500', '8326985540', '10130 Louetta Rd Ste G', 'Houston', 'Harris', 'TX', '77070', '8326985500', '8326985540', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336142553', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9997, -95.563, NULL, NULL),
('300520570', 'ELTMH0045', 'ELTMH0045', 'TXHOUSTD', 'TMH Physician Associates', 'Eunice', '', 'Ihaza', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336173327', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('134298938', 'ELTMH0449', 'ELTMH0449', 'TXHOUSTD', 'Pierre Yves Chevray MD', 'Pierre Yves', '', 'Chevray', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134410714', '7137902086', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134410714', '7137902086', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336249333', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'ELTMH0300', 'ELTMH0300', 'TXHOUSTD', 'TMH Physician Organization', 'Jessica', '', 'Lee', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 100', 'Tomball', 'Harris', 'TX', '77070', '2817371320', '2817371321', '18220 Tomball Pkwy Ste 100', 'Tomball', 'Harris', 'TX', '77070', '2817371320', '2817371321', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336334507', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('300520570', 'ELTMH0061', 'ELTMH0061', 'TXHOUSTD', 'TMH Physician Associates', 'Jerry', '', 'Estep', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336343847', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0328', 'ELTMH0328', 'TXHOUSTD', 'TMH Physician Associates', 'Donald', '', 'Dominy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1336370527', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'ELTMH0262', 'ELTMH0262', 'TXHOUSTD', 'TMH Physician Associates', 'Irum', '', 'Zaheer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1336390707', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('134298938', 'ELTMH0452', 'ELTMH0452', 'TXHOUSTD', 'Warren Ellsworth MD', 'Warren', '', 'Ellsworth', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137998428', '6560 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137998428', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336470343', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'ELTMH0282', 'ELTMH0282', 'TXHOUSTD', 'TMH Physician Organization', 'John', '', 'Volpi', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134413780', '7137937271', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346443843', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0002', 'ELTMH0002', 'TXHOUSTD', 'TMH Physician Associates', 'Daniel', '', 'Arellano', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346552437', 0, 'Y', 0, '2013-05-30', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0352', 'ELTMH0352', 'TXHOUSTD', 'TMH Physician Associates', 'Jeffrey', '', 'Wood', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356339832', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'ELTMH0068', 'ELTMH0068', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Nabi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356382816', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0513', 'ELTMH0513', 'TXHOUSTD', 'TMH Physician Associates', 'Eric', '', 'Peden', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356421770', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0055', 'ELTMH0055', 'TXHOUSTD', 'TMH Physician Associates', 'Chun', '', 'Lin', 'MD', 'Cardiology', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356532261', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'ELTMH0020', 'ELTMH0020', 'TXHOUSTD', 'TMH Physician Organization', 'Delmar', '', 'Imperial Aubin', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134416712', '7137906468', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134416712', '7137906468', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356548382', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0128', 'ELTMH0128', 'TXHOUSTD', 'TMH Physician Associates', 'Claire', '', 'Pollard', 'ACNP', 'Family Practice', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1356571764', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0496', 'ELTMH0496', 'TXHOUSTD', 'TMH Physician Associates', 'Erik', '', 'Suarez', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1356589675', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0227', 'ELTMH0227', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Soliman', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', '6565 Fannin Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356590970', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0228', 'ELTMH0228', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Soliman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356590970', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0403', 'ELTMH0403', 'TXHOUSTD', 'TMH Physician Organization', 'Teresa', '', 'Kaldis', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '6560 Fannin St Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', '6560 Fannin Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411225', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0340', 'ELTMH0340', 'TXHOUSTD', 'TMH Physician Associates', 'Patrick', '', 'McCulloch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', '6550 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366421679', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0066', 'ELTMH0066', 'TXHOUSTD', 'TMH Physician Associates', 'Ronald', '', 'Mahoney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', '7777 Southwest Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1366490237', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6948, -95.5233, NULL, NULL),
