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
('264288765', 'SPA100373', 'SPA100373', 'TXDALSTD', 'Gretchen Prater MD', 'Gretchen', '', 'Prater', 'MD', 'Pediatrics', '', '', NULL, 'O', '2140 FM 157 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174537770', '8174537703', '2140 FM 157 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174537770', '8174537703', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1811096696', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.5732, -97.1408, NULL, NULL),
('752657594', 'SPA100375', 'SPA100375', 'TXDALSTD', 'Michael D Grant MD', 'Michael', 'D', 'Grant', 'MD', 'General Surgery', '', '', NULL, 'B', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264362', '2148277032', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264362', '2148277032', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811906993', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7285, -97.3433, NULL, NULL),
('752657594', 'SPA100376', 'SPA100376', 'TXDALSTD', 'Michael D Grant MD', 'Michael', 'D', 'Grant', 'MD', 'General Surgery', '', '', NULL, 'M', '3900 Junius St Ste 220', 'Dallas', 'Dallas', 'TX', '75246', '2148267300', '2148277032', '3900 Junius St Ste 220', 'Dallas', 'Dallas', 'TX', '75246', '2148267300', '2148277032', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811906993', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752548905', 'SPA100378', 'SPA100378', 'TXDALSTD', 'Eric J Coligado MD', 'Eric', 'J', 'Coligado', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '350 W Park Way Ste 121', 'Euless', 'Tarrant', 'TX', '76040', '8173181414', '8173181515', '350 W Park Way Ste 121', 'Euless', 'Tarrant', 'TX', '76040', '8173181414', '8173181515', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB|', '1821081811', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8333, -97.1199, NULL, NULL),
('752548905', 'SPA100380', 'SPA100380', 'TXDALSTD', 'Eric J Coligado MD', 'Eric', 'J', 'Coligado', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '8173181414', '8173181515', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '8173181414', '8173181515', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB|', '1821081811', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100381', 'SPA100381', 'TXDALSTD', 'OB Hospitalists of Texas', 'Ashwin', 'G', 'Gaitonde', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1327 E Pioneer Pkwy', 'Arlington', 'Tarrant', 'TX', '76010', NULL, '2143619379', '1327 E Pioneer Pkwy', 'Arlington', 'Tarrant', 'TX', '76010', '', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831395219', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7082, -97.0899, NULL, NULL),
('383751560', 'SPA100382', 'SPA100382', 'TXDALSTD', 'OB Hospitalists of Texas', 'Ashwin', 'G', 'Gaitonde', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831395219', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100383', 'SPA100383', 'TXDALSTD', 'OB Hospitalists of Texas', 'Ashwin', 'G', 'Gaitonde', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831395219', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('262382573', 'SPA100390', 'SPA100390', 'TXDALSTD', 'Mansfield Surgical Associates', 'Michael', 'L', 'Thornton', 'DO', 'General Surgery', '', '', NULL, 'B', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '8178875924', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '8178875924', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1851333785', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('262382573', 'SPA100391', 'SPA100391', 'TXDALSTD', 'Mansfield Surgical Associates', 'Michael', 'L', 'Thornton', 'DO', 'General Surgery', '', '', NULL, 'O', '550 N Walnut Creek Dr Ste 120', 'Mansfield', 'Tarrant', 'TX', '76063', '8174779000', '8178875924', '550 N Walnut Creek Dr Ste 120', 'Mansfield', 'Tarrant', 'TX', '76063', '8174779000', '8178875924', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1851333785', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5723, -97.1336, NULL, NULL),
('752952407', 'SPA100393', 'SPA100393', 'TXDALSTD', 'Berry Milner and Uhr', 'Michael', NULL, 'Milner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3600 Gaston Ave Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', '3600 Gaston Ave Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851359079', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752952407', 'SPA100394', 'SPA100394', 'TXDALSTD', 'Berry Milner and Uhr', 'Michael', NULL, 'Milner', 'MD', 'Ophthalmology', '', '', NULL, 'M', '3600 Gaston Ave LB120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', '3600 Gaston Ave LB120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851359079', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752952407', 'SPA100395', 'SPA100395', 'TXDALSTD', 'Berry Milner and Uhr', 'Michael', NULL, 'Milner', 'MD', 'Ophthalmology', '', '', NULL, 'B', '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317512', '2148278515', '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317512', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851359079', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.1053, -96.839, NULL, NULL),
('752949110', 'SPA100396', 'SPA100396', 'TXDALSTD', 'Cecilia Okafor DO', 'Cecilia', 'N', 'Okafor', 'DO', 'Family Practice', '', '', NULL, 'O', '1143 S Buckner Blvd Ste 144', 'Dallas', 'Dallas', 'TX', '75217', '2143980398', '2143987200', '1143 S Buckner Blvd Ste 144', 'Dallas', 'Dallas', 'TX', '75217', '2143980398', '2143987200', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1851470298', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7319, -96.683, NULL, NULL),
('752949110', 'SPA100397', 'SPA100397', 'TXDALSTD', 'Cecilia Okafor DO', 'Cecilia', 'N', 'Okafor', 'DO', 'Family Practice', '', '', NULL, 'M', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1851470298', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('752949110', 'SPA100398', 'SPA100398', 'TXDALSTD', 'Cecilia Okafor DO', 'Cecilia', 'N', 'Okafor', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2143980398', '2143987200', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2143980398', '2143987200', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1851470298', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383870044', 'SPA100399', 'SPA100399', 'TXDALSTD', 'Paragonin and Rehabilitation', 'Norberto', 'J', 'Vargas', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '341 Wheatfield Dr Ste 120', 'Sunnyvale', 'Dallas', 'TX', '75182', '9722033600', '9722033601', '341 Wheatfield Dr Ste 120', 'Sunnyvale', 'Dallas', 'TX', '75182', '9722033600', '9722033601', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1861410995', 0, 'N', 0, '2013-12-23', NULL, NULL, 32.7791, -96.5628, NULL, NULL),
('383870044', 'SPA100401', 'SPA100401', 'TXDALSTD', 'Paragonin and Rehabilitation', 'Norberto', 'J', 'Vargas', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3435 NE Loop 286', 'Paris', 'Lamar', 'TX', '75460', '9722033600', '9722033600', '3435 NE Loop 286', 'Paris', 'Lamar', 'TX', '75460', '9722033600', '9722033600', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1861410995', 0, 'N', 0, '2013-12-23', NULL, NULL, 33.6687, -95.512, NULL, NULL),
('383870044', 'SPA100402', 'SPA100402', 'TXDALSTD', 'Paragonin and Rehabilitation', 'Norberto', 'J', 'Vargas', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722033600', '9722033601', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722033600', '9722033601', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1861410995', 0, 'Y', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('272251086', 'SPA100403', 'SPA100403', 'TXDALSTD', 'Malathi Ellis MD', 'Malathi', 'V', 'Ellis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471106', '9724069930', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471106', '9724069930', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1861509275', 0, 'Y', 0, '2014-04-28', NULL, NULL, 32.5394, -97.333, NULL, NULL),
('272251086', 'SPA100404', 'SPA100404', 'TXDALSTD', 'Malathi Ellis MD', 'Malathi', 'V', 'Ellis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069911', '9724069930', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069911', '9724069930', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1861509275', 0, 'N', 0, '2014-04-28', NULL, NULL, 32.9021, -96.9587, NULL, NULL),
('352386201', 'SPA100406', 'SPA100406', 'TXDALSTD', 'Stonebridge Foot and Ankle', 'Christina', 'M', 'Salcher', 'DPM', 'Podiatry', '', '', NULL, 'O', '175 Ridge Rd Ste 800', 'McKinney', 'Collin', 'TX', '75070', '9725400006', '9729841102', '175 Ridge Rd Ste 800', 'McKinney', 'Collin', 'TX', '75070', '9725400006', '9729841102', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871741892', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.1976, -96.698, NULL, NULL),
('352386201', 'SPA100408', 'SPA100408', 'TXDALSTD', 'Stonebridge Foot and Ankle', 'Christina', 'M', 'Salcher', 'DPM', 'Podiatry', '', '', NULL, 'B', '701 N Preston Rd Ste 100', 'Celina', 'Collin', 'TX', '75009', '9723821167', '9729841102', '701 N Preston Rd Ste 100', 'Celina', 'Collin', 'TX', '75009', '9723821167', '9729841102', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871741892', 0, 'Y', 0, '2014-04-02', NULL, NULL, 33.332, -96.7725, NULL, NULL),
('383751560', 'SPA100409', 'SPA100409', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'Tau', 'Gunby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891788790', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100410', 'SPA100410', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'Tau', 'Gunby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891788790', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100411', 'SPA100411', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'Tau', 'Gunby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 35761', 'Dallas', 'Dallas', 'TX', '75235', '9724811888', '2143619379', 'PO Box 35761', 'Dallas', 'Dallas', 'TX', '75235', '9724811888', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891788790', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751693117', 'SPA100412', 'SPA100412', 'TXDALSTD', 'Marwan Tamim MD', 'Marwan', 'Y', 'Tamim', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9724049609', '9722404222', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9724049609', '9722404222', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902817778', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.9234, -96.7841, NULL, NULL),
('751693117', 'SPA100413', 'SPA100413', 'TXDALSTD', 'Marwan Tamim MD', 'Marwan', 'Y', 'Tamim', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '517 W I-30 Ste C', 'Garland', 'Dallas', 'TX', '75043', '9722404242', '9722404222', '517 W I-30 Ste C', 'Garland', 'Dallas', 'TX', '75043', '9722404242', '9722404222', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902817778', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8402, -96.5965, NULL, NULL),
('752592722', 'SPA100415', 'SPA100415', 'TXDALSTD', 'Allan O Cook Jr MD', 'Allan', 'O', 'Cook', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '10611 Garland Rd Ste 114', 'Dallas', 'Dallas', 'TX', '75218', '9724877057', '9722724256', '10611 Garland Rd Ste 114', 'Dallas', 'Dallas', 'TX', '75218', '9724877057', '9722724256', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-08', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', '', '', 'HCFA|UB|', '1902842008', 0, 'N', 0, '2014-05-08', NULL, NULL, 32.8439, -96.6898, NULL, NULL),
('752592722', 'SPA100416', 'SPA100416', 'TXDALSTD', 'Allan O Cook Jr MD', 'Allan', 'O', 'Cook', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', '2461 Robinson Rd Bldg A', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726061637', '9722724256', '2461 Robinson Rd Bldg A', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726061637', '9722724256', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-08', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', '', '', 'HCFA|UB|', '1902842008', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('752592722', 'SPA100417', 'SPA100417', 'TXDALSTD', 'Allan O Cook Jr MD', 'Allan', 'O', 'Cook', 'MD', 'Thoracic Surgery', '', '', NULL, 'M', '777 Walter Reed Blvd Ste B210', 'Garland', 'Dallas', 'TX', '75042', '9724877057', '9722724256', '777 Walter Reed Blvd Ste B210', 'Garland', 'Dallas', 'TX', '75042', '9724877057', '9722724256', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', '', '', 'HCFA|UB|', '1902842008', 0, 'Y', 0, '2014-05-08', NULL, NULL, 32.9198, -96.6641, NULL, NULL),
('752592722', 'SPA100418', 'SPA100418', 'TXDALSTD', 'Allan O Cook Jr MD', 'Allan', 'O', 'Cook', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '777 Walter Reed Blvd Med Plz II Ste B 10', 'Garland', 'Dallas', 'TX', '75042', '9724877057', '9722724256', '777 Walter Reed Blvd Med Plz II Ste B 10', 'Garland', 'Dallas', 'TX', '75042', '9724877057', '9722724256', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', '', '', 'HCFA|UB|', '1902842008', 0, 'N', 0, '2014-05-08', NULL, NULL, 32.9175, -96.6798, NULL, NULL),
('752333069', 'SPA100419', 'SPA100419', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'Matthew', NULL, 'Westmoreland', 'MD', 'General Surgery', '', '', NULL, 'B', '2200 Physicians Blvd Ste C', 'Ennis', 'Ellis', 'TX', '75119', '9728751490', '2148242404', '2200 Physicians Blvd Ste C', 'Ennis', 'Ellis', 'TX', '75119', '9728751490', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902877186', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.3059, -96.6427, NULL, NULL),
('752333069', 'SPA100420', 'SPA100420', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'Matthew', NULL, 'Westmoreland', 'MD', 'General Surgery', '', '', NULL, 'O', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902877186', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7931, -96.7805, NULL, NULL),
('752932354', 'SPA100422', 'SPA100422', 'TXDALSTD', 'Latino Medical and Weight Loss Center', 'Victor', 'H', 'Ron', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9726200382', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9726200382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902893365', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7933, -96.7803, NULL, NULL),
('752932354', 'SPA100423', 'SPA100423', 'TXDALSTD', 'Latino Medical and Weight Loss Center', 'Victor', 'H', 'Ron', 'MD', 'Internal Medicine', '', '', NULL, 'M', '8 Medical Pkwy Plaza 2 Ste 301', 'Dallas', 'Dallas', 'TX', '75234', '9726202696', '9726200382', '8 Medical Pkwy Plaza 2 Ste 301', 'Dallas', 'Dallas', 'TX', '75234', '9726202696', '9726200382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902893365', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('466118431', 'SPA100425', 'SPA100425', 'TXDALSTD', 'Brent Bender DPM', 'Brent', NULL, 'Bender', 'DPM', 'Podiatry', '', '', NULL, 'B', '6529 W Plano Pkwy Ste B', 'Plano', 'Collin', 'TX', '75093', '2149463668', '2149435130', '6529 W Plano Pkwy Ste B', 'Plano', 'Collin', 'TX', '75093', '2149463668', '2149435130', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1912934654', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('466118431', 'SPA100426', 'SPA100426', 'TXDALSTD', 'Brent Bender DPM', 'Brent', NULL, 'Bender', 'DPM', 'Podiatry', '', '', NULL, 'O', '707 N Zang Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149463668', '2149435130', '707 N Zang Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149463668', '2149435130', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1912934654', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7508, -96.8242, NULL, NULL),
('270504871', 'SPA100434', 'SPA100434', 'TXDALSTD', 'Osteopods', 'Sam', 'W', 'Buchanan', 'DO', 'General Surgery', '', '', NULL, 'O', '2501 Parkview Dr', 'Ft Worth', 'Tarrant', 'TX', '76102', '8173134616', '8173330173', '2501 Parkview Dr', 'Ft Worth', 'Tarrant', 'TX', '76102', '8173134616', '8173330173', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932143823', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7405, -97.3528, NULL, NULL),
('270504871', 'SPA100435', 'SPA100435', 'TXDALSTD', 'Osteopods', 'Sam', 'W', 'Buchanan', 'DO', 'General Surgery', '', '', NULL, 'B', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '8668011503', '8173330173', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '8668011503', '8173330173', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932143823', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9125, -96.5293, NULL, NULL),
('270504871', 'SPA100436', 'SPA100436', 'TXDALSTD', 'Osteopods', 'Sam', 'W', 'Buchanan', 'DO', 'General Surgery', '', '', NULL, 'O', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177597000', '8173330173', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177597000', '8173330173', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932143823', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7306, -97.3325, NULL, NULL),
('270504871', 'SPA100437', 'SPA100437', 'TXDALSTD', 'Osteopods', 'Sam', 'W', 'Buchanan', 'DO', 'General Surgery', '', '', NULL, 'M', 'PO Box 100937', 'Fort Worth', 'Tarrant', 'TX', '76185', '8173134616', '8173330173', 'PO Box 100937', 'Fort Worth', 'Tarrant', 'TX', '76185', '8173134616', '8173330173', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932143823', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752061371', 'SPA100438', 'SPA100438', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Rolando', 'M', 'Solis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932185261', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752061371', 'SPA100440', 'SPA100440', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Rolando', 'M', 'Solis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 851888', 'Mesquite', 'Dallas', 'TX', '75185', '9726135015', '9724942082', 'PO Box 851888', 'Mesquite', 'Dallas', 'TX', '75185', '9726135015', '9724942082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932185261', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751892943', 'SPA100441', 'SPA100441', 'TXDALSTD', 'Burleson Family Medical Center', 'William', 'A', 'Thomas', 'DO', 'Family Practice', '', '', NULL, 'B', '3012 Hebron Pkwy Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9724923390', '8174471106', '3012 Hebron Pkwy Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9724923390', '8174471106', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1942202213', 0, 'Y', 0, '2013-08-05', NULL, NULL, 33.0253, -96.8552, NULL, NULL),
('751892943', 'SPA100442', 'SPA100442', 'TXDALSTD', 'Burleson Family Medical Center', 'William', 'A', 'Thomas', 'DO', 'Family Practice', '', '', NULL, 'O', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471208', '8174471106', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471208', '8174471106', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1942202213', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.5394, -97.3324, NULL, NULL),
('202600100', 'SPA100444', 'SPA100444', 'TXDALSTD', 'ENT for Children', 'Paul', 'W', 'Bauer', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9723159011', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9723159011', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1942265285', 0, 'Y', 0, '2013-08-05', NULL, NULL, 32.7933, -96.7803, NULL, NULL),
('202600100', 'SPA100445', 'SPA100445', 'TXDALSTD', 'ENT for Children', 'Paul', 'W', 'Bauer', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1942265285', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.9741, -96.989, NULL, NULL),
('751662624', 'SPA100450', 'SPA100450', 'TXDALSTD', 'Total Womens Healthcare', 'Robert', 'L', 'Levy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9723940200', '9724923390', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9723940200', '9724923390', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1952344061', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('751662624', 'SPA100451', 'SPA100451', 'TXDALSTD', 'Total Womens Healthcare', 'Robert', 'L', 'Levy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3012 Hebron Pkwy Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723940200', '9724923390', '3012 Hebron Pkwy Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723940200', '9724923390', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1952344061', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.0258, -96.8546, NULL, NULL),
('752343523', 'SPA100460', 'SPA100460', 'TXDALSTD', 'Southwest Dallas Orthopedic Associates', 'James', 'Scott', 'Ellis', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1505 W Jefferson Ste 102', 'Waxahachie', 'Ellis', 'TX', '75165', '9729233800', NULL, '1505 W Jefferson Ste 102', 'Waxahachie', 'Ellis', 'TX', '75165', '9729233800', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1962554915', 0, 'N', 0, '2014-02-12', NULL, NULL, 32.3972, -96.8656, NULL, NULL),
('752343523', 'SPA100461', 'SPA100461', 'TXDALSTD', 'Southwest Dallas Orthopedic Associates', 'James', 'Scott', 'Ellis', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '2143304609', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '2143304609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1962554915', 0, 'Y', 0, '2013-08-05', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('752343523', 'SPA100462', 'SPA100462', 'TXDALSTD', 'Southwest Dallas Orthopedic Associates', 'James', 'Scott', 'Ellis', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2909 S Hampton Rd Ste 107 D', 'Dallas', 'Dallas', 'TX', '75224', '2143339175', '2143304609', '2909 S Hampton Rd Ste 107 D', 'Dallas', 'Dallas', 'TX', '75224', '2143339175', '2143304609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1962554915', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.7151, -96.8571, NULL, NULL),
('752343523', 'SPA100463', 'SPA100463', 'TXDALSTD', 'Southwest Dallas Orthopedic Associates', 'James', 'Scott', 'Ellis', 'DO', 'Orthopedic Surgery', '', '', NULL, 'M', 'PO Box 381329', 'Duncanville', 'Dallas', 'TX', '75138', '2143339175', '2143304609', 'PO Box 381329', 'Duncanville', 'Dallas', 'TX', '75138', '2143339175', '2143304609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1962554915', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('752194466', 'SPA100464', 'SPA100464', 'TXDALSTD', 'Pediatric Offices at WIllow Bend', 'Sharon', 'L', 'Wiener', 'MD', 'Pediatrics', '', '', NULL, 'O', '6529 W Plano Pkwy Ste B', 'Plano', 'Collin', 'TX', '75093', '9727811414', '9727811717', '6529 W Plano Pkwy Ste B', 'Plano', 'Collin', 'TX', '75093', '9727811414', '9727811717', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1972535383', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.0308, -96.8391, NULL, NULL),
('752194466', 'SPA100466', 'SPA100466', 'TXDALSTD', 'Pediatric Offices at WIllow Bend', 'Sharon', 'L', 'Wiener', 'MD', 'Pediatrics', '', '', NULL, 'B', '8111 LBJ Frwy Ste 835', 'Dallas', 'Dallas', 'TX', '75251', '9726443810', '9727811717', '8111 LBJ Frwy Ste 835', 'Dallas', 'Dallas', 'TX', '75251', '9726443810', '9727811717', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1972535383', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('264482005', 'SPA100467', 'SPA100467', 'TXDALSTD', 'Dermatology and Skin Surgery', 'Gina', NULL, 'Harney', 'MD', 'Dermatology', '', '', NULL, 'B', '175 Ridge Rd Ste 800', 'McKinney', 'Collin', 'TX', '75070', '9035323484', '2145446737', '175 Ridge Rd Ste 800', 'McKinney', 'Collin', 'TX', '75070', '9035323484', '2145446737', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1972570091', 0, 'Y', 0, '2013-08-05', NULL, NULL, 33.1975, -96.6974, NULL, NULL),
('264482005', 'SPA100468', 'SPA100468', 'TXDALSTD', 'Dermatology and Skin Surgery', 'Gina', NULL, 'Harney', 'MD', 'Dermatology', '', '', NULL, 'O', '2760 Virginia Pkwy Ste 200', 'McKinney', 'Collin', 'TX', '75070', '4695877546', '2145446737', '2760 Virginia Pkwy Ste 200', 'McKinney', 'Collin', 'TX', '75070', '4695877546', '2145446737', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1972570091', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.1989, -96.6522, NULL, NULL),
('272311345', 'SPA100470', 'SPA100470', 'TXDALSTD', 'Kimberly Chesshir MD', 'Kimberly', 'A', 'Chesshir', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471106', '9724069930', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471106', '9724069930', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1972600583', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.5394, -97.333, NULL, NULL),
('272311345', 'SPA100471', 'SPA100471', 'TXDALSTD', 'Kimberly Chesshir MD', 'Kimberly', 'A', 'Chesshir', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069911', '9724069930', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069911', '9724069930', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1972600583', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9021, -96.9587, NULL, NULL),
('752333069', 'SPA100473', 'SPA100473', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'David', 'T', 'Arnold', 'MD', 'General Surgery', '', '', NULL, 'B', '3600 Gaston Ave Ste 1055', 'Dallas', 'Dallas', 'TX', '75246', '2148232650', '2148242404', '3600 Gaston Ave Ste 1055', 'Dallas', 'Dallas', 'TX', '75246', '2148232650', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1982675161', 0, 'Y', 0, '2013-08-05', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('752333069', 'SPA100474', 'SPA100474', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'David', 'T', 'Arnold', 'MD', 'General Surgery', '', '', NULL, 'O', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1982675161', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.7931, -96.7805, NULL, NULL),
('752719777', 'SPA100476', 'SPA100476', 'TXDALSTD', 'Southwest Neurology', 'Walter', 'L', 'Taylor', 'MD', 'Neurology', '', '', NULL, 'B', '1309 Ridge Rd Ste 109', 'Rockwall', 'Rockwall', 'TX', '75087', '9728642050', '9724129700', '1309 Ridge Rd Ste 109', 'Rockwall', 'Rockwall', 'TX', '75087', '9728642050', '9724129700', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1992709620', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('752719777', 'SPA100477', 'SPA100477', 'TXDALSTD', 'Southwest Neurology', 'Walter', 'L', 'Taylor', 'MD', 'Neurology', '', '', NULL, 'M', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9728642050', '9722713437', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9728642050', '9722713437', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1992709620', 0, 'Y', 0, '2013-08-05', NULL, NULL, 32.8952, -96.6666, NULL, NULL),
('752719777', 'SPA100478', 'SPA100478', 'TXDALSTD', 'Southwest Neurology', 'Walter', 'L', 'Taylor', 'MD', 'Neurology', '', '', NULL, 'O', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724128700', '9724129700', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724128700', '9724129700', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1992709620', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.9187, -96.5064, NULL, NULL),