('371520288', 'ELTMH0401', 'ELTMH0401', 'TXHOUSTD', 'Methodist Pathology Associates', 'Youli', '', 'Zu', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376501775', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0492', 'ELTMH0492', 'TXHOUSTD', 'TMH Physician Associates', 'Walter', '', 'OHara', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '13300 Hargrave Rd Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817372918', '2817372919', '13300 Hargrave Rd Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817372918', '2817372919', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1376541789', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9679, -95.5517, NULL, NULL),
('300520570', 'ELTMH0418', 'ELTMH0418', 'TXHOUSTD', 'TMH Physician Associates', 'Hieu', '', 'Ha', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376570671', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7366, -95.4371, NULL, NULL),
('300520570', 'ELTMH0313', 'ELTMH0313', 'TXHOUSTD', 'TMH Physician Associates', 'Janet', '', 'Macheledt', 'MD', 'Oncology', '', '', NULL, 'O', '18400 Katy Fwy Ste 520', 'Houston', 'Harris', 'TX', '77094', '8325228521', '8325228524', '18400 Katy Fwy Ste 520', 'Houston', 'Harris', 'TX', '77094', '8325228521', '8325228524', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1376585281', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7873, -95.6961, NULL, NULL),
('300520570', 'ELTMH0134', 'ELTMH0134', 'TXHOUSTD', 'TMH Physician Associates', 'Paula', '', 'Rupert', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137903047', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137903047', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376622993', 0, 'Y', 0, '2013-03-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0135', 'ELTMH0135', 'TXHOUSTD', 'TMH Physician Associates', 'Paula', '', 'Rupert', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', '', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376622993', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0006', 'ELTMH0006', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'Broome', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376730051', 0, 'Y', 0, '2013-07-03', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0258', 'ELTMH0258', 'TXHOUSTD', 'TMH Physician Associates', 'Eric', '', 'Mueller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', '6560 Fannin Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376794750', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0027', 'ELTMH0027', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'OBrien', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376861971', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, 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
('300520570', 'ELTMH0409', 'ELTMH0409', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Baker', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386663268', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('371520288', 'ELTMH0366', 'ELTMH0366', 'TXHOUSTD', 'Methodist Pathology Associates', 'Patricia', '', 'Chevez Barrios', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1386692853', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('412152284', 'ELTMH0286', 'ELTMH0286', 'TXHOUSTD', 'TMH Physician Organization', 'Paul', '', 'Holman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1386698314', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0209', 'ELTMH0209', 'TXHOUSTD', 'TMH Physician Associates', 'Daniela', '', 'Moran', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386711828', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0210', 'ELTMH0210', 'TXHOUSTD', 'TMH Physician Associates', 'Daniela', '', 'Moran', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386711828', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'ELTMH0373', 'ELTMH0373', 'TXHOUSTD', 'Methodist Pathology Associates', 'Enrique', '', 'Gomez', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1386805828', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('383768845', 'ELTMH0090', 'ELTMH0090', 'TXHOUSTD', 'Methodist Radiology Associates', 'Sheleika', '', 'Hervey', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386842292', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0091', 'ELTMH0091', 'TXHOUSTD', 'Methodist Radiology Associates', 'Sheleika', '', 'Hervey', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386842292', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('383768845', 'ELTMH0096', 'ELTMH0096', 'TXHOUSTD', 'Methodist Radiology Associates', 'Stephen', '', 'Phillips', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396722393', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0097', 'ELTMH0097', 'TXHOUSTD', 'Methodist Radiology Associates', 'Stephen', '', 'Phillips', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396722393', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0301', 'ELTMH0301', 'TXHOUSTD', 'TMH Physician Organization', 'Bani', '', 'Ratan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6550 Fannin St Ste 2201', 'Houston', 'Harris', 'TX', '77030', '7137979498', '7137970661', '6550 Fannin Ste 2201', 'Houston', 'Harris', 'TX', '77030', '7137979498', '7137970661', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1396906517', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('300520570', 'ELTMH0150', 'ELTMH0150', 'TXHOUSTD', 'TMH Physician Associates', 'Brian', '', 'Dunkin', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407812670', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('371520288', 'ELTMH0370', 'ELTMH0370', 'TXHOUSTD', 'Methodist Pathology Associates', 'April', '', 'Ewton', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407814783', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0147', 'ELTMH0147', 'TXHOUSTD', 'TMH Physician Associates', 'Howard', '', 'Monsour', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407853518', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0164', 'ELTMH0164', 'TXHOUSTD', 'TMH Physician Associates', 'Hemangshu', '', 'Podder', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1407885163', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0069', 