('900128012', 'SPA100479', 'SPA100479', 'TXDALSTD', 'Alan Yedwab MD', 'Alan', 'J', 'Yedwab', 'MD', 'Pediatrics', '', '', NULL, 'M', '2821 E Pres George Bush Hwy Ste 308', 'Richardson', 'Dallas', 'TX', '75082', '2143201661', '2143201691', '2821 E Pres George Bush Hwy Ste 308', 'Richardson', 'Dallas', 'TX', '75082', '2143201661', '2143201691', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992740773', 0, 'Y', 0, '2014-03-31', NULL, NULL, 32.9958, -96.667, NULL, NULL),
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('752937389', 'SPA200043', 'SPA200043', 'TXDALSTD', 'Advanced Family Medical Care', 'Ahtaram', 'M', 'Khan', 'md', 'Family Practice', '', '', NULL, 'O', '4002 W Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9729858000', '9729850050', '4002 W Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9729858000', '9729850050', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336258003', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0267, -96.7702, NULL, NULL),
('390816848', 'W12035862', 'W12035862', 'ILCHIGSTD', 'MHS Physician Services', 'Jung', '', 'Rhee', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1023031770', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('362120183', 'W12035745', 'W12035745', 'ILCHIGSTD', 'Villa Medical Arts', 'Alan', 'D', 'Glassman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477592921', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.8886, -87.9691, NULL, NULL),
('362120183', 'W12035746', 'W12035746', 'ILCHIGSTD', 'Villa Medical Arts', 'Anthony', '', 'Lin', 'MD', 'Family Practice', '', '', NULL, 'O', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548258197', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.9691, NULL, NULL),
('362120183', 'W12035748', 'W12035748', 'ILCHIGSTD', 'Villa Medical Arts', 'Abdul', '', 'Razzaq', 'MD', 'Internal Medicine', '', '', NULL, 'O', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '33 S Villa Ave Ste 2', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760470314', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.9691, NULL, NULL),
('362167784', 'W12035749', 'W12035749', 'ILCHIGSTD', 'Elmhurst Memorial Hospital', 'William', 'V', 'Galassi', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-07-22', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1508900366', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363317058', 'W12035750', 'W12035750', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Jhansi', 'R', 'Raju', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013091032', 0, 'Y', 0, '2014-03-24', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('364088232', 'W12035759', 'W12035759', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Pamela', 'J', 'Schulz', 'DO', 'Pediatrics', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '8154399400', '8154394959', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '8154399400', '8154394959', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1174625206', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('271789847', 'W12048909', 'W12048909', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1,2,3', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009966', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12035761', 'W12035761', 'ID02', 'Ontario Emergency Specialists', 'Brad', 'L', 'Barlow', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1003870536', 0, 'N', 0, '2014-01-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035762', 'W12035762', 'ID02', 'Ontario Emergency Specialists', 'Kenneth', 'L', 'Bean', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2014-07-14', 0, 0, 1, '', '', '', '', 'HCFA', '1346274115', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035764', 'W12035764', 'ID02', 'Ontario Emergency Specialists', 'Morris', '', 'Smith', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1487911877', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035765', 'W12035765', 'ID02', 'Ontario Emergency Specialists', 'Harold', 'K', 'Thompson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1336185073', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035766', 'W12035766', 'ID02', 'Ontario Emergency Specialists', 'Rick', 'L', 'Wright', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1780706283', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035768', 'W12035768', 'ID02', 'Ontario Emergency Specialists', 'Nancy', '', 'Tate', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1023392636', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12035771', 'W12035771', 'ID02', 'Ontario Emergency Specialists', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('390816848', 'W12035775', 'W12035775', 'ILCHIGSTD', 'Mercy Pediatrics Elgin', 'Javed', 'I', 'Bangash', 'MD', 'Pediatrics', '', '', NULL, 'O', '2050 Larkin Ave', 'Elgin', 'Kane', 'IL', '60123', '8477429743', '8477429743', '2050 Larkin Ave', 'Elgin', 'Kane', 'IL', '60123', '8477429743', '8477429743', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1326090598', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.0322, -88.3294, NULL, NULL),
('202186142', 'SPA100007', 'SPA100007', 'TXDALSTD', 'Pradip Kanani and Harini Kanani MD', 'Harini', '', 'Kanani', 'MD', 'Family Practice', '', '', NULL, 'O', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1013925601', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8012, -96.6111, NULL, NULL),
('202186142', 'SPA100009', 'SPA100009', 'TXDALSTD', 'Pradip Kanani and Harini Kanani MD', 'Harini', '', 'Kanani', 'MD', 'Family Practice', '', '', NULL, 'B', '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '9722854141', '9722707320', '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '9722854141', '9722707320', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1013925601', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.1085, -96.8049, NULL, NULL),
('202186142', 'SPA100010', 'SPA100010', 'TXDALSTD', 'Pradip Kanani and Harini Kanani MD', 'Harini', '', 'Kanani', 'MD', 'Family Practice', '', '', NULL, 'O', '410 Pinson Rd', 'Forney', 'Kaufman', 'TX', '75126', '9722854141', '9722707320', '410 Pinson Rd', 'Forney', 'Kaufman', 'TX', '75126', '9722854141', '9722707320', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1013925601', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7528, -96.4715, NULL, NULL),
('752935588', 'SPA100014', 'SPA100014', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'James', '', 'Sharp', 'MD', 'Cardiology', '', '', NULL, 'O', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1023095452', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('752935588', 'SPA100015', 'SPA100015', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'James', '', 'Sharp', 'MD', 'Cardiology', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1023095452', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, 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
('752935588', 'SPA100017', 'SPA100017', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'James', '', 'Sharp', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1023095452', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752673192', 'SPA100018', 'SPA100018', 'TXDALSTD', 'North Texas Family Clinic', 'Ali', '', 'Jafarian', 'DO', 'Family Practice', '', '', NULL, 'O', '1143 S Buckner Blvd Ste 133', 'Dallas', 'Dallas', 'TX', '75217', '9726135500', '9726135015', '1143 S Buckner Blvd Ste 133', 'Dallas', 'Dallas', 'TX', '75217', '9726135500', '9726135015', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1033127873', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7319, -96.683, NULL, NULL),
('752673192', 'SPA100020', 'SPA100020', 'TXDALSTD', 'North Texas Family Clinic', 'Ali', '', 'Jafarian', 'DO', 'Family Practice', '', '', NULL, 'O', '2696 N Galloway Ste 102', 'Mesquite', 'Dallas', 'TX', '75150', '9726135500', '9726135015', '2696 N Galloway Ste 102', 'Mesquite', 'Dallas', 'TX', '75150', '9726135500', '9726135015', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1033127873', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.801, -96.6111, NULL, NULL),
('752673192', 'SPA100021', 'SPA100021', 'TXDALSTD', 'North Texas Family Clinic', 'Ali', '', 'Jafarian', 'DO', 'Family Practice', '', '', NULL, 'B', '777 Walter Reed Blvd Ste B210', 'Garland', 'Dallas', 'TX', '75042', '9722724256', '9726135015', '777 Walter Reed Blvd Ste B210', 'Garland', 'Dallas', 'TX', '75042', '9722724256', '9726135015', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1033127873', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9198, -96.6641, NULL, NULL),
('421619524', 'SPA100084', 'SPA100084', 'TXDALSTD', 'G Kimble Jett MD', 'G', 'Kimbel', 'Jett', 'MD', 'Vascular Surgery', '', '', NULL, 'B', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9724049609', '9727317512', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9724049609', '9727317512', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1184690810', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9234, -96.7841, NULL, NULL),
('421619524', 'SPA100085', 'SPA100085', 'TXDALSTD', 'G Kimble Jett MD', 'G', 'Kimbel', 'Jett', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317506', '9727317512', '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317506', '9727317512', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1184690810', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1067, -96.8401, NULL, NULL),
('364702412', 'SPA100141', 'SPA100141', 'TXDALSTD', 'Robert Ian Myers MD', 'Robert', 'Ian', 'Myers', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2148244585', '2143705408', '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2148244585', '2143705408', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295833721', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('364702412', 'SPA100143', 'SPA100143', 'TXDALSTD', 'Robert Ian Myers MD', 'Robert', 'Ian', 'Myers', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 95205', 'Grapevine', 'Tarrant', 'TX', '76099', '2148244585', '2143705480', 'PO Box 95205', 'Grapevine', 'Tarrant', 'TX', '76099', '2148244585', '2143705480', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295833721', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205873288', 'SPA100147', 'SPA100147', 'TXDALSTD', 'MacArthur OB GYN Management', 'Wiyatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1295921948', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100144', 'SPA100144', 'TXDALSTD', 'MacArthur OB GYN Management', 'Wiyatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '341 Wheatfield Dr Ste 120', 'Sunnyvale', 'Dallas', 'TX', '75182', '9722563700', '9722589887', '341 Wheatfield Dr Ste 120', 'Sunnyvale', 'Dallas', 'TX', '75182', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1295921948', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205873288', 'SPA100145', 'SPA100145', 'TXDALSTD', 'MacArthur OB GYN Management', 'Wiyatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1295921948', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('752935588', 'SPA100148', 'SPA100148', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Ryan', '', 'Woodham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1316023211', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('752935588', 'SPA100149', 'SPA100149', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Ryan', '', 'Woodham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1316023211', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('752935588', 'SPA100151', 'SPA100151', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Ryan', '', 'Woodham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1316023211', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('205641115', 'SPA100160', 'SPA100160', 'TXDALSTD', 'Collin County Cardiology', 'Ramarao', 'S', 'Lankipalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '9725965522', '9725968976', '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '9725965522', '9725968976', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336121193', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0192, -96.7657, NULL, NULL),
('205641115', 'SPA100162', 'SPA100162', 'TXDALSTD', 'Collin County Cardiology', 'Ramarao', 'S', 'Lankipalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '670 N Coit Rd Ste 2355', 'Richardson', 'Dallas', 'TX', '75080', '9725965522', '9725968976', '670 N Coit Rd Ste 2355', 'Richardson', 'Dallas', 'TX', '75080', '9725965522', '9725968976', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336121193', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752935588', 'SPA100166', 'SPA100166', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Yeraldine', '', 'Toledo', 'MD', 'Cardiology', '', '', NULL, 'B', '3600 Gaston Ave LB 120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148278515', '9724756131', '3600 Gaston Ave LB 120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148278515', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1346323839', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752935588', 'SPA100167', 'SPA100167', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Yeraldine', '', 'Toledo', 'MD', 'Cardiology', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1346323839', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('752845933', 'SPA100185', 'SPA100185', 'TXDALSTD', 'Procare Medical Clinic', 'Subuhi', '', 'Naghmi', 'MD', 'Family Practice', '', '', NULL, 'O', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1417913443', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.914, -96.6727, NULL, NULL),
('752845933', 'SPA100187', 'SPA100187', 'TXDALSTD', 'Procare Medical Clinic', 'Subuhi', '', 'Naghmi', 'MD', 'Family Practice', '', '', NULL, 'B', '6913 Camp Bowie Blvd Ste 171', 'Fort Worth', 'Tarrant', 'TX', '76116', '8178602704', '9722765560', '6913 Camp Bowie Blvd Ste 171', 'Fort Worth', 'Tarrant', 'TX', '76116', '8178602704', '9722765560', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1417913443', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752878179', 'SPA100197', 'SPA100197', 'TXDALSTD', 'Robert R Cloud MD', 'Robert', 'R', 'Cloud', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1005 Ralph Hall Pkwy Ste 241', 'Rockwall', 'Rockwall', 'TX', '75032', '8173134616', '9727884971', '1005 Ralph Hall Pkwy Ste 241', 'Rockwall', 'Rockwall', 'TX', '75032', '8173134616', '9727884971', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467440073', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8873, -96.4706, NULL, NULL),
('752878179', 'SPA100199', 'SPA100199', 'TXDALSTD', 'Robert R Cloud MD', 'Robert', 'R', 'Cloud', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '350 W Park Way Ste 121', 'Euless', 'Tarrant', 'TX', '76040', '8173181515', '9727884971', '350 W Park Way Ste 121', 'Euless', 'Tarrant', 'TX', '76040', '8173181515', '9727884971', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467440073', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.8328, -97.1204, NULL, NULL),
('752878179', 'SPA100200', 'SPA100200', 'TXDALSTD', 'Robert R Cloud MD', 'Robert', 'R', 'Cloud', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4101 Wesley Ste E', 'Greenville', 'Hunt', 'TX', '75401', '8173134616', '9727884971', '4101 Wesley Ste E', 'Greenville', 'Hunt', 'TX', '75401', '8173134616', '9727884971', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467440073', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.1281, -96.1092, NULL, NULL),
('453796432', 'SPA100201', 'SPA100201', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Hoang Lan', '', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'B', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809163', '9723885971', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809163', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1467611582', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9786, -96.718, NULL, NULL),
('453796432', 'SPA100202', 'SPA100202', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Hoang Lan', '', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'O', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1467611582', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('453796432', 'SPA100203', 'SPA100203', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Hoang Lan', '', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'M', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9726809163', '9723885971', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9726809163', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1467611582', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9594, -96.6831, NULL, NULL),
('352415950', 'SPA100214', 'SPA100214', 'TXDALSTD', 'Associates of Surgery', 'Bryan', 'D', 'Brewer', 'MD', 'General Surgery', '', '', NULL, 'B', '1410 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729370243', '9722190053', '1410 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729370243', '9722190053', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1487865457', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.3969, -96.8646, NULL, NULL),
('352415950', 'SPA100215', 'SPA100215', 'TXDALSTD', 'Associates of Surgery', 'Bryan', 'D', 'Brewer', 'MD', 'General Surgery', '', '', NULL, 'O', '4300 Windsor Centre Trl Ste 400', 'Flower Mound', 'Denton', 'TX', '75028', '9722196800', '9722190053', '4300 Windsor Centre Trl Ste 400', 'Flower Mound', 'Denton', 'TX', '75028', '9722196800', '9722190053', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1487865457', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0393, -97.0632, NULL, NULL),
('205873288', 'SPA100228', 'SPA100228', 'TXDALSTD', 'MacArthur OB GYN Management', 'Stephen', '', 'Sakovich', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1508869769', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100226', 'SPA100226', 'TXDALSTD', 'MacArthur OB GYN Management', 'Stephen', '', 'Sakovich', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1508869769', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100229', 'SPA100229', 'TXDALSTD', 'MacArthur OB GYN Management', 'Stephen', '', 'Sakovich', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1508869769', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752280307', 'SPA100237', 'SPA100237', 'TXDALSTD', 'Robert Haynsworth Jr MD', 'Robert', '', 'Haynsworth', 'MD', 'Anesthesiology', '', '', NULL, 'B', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '9722354138', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, NULL, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1528046414', 0, 'Y', 0, '2013-07-23', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('752280307', 'SPA100238', 'SPA100238', 'TXDALSTD', 'Robert Haynsworth Jr MD', 'Robert', '', 'Haynsworth', 'MD', 'Anesthesiology', '', '', NULL, 'O', '2520 N Central Expy Ste 400', 'Richardson', 'Dallas', 'TX', '75080', '9722311591', '9722354138', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, NULL, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1528046414', 0, 'N', 0, '2013-07-23', NULL, NULL, 32.986, -96.7108, NULL, NULL),
('752846193', 'SPA100250', 'SPA100250', 'TXDALSTD', 'Shawn Bonsell MD', 'Shawn', 'C', 'Bonsell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75246', '2148247744', '2148247755', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75246', '2148247744', '2148247755', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558373423', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7974, -96.7743, NULL, NULL),
('752846193', 'SPA100249', 'SPA100249', 'TXDALSTD', 'Shawn Bonsell MD', 'Shawn', 'C', 'Bonsell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1650 Republic Pkwy Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '2148247744', '2148247755', '1650 Republic Pkwy Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '2148247744', '2148247755', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558373423', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8291, -96.6254, NULL, NULL),
('752846193', 'SPA100252', 'SPA100252', 'TXDALSTD', 'Shawn Bonsell MD', 'Shawn', 'C', 'Bonsell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '604 Southeast Pkwy', 'Azle', 'Tarrant', 'TX', '76020', '2148247744', '2148247755', '604 Southeast Pkwy', 'Azle', 'Tarrant', 'TX', '76020', '2148247744', '2148247755', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558373423', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8825, -97.5383, NULL, NULL),
('752935588', 'SPA100253', 'SPA100253', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Yoon', '', 'Dong Hi Anthony', 'MD', 'Cardiology', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1578754206', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('752935588', 'SPA100255', 'SPA100255', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Yoon', '', 'Dong Hi Anthony', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1578754206', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205873288', 'SPA100264', 'SPA100264', 'TXDALSTD', 'MacArthur OB GYN Management', 'Colette', 'M', 'Dominique', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '9722563700', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1598768749', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100262', 'SPA100262', 'TXDALSTD', 'MacArthur OB GYN Management', 'Colette', 'M', 'Dominique', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1598768749', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100265', 'SPA100265', 'TXDALSTD', 'MacArthur OB GYN Management', 'Colette', 'M', 'Dominique', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1598768749', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752694562', 'SPA100266', 'SPA100266', 'TXDALSTD', 'Kalavalli Ezekiel MD', 'Kalavalli', '', 'Ezekiel', 'MD', 'Pediatrics', '', '', NULL, 'O', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315364', '9722315357', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315364', '9722315357', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Houston Methodist Hospital', '', '', 'HCFA|UB|', '1598836116', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9735, -96.7258, NULL, NULL),
('752694562', 'SPA100268', 'SPA100268', 'TXDALSTD', 'Kalavalli Ezekiel MD', 'Kalavalli', '', 'Ezekiel', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '9722315357', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '9722315357', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Houston Methodist Hospital', '', '', 'HCFA|UB|', '1598836116', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752061371', 'SPA100272', 'SPA100272', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Dhiren', 'L', 'Shah', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '9724942082', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '9724942082', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1629054358', 0, 'Y', 0, '2014-05-07', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('752061371', 'SPA100273', 'SPA100273', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Dhiren', 'L', 'Shah', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1629054358', 0, 'N', 0, '2014-05-07', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('205873288', 'SPA100300', 'SPA100300', 'TXDALSTD', 'MacArthur OB GYN Management', 'Elia', '', 'Fanous', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '9722563700', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1659308047', 0, 'N', 0, '2014-01-15', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100298', 'SPA100298', 'TXDALSTD', 'MacArthur OB GYN Management', 'Elia', '', 'Fanous', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1659308047', 0, 'N', 0, '2014-01-15', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100301', 'SPA100301', 'TXDALSTD', 'MacArthur OB GYN Management', 'Elia', '', 'Fanous', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1659308047', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('455582889', 'SPA100315', 'SPA100315', 'TXDALSTD', 'Cubic Care Incorporated', 'Thein An', '', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'M', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9724799960', '9724799996', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9724799960', '9724799996', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-07-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669663654', 0, 'Y', 0, '2014-07-21', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('455582889', 'SPA100316', 'SPA100316', 'TXDALSTD', 'Cubic Care Incorporated', 'Thein An', '', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'B', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '9724799960', '9724799996', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '9724799960', '9724799996', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-07-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669663654', 0, 'Y', 0, '2014-07-21', NULL, NULL, 33.027, -96.8836, NULL, NULL),
('455582889', 'SPA100317', 'SPA100317', 'TXDALSTD', 'Cubic Care Incorporated', 'Thein An', '', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9724799960', '9724799996', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9724799960', '9724799996', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669663654', 0, 'N', 0, '2014-07-21', NULL, NULL, 32.9595, -96.6827, NULL, NULL),
('205873288', 'SPA100321', 'SPA100321', 'TXDALSTD', 'MacArthur OB GYN Management', 'Kevin', '', 'ONeil', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1143 S Buckner Blvd Ste 144', 'Dallas', 'Dallas', 'TX', '75217', '2143980393', '2143987200', '1143 S Buckner Blvd Ste 144', 'Dallas', 'Dallas', 'TX', '75217', '2143980393', '2143987200', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700813102', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7323, -96.6834, NULL, NULL),
('205873288', 'SPA100322', 'SPA100322', 'TXDALSTD', 'MacArthur OB GYN Management', 'Kevin', '', 'ONeil', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2001 N MacArthur Ste 540', 'Irving', 'Dallas', 'TX', '75061', '9722563700', '9722589887', '2001 N MacArthur Ste 540', 'Irving', 'Dallas', 'TX', '75061', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700813102', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8349, -96.9592, NULL, NULL),
('205873288', 'SPA100323', 'SPA100323', 'TXDALSTD', 'MacArthur OB GYN Management', 'Kevin', '', 'ONeil', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700813102', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100324', 'SPA100324', 'TXDALSTD', 'MacArthur OB GYN Management', 'Kevin', '', 'ONeil', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '9722563700', '9722589887', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700813102', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('272378173', 'SPA100325', 'SPA100325', 'TXDALSTD', 'Marcus A Roux MD', 'Marcus', 'Anderson', 'Roux', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239999', '9729239488', '1404 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239999', '9729239488', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1700820743', 0, 'N', 0, '2014-01-08', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('272378173', 'SPA100327', 'SPA100327', 'TXDALSTD', 'Marcus A Roux MD', 'Marcus', 'Anderson', 'Roux', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310400', '9729239488', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310400', '9729239488', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1700820743', 0, 'Y', 0, '2014-01-08', NULL, NULL, 32.9922, -96.8002, NULL, NULL),