'ELTMH0069', 'TXHOUSTD', 'TMH Physician Associates', 'Sherif', '', 'Nagueh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407891807', 0, 'N', 0, '2013-01-04', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0257', 'ELTMH0257', 'TXHOUSTD', 'TMH Physician Associates', 'Terry', '', 'McLendon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1407930399', 0, 'N', 0, '2013-03-22', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0468', 'ELTMH0468', 'TXHOUSTD', 'TMH Physician Associates', 'Harish', '', 'Seethamraju', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1417037847', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('371520288', 'ELTMH0360', 'ELTMH0360', 'TXHOUSTD', 'Methodist Pathology Associates', 'Roberto', '', 'Barrios', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1417915828', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0176', 'ELTMH0176', 'TXHOUSTD', '', 'Ethan', '', 'Natelson', 'MD', 'Hematology', '', '', NULL, 'O', '6560 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134416262', '7134412727', '6560 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134416262', '7134412727', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-05-19', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417921032', 0, 'N', 0, '2013-05-20', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0315', 'ELTMH0315', 'TXHOUSTD', 'TMH Physician Associates', 'Hilary', '', 'Beaver', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', '6560 Fannin Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1417958869', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('383768845', 'ELTMH0092', 'ELTMH0092', 'TXHOUSTD', 'Methodist Radiology Associates', 'Tuenchit', '', 'Khamapirad', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427132760', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0093', 'ELTMH0093', 'TXHOUSTD', 'Methodist Radiology Associates', 'Tuenchit', '', 'Khamapirad', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427132760', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0263', 'ELTMH0263', 'TXHOUSTD', 'TMH Physician Organization', 'Mohammad', '', 'Al Baeer', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', '6560 Fannin Ste 802', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1427203728', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('300520570', 'ELTMH0335', 'ELTMH0335', 'TXHOUSTD', 'TMH Physician Associates', 'Shari', '', 'Liberman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', '6550 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427282565', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0485', 'ELTMH0485', 'TXHOUSTD', 'TMH Physician Associates', 'Kenneth', '', 'Renney', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437147998', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('371520288', 'ELTMH0389', 'ELTMH0389', 'TXHOUSTD', 'Methodist Pathology Associates', 'Yingchao', '', 'Piao', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447224399', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0469', 'ELTMH0469', 'TXHOUSTD', 'TMH Physician Organization', 'Angel', '', 'Blanco', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '6565 Fannin St Ste DB1 077', 'Houston', 'Harris', 'TX', '77030', '7134414800', '7134414493', '6565 Fannin Ste DB1 077', 'Houston', 'Harris', 'TX', '77030', '7134414800', '7134414493', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447240593', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'ELTMH0470', 'ELTMH0470', 'TXHOUSTD', 'TMH Physician Organization', 'Angel', '', 'Blanco', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447240593', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0193', 'ELTMH0193', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Cortes', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447258959', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0194', 'ELTMH0194', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Cortes', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447258959', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0247', 'ELTMH0247', 'TXHOUSTD', 'TMH Physician Associates', 'Melina', '', 'Awar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1447443601', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0014', 'ELTMH0014', 'TXHOUSTD', 'TMH Physician Associates', 'Miles', '', 'Griffin', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447490289', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0431', 'ELTMH0431', 'TXHOUSTD', 'TMH Physician Associates', 'Jim', '', 'Nguyen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', '13802 Centerfield Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447498746', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'ELTMH0070', 'ELTMH0070', 'TXHOUSTD', 'TMH Physician Associates', 'Anton', '', 'Nielsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1457315632', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0221', 'ELTMH0221', 'TXHOUSTD', 'TMH Physician Associates', 'Hany', '', 'Samir', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457397978', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0222', 'ELTMH0222', 'TXHOUSTD', 'TMH Physician Associates', 'Hany', '', 'Samir', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457397978', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('571201170', 'ELTMH0042', 'ELTMH0042', 'TXHOUSTD', 'TMH Physician Organization', 'Guelbert', '', 'Abellana', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 489', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', '6550 Fannin St Ste 489', 'Houston', 'Harris', 'TX', '77030', '7134412889', '7134415764', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457605156', 0, 'Y', 0, '2013-06-05', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('300520570', 'ELTMH0491', 'ELTMH0491', 'TXHOUSTD', 'TMH Physician Associates', 'Javier', '', 