('201278257', 'SPA100334', 'SPA100334', 'TXDALSTD', 'Drul Phorr DO', 'Paul', 'P', 'Schorr', 'DO', 'Family Practice', '', '', NULL, 'B', '3600 Gaston Ave Ste 56O', 'Dallas', 'Dallas', 'TX', '75246', '2148231230', '9722164903', '3600 Gaston Ave Ste 56O', 'Dallas', 'Dallas', 'TX', '75246', '2148231230', '9722164903', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1710920707', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('201278257', 'SPA100335', 'SPA100335', 'TXDALSTD', 'Drul Phorr DO', 'Paul', 'P', 'Schorr', 'DO', 'Family Practice', '', '', NULL, 'O', '901 N Galloway Ste 149', 'Mesquite', 'Dallas', 'TX', '75149', '9722164900', '9722164903', '901 N Galloway Ste 149', 'Mesquite', 'Dallas', 'TX', '75149', '9722164900', '9722164903', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1710920707', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7755, -96.5992, NULL, NULL),
('752384311', 'SPA100340', 'SPA100340', 'TXDALSTD', 'Paul S Worrell DO', 'Paul', 'S', 'Worrell', 'MD', 'Family Practice', '', '', NULL, 'B', '6760 Abrams Ste 203', 'Dallas', 'Dallas', 'TX', '75231', '2143404046', '2143494973', '6760 Abrams Ste 203', 'Dallas', 'Dallas', 'TX', '75231', '2143404046', '2143494973', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1720195779', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8669, -96.7429, NULL, NULL),
('752384311', 'SPA100341', 'SPA100341', 'TXDALSTD', 'Paul S Worrell DO', 'Paul', 'S', 'Worrell', 'MD', 'Family Practice', '', '', NULL, 'O', '8668 Skillman', 'Dallas', 'Dallas', 'TX', '75243', '2143494909', '2143494973', '8668 Skillman', 'Dallas', 'Dallas', 'TX', '75243', '2143494909', '2143494973', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1720195779', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8959, -96.7226, NULL, NULL),
('453796432', 'SPA100349', 'SPA100349', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Sana', '', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'M', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1730495037', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('453796432', 'SPA100351', 'SPA100351', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Sana', '', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'B', '6930 Parkwood Blvd', 'Frisco', 'Denton', 'TX', '75034', '9723885970', '9723885971', '6930 Parkwood Blvd', 'Frisco', 'Denton', 'TX', '75034', '9723885970', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1730495037', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.1356, -96.8226, NULL, NULL),
('201260137', 'SPA100362', 'SPA100362', 'TXDALSTD', 'Our Family Doctor', 'Jeffrey', 'Barrington', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9728642050', '9722713437', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9728642050', '9722713437', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780695031', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8954, -96.6657, NULL, NULL),
('201260137', 'SPA100363', 'SPA100363', 'TXDALSTD', 'Our Family Doctor', 'Jeffrey', 'Barrington', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'M', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724128700', '9724129700', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724128700', '9724129700', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780695031', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('201260137', 'SPA100364', 'SPA100364', 'TXDALSTD', 'Our Family Doctor', 'Jeffrey', 'Barrington', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'B', '8345 Walnut Hill Ln Ste 140', 'Dallas', 'Dallas', 'TX', '75231', '2143688604', '9722713437', '8345 Walnut Hill Ln Ste 140', 'Dallas', 'Dallas', 'TX', '75231', '2143688604', '9722713437', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780695031', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8834, -96.7613, NULL, NULL),
('752935588', 'SPA100384', 'SPA100384', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Andrew', 'T', 'Berggren', 'MD', 'Cardiology', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1841277373', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('752935588', 'SPA100386', 'SPA100386', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Andrew', 'T', 'Berggren', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1841277373', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752497923', 'SPA100387', 'SPA100387', 'TXDALSTD', 'Lauren B Monti MD', 'Lauren', 'B', 'Monti', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '11445 Dallas Pkwy Ste 240', 'Frisco', NULL, 'TX', '75033', '9723159011', '2148231230', '11445 Dallas Pkwy Ste 240', 'Frisco', '', 'TX', '75033', '9723159011', '2148231230', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841398088', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.1724, -96.8407, NULL, NULL),
('752497923', 'SPA100388', 'SPA100388', 'TXDALSTD', 'Lauren B Monti MD', 'Lauren', 'B', 'Monti', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3600 Gaston Ave Ste 560', 'Dallas', 'Dallas', 'TX', '75246', '2148289495', '2148231230', '3600 Gaston Ave Ste 560', 'Dallas', 'Dallas', 'TX', '75246', '2148289495', '2148231230', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841398088', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('453796432', 'SPA100428', 'SPA100428', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Christopher', '', 'Hebert', 'MD', 'Nephrology', '', '', NULL, 'B', '3600 Gaston Ave LB 120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148278515', '9723885971', '3600 Gaston Ave LB 120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148278515', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1912966045', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('453796432', 'SPA100429', 'SPA100429', 'TXDALSTD', 'Kidney and Hypertension Assoc of Dallas', 'Christopher', '', 'Hebert', 'MD', 'Nephrology', '', '', NULL, 'M', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '9723885971', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1912966045', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('272799195', 'SPA100431', 'SPA100431', 'TXDALSTD', 'Elite Primary Care', 'Asif', '', 'Aziz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9034501515', '9034509466', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9034501515', '9034509466', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1922194992', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1262, -96.1232, NULL, NULL),
('272799195', 'SPA100433', 'SPA100433', 'TXDALSTD', 'Elite Primary Care', 'Asif', '', 'Aziz', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 210608', 'Bedford', 'Tarrant', 'TX', '76095', '8172686247', '9034509466', 'PO Box 210608', 'Bedford', 'Tarrant', 'TX', '76095', '8172686247', '9034509466', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1922194992', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752061371', 'SPA100447', 'SPA100447', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Kanti', 'L', 'Agrawal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3900 Junius St Ste 220', 'Dallas', 'Dallas', 'TX', '75246', '9724871117', '9724942082', '3900 Junius St Ste 220', 'Dallas', 'Dallas', 'TX', '75246', '9724871117', '9724942082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1942285671', 0, 'Y', 0, '2013-08-05', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752061371', 'SPA100448', 'SPA100448', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Kanti', 'L', 'Agrawal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '9724942082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1942285671', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('364712381', 'SPA100455', 'SPA100455', 'TXDALSTD', 'Lakeside Surgery', 'Katherine', 'R', 'Makohon', 'MD', 'General Surgery', '', '', NULL, 'O', '200 N Arch St', 'Royse', 'Rockwall', 'TX', '75189', '9727223290', '9727723815', '200 N Arch St', 'Royse', 'Rockwall', 'TX', '75189', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952393415', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.976, -96.3315, NULL, NULL),
('364712381', 'SPA100453', 'SPA100453', 'TXDALSTD', 'Lakeside Surgery', 'Katherine', 'R', 'Makohon', 'MD', 'General Surgery', '', '', NULL, 'B', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-01', 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952393415', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'SPA100456', 'SPA100456', 'TXDALSTD', 'Lakeside Surgery', 'Katherine', 'R', 'Makohon', 'MD', 'General Surgery', '', '', NULL, 'O', '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-01', 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952393415', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('205873288', 'SPA100457', 'SPA100457', 'TXDALSTD', 'MacArthur OB GYN Management', 'Rebecca', '', 'Gray', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1952501777', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100459', 'SPA100459', 'TXDALSTD', 'MacArthur OB GYN Management', 'Rebecca', '', 'Gray', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1952501777', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035776', 'W12035776', 'ILCHIGSTD', 'Mercy Pediatrics Algonquin', 'Javed', 'I', 'Bangash', 'MD', 'Pediatrics', '', '', NULL, 'O', '2537 W Algonquin Rd', 'Algonquin', 'Mchenry', 'IL', '60102', '8474580173', '8474589750', '2537 W Algonquin Rd', 'Algonquin', 'Mchenry', 'IL', '60102', '8474580173', '8474589750', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1326090598', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1756, -88.3376, NULL, NULL),
('390816848', 'W12035778', 'W12035778', 'ILCHIGSTD', 'Mercy Pediatrics Elgin', 'Virginia', 'P', 'Luces', 'MD', 'Pediatrics', '', '', NULL, 'O', '2050 Larkin Ave', 'Elgin', 'Kane', 'IL', '60123', '8477429743', '8477429743', '2050 Larkin Ave', 'Elgin', 'Kane', 'IL', '60123', '8477429743', '8477429743', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1366494585', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.0322, -88.3294, NULL, NULL),
('390816848', 'W12035779', 'W12035779', 'ILCHIGSTD', 'Mercy Pediatrics Algonquin', 'Virginia', 'P', 'Luces', 'MD', 'Pediatrics', '', '', NULL, 'O', '2537 W Algonquin Rd', 'Algonquin', 'Mchenry', 'IL', '60102', '8474580173', '8474589750', '2537 W Algonquin Rd', 'Algonquin', 'Mchenry', 'IL', '60102', '8474580173', '8474589750', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1366494585', 0, 'N', 0, '2013-08-09', NULL, NULL, 42.1756, -88.3376, NULL, NULL),
('390816848', 'W12035782', 'W12035782', 'ILCHIGSTD', 'Mercy McHenry Immediate Care', 'Hilario', '', 'Del Peral', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', NULL, '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1194957753', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12035781', 'W12035781', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Hilario', '', 'Del Peral', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153371544', '8153374792', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153371544', '8153374792', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1194957753', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12035786', 'W12035786', 'ILCHIGSTD', 'MHS Physician Services', 'Susan', 'K', 'Ipsen', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-20', '2013-01-20', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205049582', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035785', 'W12035785', 'ILCHIGSTD', 'Mercy Health Mall', 'Susan', 'K', 'Ipsen', 'APRN', 'Family Practice', '', '', NULL, 'O', '1010 N Washington', 'Janesville', 'Rock', 'WI', '53548', '6087413800', '6087413838', '1010 N Washington', 'Janesville', 'Rock', 'WI', '53548', '6087413800', '6087413838', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-20', '2013-01-20', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205049582', 0, 'N', 0, '2013-07-23', 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
('390816848', 'W12035784', 'W12035784', 'ILCHIGSTD', 'Mercy Beloit Medical Center', 'Susan', 'K', 'Ipsen', 'APRN', 'Family Practice', '', '', NULL, 'O', '2825 Praire Ave', 'Beloit', 'Rock', 'WI', '53511', '6083635500', '6083635539', '2825 Praire Ave', 'Beloit', 'Rock', 'WI', '53511', '6083635500', '6083635539', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-20', '2013-01-20', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205049582', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035787', 'W12035787', 'ILCHIGSTD', 'MHS Physician Services', 'Hilario', '', 'Del Peral', 'PA-C', 'Urgent Care', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1194957753', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035788', 'W12035788', 'ILCHIGSTD', 'MHS Physician Services', 'Virginia', 'P', 'Luces', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1366494585', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035789', 'W12035789', 'ILCHIGSTD', 'MHS Physician Services', 'Javed', 'I', 'Bangash', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB', '1326090598', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035791', 'W12035791', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Laura', 'D', 'Zalnis', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438657', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438657', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1407049463', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12035792', 'W12035792', 'ILCHIGSTD', 'MHS Physician Services', 'Laura', 'D', 'Zalnis', 'SLP', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1407049463', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('752889570', 'W12035793', 'W12035793', 'TXDALSTD', 'Stevens Park Clinic Medical Group', 'Kevin', 'M', 'Bryant', 'DO', 'Family Practice', '', '', NULL, 'O', '2100 W Colorado', 'Dallas', 'Dallas', 'TX', '75211', '2149434631', '2149465334', '2100 W Colorado', 'Dallas', 'Dallas', 'TX', '75211', '2149434631', '2149465334', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1790871127', 0, 'N', 0, '2013-08-07', NULL, NULL, 32.7602, -96.8568, NULL, NULL),