'Lafuente', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1467481721', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('371520288', 'ELTMH0395', 'ELTMH0395', 'TXHOUSTD', 'Methodist Pathology Associates', 'Nour', '', 'Sneige', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467558288', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('371520288', 'ELTMH0393', 'ELTMH0393', 'TXHOUSTD', 'Methodist Pathology Associates', 'Mary', '', 'Schwartz', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477501948', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('300520570', 'ELTMH0170', 'ELTMH0170', 'TXHOUSTD', 'TMH Physician Associates', 'Todd', '', 'Worley', 'MD', 'General Surgery', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1477789931', 0, 'N', 0, '2013-03-22', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0131', 'ELTMH0131', 'TXHOUSTD', 'TMH Physician Associates', 'Dena', '', 'Rose', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1477885259', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'ELTMH0307', 'ELTMH0307', 'TXHOUSTD', 'TMH Physician Organization', 'Eugene', '', 'Toy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 St Joseph Pkwy', 'Houston', 'Harris', 'TX', '77003', '7137577406', '7136577191', '1601 St Joseph Pkwy', 'Houston', 'Harris', 'TX', '77003', '7137577406', '7136577191', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1487606851', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7471, -95.3651, NULL, NULL),
('300520570', 'ELTMH0316', 'ELTMH0316', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Coburn', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', '6560 Fannin Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1487619300', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'ELTMH0412', 'ELTMH0412', 'TXHOUSTD', 'TMH Physician Associates', 'Shawna', '', 'Blackmon', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487641536', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'ELTMH0239', 'ELTMH0239', 'TXHOUSTD', 'TMH Physician Associates', 'Asma', '', 'Zainab', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487646253', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0240', 'ELTMH0240', 'TXHOUSTD', 'TMH Physician Associates', 'Asma', '', 'Zainab', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487646253', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0074', 'ELTMH0074', 'TXHOUSTD', 'TMH Physician Associates', 'George', '', 'Schroth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137969312', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137969312', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487665097', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0231', 'ELTMH0231', 'TXHOUSTD', 'TMH Physician Associates', 'Kamlesh', '', 'Thaker', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487680088', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0232', 'ELTMH0232', 'TXHOUSTD', 'TMH Physician Associates', 'Kamlesh', '', 'Thaker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487680088', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0080', 'ELTMH0080', 'TXHOUSTD', 'TMH Physician Associates', 'William', '', 'Zoghbi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487684783', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0309', 'ELTMH0309', 'TXHOUSTD', 'TMH Physician Associates', 'Jenny', '', 'Chang', 'MD', 'Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487734810', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7123, -95.4002, NULL, NULL),
('300520570', 'ELTMH0314', 'ELTMH0314', 'TXHOUSTD', 'TMH Physician Associates', 'Angel', '', 'Rodriguez', 'MD', 'Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1487818811', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7123, -95.4002, NULL, NULL),
('371520288', 'ELTMH0388', 'ELTMH0388', 'TXHOUSTD', 'Methodist Pathology Associates', 'Randall', '', 'Olsen', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487841334', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0422', 'ELTMH0422', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Luczak', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137987428', '6550 Fannin Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137987428', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487884672', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0419', 'ELTMH0419', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Hawks', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', '6550 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497028831', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0145', 'ELTMH0145', 'TXHOUSTD', 'TMH Physician Associates', 'Tim', '', 'Tran', 'FNP', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497032528', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0146', 'ELTMH0146', 'TXHOUSTD', 'TMH Physician Associates', 'Tim', '', 'Tran', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', '', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497032528', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0112', 'ELTMH0112', 'TXHOUSTD', 'TMH Physician Associates', 'Kathleen', '', 'Wyne', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497731640', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0229', 'ELTMH0229', 'TXHOUSTD', 'TMH Physician Associates', 'Anakara', '', 'Sukumaran', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497763106', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0230', 'ELTMH0230', 'TXHOUSTD', 'TMH Physician Associates', 'Anakara', '', 'Sukumaran', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497763106', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0119', 'ELTMH0119', 'TXHOUSTD', 'TMH Physician Associates', 'Yana', '', 'Finkelshteyn', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497786651', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.5909, -95.6296, NULL, NULL),