('820536242', 'W12035794', 'W12035794', 'ID02', 'Idaho Arthritis & Osteoporosis PC', 'Lisa', 'L', 'Morrison', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3277 E Louise Dr Ste 350', 'Meridian', 'Ada', 'ID', '83642', '2088879500', '2088879800', '3277 E Louise Dr Ste 350', 'Meridian', 'Ada', 'ID', '83642', '2088879500', '2088879800', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770824047', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('820536242', 'W12035795', 'W12035795', 'ID02', 'Idaho Arthritis & Osteoporosis PC', 'Brian', 'M', 'Holgate', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3277 E Louise Dr Ste 350', 'Meridian', 'Ada', 'ID', '83642', '2088879500', '2088879800', '3277 E Louise Dr Ste 350', 'Meridian', 'Ada', 'ID', '83642', '2088879500', '2088879800', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629312269', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12035797', 'W12035797', 'UTMH1', 'The Counseling Center', 'Melanie', '', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-10-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447697362', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12035796', 'W12035796', 'UTMH1', 'The Counseling Center', 'Melanie', '', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447697362', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9214, -111.879, NULL, NULL),
('870235759', 'W12035798', 'W12035798', 'UT01', 'Central Utah Foot Clinic', 'David', 'G', 'McKenzie', 'DPM', 'Podiatry', '', '', NULL, 'O', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1245541937', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.379, -111.765, NULL, NULL),
('870235759', 'W12035799', 'W12035799', 'UT01', 'Central Utah Foot Clinic', 'David', 'G', 'McKenzie', 'DPM', 'Podiatry', '', '', NULL, 'O', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019001130', '8017568252', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019001130', '8017568252', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1245541937', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('300038860', 'W12035801', 'W12035801', 'TXHOUSTD', 'Lone Star Family Health Center', '', '', 'Lone Star Community Health Center Inc', '', 'Clinics', '', '', NULL, 'O', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '9365394004', '9365393635', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326045774', 0, 'Y', 0, '2013-08-02', NULL, NULL, 30.3427, -95.551, NULL, NULL),
('300038860', 'W12035805', 'W12035805', 'TXHOUSTD', 'Lone Star Family Health Center', 'Kenneth', 'G', 'Davis', 'MD', 'Family Practice', '', '', NULL, 'O', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '9365394004', '9365393635', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1639265010', 0, 'N', 0, '2014-01-16', NULL, NULL, 30.3427, -95.551, NULL, NULL),
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('364115842', 'ELMC00001', 'ELMC00001', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Zeenath', '', 'Asma', 'MD', 'Pathology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210556', '3312213793', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210556', '3312213793', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1023277928', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
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('363081366', 'ELMC00006', 'ELMC00006', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Thomas', 'P', 'King', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073514220', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00005', 'ELMC00005', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Thomas', 'P', 'King', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073514220', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
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('363766603', 'ELMC00009', 'ELMC00009', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Laura', 'G', 'Hahn', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852177', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362167784', 'ELMC00011', 'ELMC00011', 'ILCHIGSTD', 'Elmhurst Memorial Occupational Health Services', 'David', 'J', 'Vitale', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '230 E Irving Park Rd', 'WoodDale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', '230 E Irving Park Rd', 'WoodDale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', '', '', '', '0.00', '45.00', '0.00', 6, '2013-09-01', '2014-03-18', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134130024', 0, 'Y', 0, '2014-03-26', NULL, NULL, 41.9627, -87.973, NULL, NULL),
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('363766603', 'ELMC00018', 'ELMC00018', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Winnie', '', 'Ruo', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194767988', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('363081366', 'ELMC00022', 'ELMC00022', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Michelle', 'S', 'Meziere', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245266675', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00021', 'ELMC00021', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Michelle', 'S', 'Meziere', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245266675', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00023', 'ELMC00023', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Regina', 'L', 'Liebman', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1265453856', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00024', 'ELMC00024', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Regina', 'L', 'Liebman', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1265453856', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELMC00025', 'ELMC00025', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Linas', 'A', 'Smulkstys', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1275655292', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELMC00027', 'ELMC00027', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Maria', '', 'Fassari', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2014-07-31', 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1295860500', 0, 'Y', 0, '2014-04-29', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363081366', 'ELMC00030', 'ELMC00030', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Bonnie', 'Lynn', 'McManus', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336277029', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00029', 'ELMC00029', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Bonnie', 'Lynn', 'McManus', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336277029', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00031', 'ELMC00031', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'George', 'S', 'Fikaris', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366484172', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00032', 'ELMC00032', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'George', 'S', 'Fikaris', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366484172', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00034', 'ELMC00034', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Kurt', 'K', 'Nakaoka', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386655256', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00033', 'ELMC00033', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Kurt', 'K', 'Nakaoka', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386655256', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00035', 'ELMC00035', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Jerold', '', 'Weinberg', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215420', '3312213701', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215420', '3312213701', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1407879943', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00036', 'ELMC00036', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Jerold', '', 'Weinberg', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1407879943', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00037', 'ELMC00037', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Joseph', '', 'Carabetta', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1417113366', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00038', 'ELMC00038', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Joseph', '', 'Carabetta', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1417113366', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00040', 'ELMC00040', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Elizabeth', '', 'Ring', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437160314', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00039', 'ELMC00039', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Elizabeth', '', 'Ring', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '630 9414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437160314', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00041', 'ELMC00041', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Alexander', 'L', 'Stonov', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447295282', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00042', 'ELMC00042', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Alexander', 'L', 'Stonov', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447295282', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00043', 'ELMC00043', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Barry', 'D', 'Lessin', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1457372054', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00044', 'ELMC00044', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Barry', 'D', 'Lessin', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1457372054', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00046', 'ELMC00046', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Matthew', 'V', 'Pisano', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477581650', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00045', 'ELMC00045', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Matthew', 'V', 'Pisano', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477581650', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00047', 'ELMC00047', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Lee', 'N', 'Dennis', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1487675088', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00048', 'ELMC00048', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Lee', 'N', 'Dennis', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1487675088', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363766603', 'ELMC00049', 'ELMC00049', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Michael', 'P', 'Zygmunt', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2014-07-31', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487760500', 0, 'Y', 0, '2014-04-11', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00050', 'ELMC00050', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Michael', 'P', 'Zygmunt', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '          ', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '          ', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2014-07-31', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487760500', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('200100106', 'W12035962', 'W12035962', 'UT01', 'Hearts for Home Health', '', '', 'Hearts for Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '942 Chambers Ste 15', 'Ogden', 'Weber', 'UT', '84403', '8014756222', '8014756061', '942 Chambers Ste 15', 'Ogden', 'Weber', 'UT', '84403', '8014756222', '8014756061', '', '', '4', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942290960', 0, 'N', 0, '2013-09-11', NULL, NULL, 41.166, -111.957, NULL, NULL),