('300520570', 'ELTMH0143', 'ELTMH0143', 'TXHOUSTD', 'TMH Physician Associates', 'Sheila', '', 'Tecson', 'MD', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497876437', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0181', 'ELTMH0181', 'TXHOUSTD', 'TMH Physician Associates', 'Rohit', '', 'Arora', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7137906334', '7137906327', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7137906334', '7137906327', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508086885', 0, 'Y', 0, '2013-05-30', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0182', 'ELTMH0182', 'TXHOUSTD', 'TMH Physician Associates', 'Rohit', '', 'Arora', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508086885', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0127', 'ELTMH0127', 'TXHOUSTD', 'TMH Physician Associates', 'Seva', '', 'Papageorge', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508836206', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.5909, -95.6296, NULL, NULL),
('300520570', 'ELTMH0308', 'ELTMH0308', 'TXHOUSTD', 'TMH Physician Associates', 'Anna', '', 'Belcheva', 'MD', 'Oncology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 280', 'Houston', 'Harris', 'TX', '77070', '2817370435', '2817370429', '18220 Tomball Pkwy Ste 280', 'Houston', 'Harris', 'TX', '77070', '2817370435', '2817370429', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518928514', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'ELTMH0111', 'ELTMH0111', 'TXHOUSTD', 'TMH Physician Associates', 'Archana', '', 'Sadhu', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528088127', 0, 'N', 0, '2014-03-18', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0139', 'ELTMH0139', 'TXHOUSTD', 'TMH Physician Associates', 'Gregory', '', 'Seelhoefer', 'MD', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528224144', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('371520288', 'ELTMH0361', 'ELTMH0361', 'TXHOUSTD', 'Methodist Pathology Associates', 'David', '', 'Bernard', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1538117007', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0073', 'ELTMH0073', 'TXHOUSTD', 'TMH Physician Associates', 'Miguel', '', 'Quinones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', '6550 Fannin Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538195466', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0270', 'ELTMH0270', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad', '', 'Khan', 'MD', 'Neurology', '', '', NULL, 'O', '16659 Southwest Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', '16659 Southwest Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1538233200', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.5881, -95.631, NULL, NULL),
('383768845', 'ELTMH0094', 'ELTMH0094', 'TXHOUSTD', 'Methodist Radiology Associates', 'Rajul', '', 'Mehta', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '6550 Fannin St Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', '6550 Fannin Ste 749', 'Houston', 'Harris', 'TX', '77030', '7134417465', '7137902996', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538322953', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('383768845', 'ELTMH0095', 'ELTMH0095', 'TXHOUSTD', 'Methodist Radiology Associates', 'Rajul', '', 'Mehta', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', NULL, 'PO Box 4109', 'Houston', 'Harris', 'TX', '77210', '2813597788', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538322953', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'ELTMH0297', 'ELTMH0297', 'TXHOUSTD', 'TMH Physician Organization', 'Konrad', '', 'Harms', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 St Joseph Pkwy', 'Houston', 'Harris', 'TX', '77003', '7137577406', '7136577157', '1601 St Joseph Pkwy', 'Houston', 'Harris', 'TX', '77003', '7137577406', '7136577157', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1548212053', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.7471, -95.3651, NULL, NULL),
('371520288', 'ELTMH0358', 'ELTMH0358', 'TXHOUSTD', 'Methodist Pathology Associates', 'Aleksandar', '', 'Babic', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', NULL, 'PO Box 4701', 'Houston', 'Harris', 'TX', '77210', '', '', '', NULL, 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1548236961', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0122', 'ELTMH0122', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'Holloway', 'DO', 'Family Practice', '', '', NULL, 'O', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', '16605 Southwest Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1548292360', 0, 'N', 0, '2012-12-27', NULL, NULL, 29.5909, -95.6296, NULL, NULL),
('300520570', 'ELTMH0003', 'ELTMH0003', 'TXHOUSTD', 'TMH Physician Associates', 'Phillip', '', 'Bowden', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548341274', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'ELTMH0004', 'ELTMH0004', 'TXHOUSTD', 'TMH Physician Associates', 'Phillip', '', 'Bowden', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548341274', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0225', 'ELTMH0225', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', '6565 Fannin Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558471441', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'ELTMH0226', 'ELTMH0226', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', '', 'TMHPHOHSP', NULL, NULL, '0.00', '0.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558471441', 0, 'Y', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'ELTMH0410', 'ELTMH0410', 'TXHOUSTD', 'TMH Physician Associates', 'Laura', '', 'Batista', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7137902082', '7137902082', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7137902082', '7137902082', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-01-01', '2013-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558539239', 0, 'Y', 0, '2012-12-27', NULL, NULL, 29.7098, -95.3999, NULL, NULL);