('364115842', 'ELMC00051', 'ELMC00051', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Rima', '', 'Bakhos', 'MD', 'Pathology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414586', '6307827896', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414586', '6307827896', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1508819095', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00052', 'ELMC00052', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Rima', '', 'Bakhos', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', NULL, 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1508819095', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363766603', 'ELMC00053', 'ELMC00053', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Robert', 'M', 'Whitcomb', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518902238', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00054', 'ELMC00054', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Robert', 'M', 'Whitcomb', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518902238', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00055', 'ELMC00055', 'ILCHIGSTD', 'Elmhurst Radiologists', 'David', '', 'Wasserman', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518988179', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00056', 'ELMC00056', 'ILCHIGSTD', 'Elmhurst Radiologists', 'David', '', 'Wasserman', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518988179', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364115842', 'ELMC00057', 'ELMC00057', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Alvaro', 'G', 'Candel', 'MD', 'Pathology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414549', '6307827896', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414549', '6307827896', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1528019189', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00058', 'ELMC00058', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Alvaro', 'G', 'Candel', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', NULL, 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1528019189', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363766603', 'ELMC00059', 'ELMC00059', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Richard', 'F', 'Lenz', 'DO', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538260815', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364478025', 'W12031965', 'W12031965', 'ILCHIGSTD', 'Subarna P Pradhan MD', 'Subarna', 'P', 'Pradhan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9722 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8474550110', '8474550199', '9722 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8474550110', '8474550199', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538282256', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9298, -87.8682, NULL, NULL),
('363766603', 'ELMC00061', 'ELMC00061', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Kelly', 'R', 'Katcher', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548203391', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00063', 'ELMC00063', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Keith', 'F', 'Izban', 'MD', 'Pathology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414549', '6307827896', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414549', '6307827896', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1548211139', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00064', 'ELMC00064', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Keith', 'F', 'Izban', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', NULL, 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6309414537', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1548211139', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00065', 'ELMC00065', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Vivek', 'Vinod', 'Dave', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '3312213701', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '3312213701', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1588786735', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00066', 'ELMC00066', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Vivek', 'Vinod', 'Dave', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1588786735', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00068', 'ELMC00068', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Fred', '', 'Jacobs', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6307340200', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6307340200', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598893273', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00067', 'ELMC00067', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Fred', '', 'Jacobs', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312218470', '3312213777', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312218470', '3312213777', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598893273', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363081366', 'ELMC00070', 'ELMC00070', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Jeffrey', 'H', 'Bohmer', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609951979', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00069', 'ELMC00069', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Jeffrey', 'H', 'Bohmer', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312218470', '3312213777', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312218470', '3312213777', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609951979', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00071', 'ELMC00071', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Christine', '', 'Kassa', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639106404', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00072', 'ELMC00072', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Christine', '', 'Kassa', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639106404', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00074', 'ELMC00074', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Karl', '', 'Vos', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639180722', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00073', 'ELMC00073', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Karl', '', 'Vos', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414540', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639180722', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00075', 'ELMC00075', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Christian', 'H', 'Bautista', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669401113', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00076', 'ELMC00076', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Christian', 'H', 'Bautista', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669401113', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELMC00077', 'ELMC00077', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Farah', '', 'Ghouse', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1669695458', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, 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
('363766603', 'ELMC00079', 'ELMC00079', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Michael', 'A', 'Less', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689600611', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00080', 'ELMC00080', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Michael', 'A', 'Less', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689600611', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00082', 'ELMC00082', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Maria', 'V', 'Hilgart', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1689702342', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00081', 'ELMC00081', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Maria', 'V', 'Hilgart', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1689702342', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00083', 'ELMC00083', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Val', 'Z', 'Evalen', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699717413', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00084', 'ELMC00084', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Val', 'Z', 'Evalen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699717413', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00086', 'ELMC00086', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'David', 'Michael', 'Andreski', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801097043', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00085', 'ELMC00085', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'David', 'Michael', 'Andreski', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210584', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210584', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801097043', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00087', 'ELMC00087', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Daniel', 'J', 'Yousif', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307521125', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307521125', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801839154', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00088', 'ELMC00088', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Daniel', 'J', 'Yousif', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801839154', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00090', 'ELMC00090', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Jennifer', 'M', 'Owens', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1811925787', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00089', 'ELMC00089', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Jennifer', 'M', 'Owens', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210584', '3312213777', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210584', '3312213777', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1811925787', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00091', 'ELMC00091', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Aloyzas', 'K', 'Pakalniskis', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1821015678', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00092', 'ELMC00092', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Aloyzas', 'K', 'Pakalniskis', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1821015678', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363766603', 'ELMC00093', 'ELMC00093', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Andrew', 'M', 'Belavic', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841226776', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00094', 'ELMC00094', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Andrew', 'M', 'Belavic', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841226776', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00095', 'ELMC00095', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Alan', 'Michael', 'Simon', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1861413411', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00096', 'ELMC00096', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Alan', 'Michael', 'Simon', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1861413411', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00097', 'ELMC00097', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Marilyn', 'J', 'Jarosky', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1881615482', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00098', 'ELMC00098', 'ILCHIGSTD', 'Elmhurst Radiologists', 'Marilyn', 'J', 'Jarosky', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1881615482', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELMC00099', 'ELMC00099', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Feras', '', 'Bankosly', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1891785044', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELMC00101', 'ELMC00101', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Christine', 'R', 'Jankowski', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1891867156', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00103', 'ELMC00103', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'John', 'G', 'Girardot', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902912025', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00104', 'ELMC00104', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'John', 'G', 'Girardot', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902912025', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('362607520', 'ELMC00105', 'ELMC00105', 'ILCHIGSTD', 'Elmhurst Radiologists', 'David', 'S', 'Morrissey', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414521', '6309414590', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922029594', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362607520', 'ELMC00106', 'ELMC00106', 'ILCHIGSTD', 'Elmhurst Radiologists', 'David', 'S', 'Morrissey', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', 'PO Box 1035', 'Bedford Park', 'Cook', 'IL', '60499', '3122242071', '3122242009', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922029594', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363766603', 'ELMC00107', 'ELMC00107', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Eric', 'R', 'Sloan', 'MD', 'Anesthesiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827815', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922034958', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363766603', 'ELMC00108', 'ELMC00108', 'ILCHIGSTD', 'Elmhurst Anesthesiologists', 'Eric', 'R', 'Sloan', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', NULL, 'PO Box 87916', 'Carol Stream', 'Dupage', 'IL', '60188', '6308340881', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922034958', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELMC00109', 'ELMC00109', 'ILCHIGSTD', 'Elmhurst Memorial Healthcare Elmhurst Clinic Hospitalist', 'Carlo', '', 'LaForgia', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1922130202', 0, 'Y', 0, '2014-03-13', NULL, NULL, 41.8595, -87.9514, NULL, NULL),
('363081366', 'ELMC00112', 'ELMC00112', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Daniel', '', 'Belmont', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932161239', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00111', 'ELMC00111', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Daniel', '', 'Belmont', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210220', '3312213777', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210220', '3312213777', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932161239', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELMC00113', 'ELMC00113', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'James', 'Y', 'Ha', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1932251527', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363081366', 'ELMC00116', 'ELMC00116', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Robert', 'S', 'Lapporte', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '1165 Paysphere Cir', 'Chicago', NULL, 'IL', '60574', '6309935842', NULL, '1165 Paysphere Cir', 'Chicago', '', 'IL', '60574', '6309935842', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952339418', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363081366', 'ELMC00115', 'ELMC00115', 'ILCHIGSTD', 'Elmhurst Emergency Med Serv', 'Robert', 'S', 'Lapporte', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6309414505', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952339418', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00117', 'ELMC00117', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Fayyaz', 'A', 'Khanani', 'MD', 'Pathology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307122611', '6307827896', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307122611', '6307827896', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1952592503', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364115842', 'ELMC00118', 'ELMC00118', 'ILCHIGSTD', 'Assoc Pathology Consultants', 'Fayyaz', 'A', 'Khanani', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6307122611', NULL, 'PO Box 3680', 'Peoria', 'Peoria', 'IL', '61612', '6307122611', '', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1952592503', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELMC00119', 'ELMC00119', 'ILCHIGSTD', 'Elmhurst Clinic Hospitalist', 'Rebecca', '', 'Kellum', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '', '', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2014-01-28', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992894372', 0, 'Y', 0, '2014-02-06', NULL, NULL, 41.8595, -87.9514, NULL, NULL),
('390816848', 'W12035832', 'W12035832', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Charles', 'B', 'Holmes', 'MD', 'Anesthesiology', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159432693', '8159435460', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159432693', '8159435460', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922014141', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12035833', 'W12035833', 'ILCHIGSTD', 'MHS Physician Services', 'Charles', 'B', 'Holmes', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922014141', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12041500', 'W12041500', 'IDONTSTD', 'Saint Alphonsus Medical Center Ontario', 'Andrew', 'P', 'Black', 'DPM', 'Podiatry', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548408669', 0, 'N', 0, '2014-06-10', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('390816848', 'W12035841', 'W12035841', 'ILCHIGSTD', 'MHS Physician Services', 'Krishanthi', 'D', 'Seneviratne', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1972814267', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035837', 'W12035837', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Steven', 'B', 'Bach', 'DO', 'Radiologist', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1457568859', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12035836', 'W12035836', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Steven', 'B', 'Bach', 'DO', 'Radiologist', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153747930', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153747930', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1457568859', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12035835', 'W12035835', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Steven', 'B', 'Bach', 'DO', 'Radiologist', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1457568859', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12035838', 'W12035838', 'ILCHIGSTD', 'MHS Physician Services', 'Steven', 'B', 'Bach', 'DO', 'Radiologist', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1457568859', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12035843', 'W12035843', 'UTIHC01', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '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, '2013-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12035844', 'W12035844', 'UTIHC02', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '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, '2013-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12035845', 'W12035845', 'UTIHC03', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '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, '2013-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12035846', 'W12035846', 'UTIHC04', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '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, '2013-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('390816848', 'W12035847', 'W12035847', 'ILCHIGSTD', 'Mercy Algonquin Medical Center', 'David', '', 'Goodman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477610665', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1638, -88.3302, NULL, NULL),
('390816848', 'W12035848', 'W12035848', 'ILCHIGSTD', 'MHS Physician Services', 'David', '', 'Goodman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477610665', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035849', 'W12035849', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'David', '', 'Goodman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153371530', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153371530', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477610665', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12035850', 'W12035850', 'ILCHIGSTD', 'Mercy Barrington Medical Center', 'David', '', 'Goodman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', '8473824755', '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', '8473824755', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477610665', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1849, -88.1804, NULL, NULL),
('390816848', 'W12035851', 'W12035851', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Jason', '', 'Cundiff', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053325233', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12035852', 'W12035852', 'ILCHIGSTD', 'Mercy Barrington Medical Center', 'Jason', '', 'Cundiff', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', '8473824755', '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', '8473824755', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053325233', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1849, -88.1804, NULL, NULL),
('390816848', 'W12035853', 'W12035853', 'ILCHIGSTD', 'Mercy Algonquin Medical Center', 'Jason', '', 'Cundiff', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053325233', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1638, -88.3302, NULL, NULL),
('390816848', 'W12035854', 'W12035854', 'ILCHIGSTD', 'MHS Physician Services', 'Jason', '', 'Cundiff', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053325233', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035855', 'W12035855', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Gary', '', 'Livingston', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184775744', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12035856', 'W12035856', 'ILCHIGSTD', 'Mercy Algonquin Medical Center', 'Gary', '', 'Livingston', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '8474585450', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184775744', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.1638, -88.3302, NULL, NULL),
('390816848', 'W12035857', 'W12035857', 'ILCHIGSTD', 'MHS Physician Services', 'Gary', '', 'Livingston', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184775744', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035859', 'W12035859', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Sammy', 'T', 'Dean', 'MD', 'Anesthesiology', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1871827147', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12035860', 'W12035860', 'ILCHIGSTD', 'MHS Physician Services', 'Sammy', 'T', 'Dean', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1871827147', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035861', 'W12035861', 'ILCHIGSTD', 'Mercy Harvard Hospital Clinic', 'Jung', '', 'Rhee', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1001 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '8159432978', '1001 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '8159432978', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1023031770', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4268, -88.6077, NULL, NULL),
('752937389', 'SPA200042', 'SPA200042', 'TXDALSTD', 'Advanced Family Medical Care', 'Ahtaram', 'M', 'Khan', 'md', 'Family Practice', '', '', NULL, 'B', 'PO Box 262129', 'Plano', 'Collin', 'TX', '75026', '9729858000', '9729850050', 'PO Box 262129', 'Plano', 'Collin', 'TX', '75026', '9729858000', '9729850050', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336258003', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752325419', 'SPA200023', 'SPA200023', 'TXDALSTD', 'Angelo C Mendez MD', 'Angelo', 'C', 'Mendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', '1600 W College Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1144226242', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('390816848', 'W12035865', 'W12035865', 'ILCHIGSTD', 'MHS Physician Services', 'Kevin', 'M', 'Burns', 'PA', 'Dermatology', '', '', NULL, 'B', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'PO Box 5081', 'Pollock', 'Idaho', 'ID', '83547', '6087417630', '6087416890', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326028143', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12035864', 'W12035864', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Kevin', 'M', 'Burns', 'PA', 'Dermatology', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326028143', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('201412932', 'SPA200032', 'SPA200032', 'TXDALSTD', 'D Blayne Laws MD', 'D Blayne', '', 'Laws', 'MD', 'Family Practice', '', '', NULL, 'O', '717 W Lampasas', 'Ennis', 'Ellis', 'TX', '75119', '9728756700', '9728756790', '717 W Lampasas', 'Ennis', 'Ellis', 'TX', '75119', '9728756700', '9728756790', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306890645', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3207, -96.6301, NULL, NULL),
('20713074', 'SPA200021', 'SPA200021', 'TXDALSTD', 'Stonebridge Pediatrics', 'Jeffrey', 'J', 'Alvis', 'MD', 'Pediatrics', '', '', NULL, 'O', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1124071667', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1986, -96.6892, NULL, NULL),
('205866081', 'SPA200012', 'SPA200012', 'TXDALSTD', 'Ruby L Anthony White MD', 'Ruby', 'L', 'Anthony White', 'MD', 'Internal Medicine', '', '', NULL, 'O', '601 S Clay St Ste 104', 'Ennis', 'Ellis', 'TX', '75119', '9728756600', NULL, '601 S Clay St Ste 104', 'Ennis', 'Ellis', 'TX', '75119', '9728756600', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073615175', 0, 'N', 0, '2014-04-01', NULL, NULL, 32.3208, -96.6298, NULL, NULL),
('271627637', 'SPA200132', 'SPA200132', 'TXDALSTD', 'Hunt Regional Medical Partners', 'Aparna', 'M', 'Ayyagari', 'MD', 'Endocrinology', '', '', NULL, 'O', '4221 Ridgecrest St Ste 105', 'Greenville', 'Hunt', 'TX', '75402', '9034087980', '9034087989', '4221 Ridgecrest St Ste 105', 'Greenville', 'Hunt', 'TX', '75402', '9034087980', '9034087989', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1932364346', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.1211, -96.1247, NULL, NULL),
('271627637', 'SPA200131', 'SPA200131', 'TXDALSTD', 'Hunt Regional Medical Partners', 'Aparna', 'M', 'Ayyagari', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 1359 Ste 105', 'Greenville', 'Hunt', 'TX', '75403', '9034087751', '9034087802', 'PO Box 1359 Ste 105', 'Greenville', 'Hunt', 'TX', '75403', '9034087751', '9034087802', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1932364346', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('274676178', 'SPA200091', 'SPA200091', 'TXDALSTD', 'Lydia Bishop MD', 'Lydia', 'A', 'Bishop', 'MD', 'Pediatrics', '', '', NULL, 'O', '2300 Matlock Rd Ste 37', 'Mansfield', 'Tarrant', 'TX', '76063', '8177181731', '8174237448', '2300 Matlock Rd Ste 37', 'Mansfield', 'Tarrant', 'TX', '76063', '8177181731', '8174237448', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700974474', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5968, -97.1089, NULL, NULL),
('262577896', 'SPA200093', 'SPA200093', 'TXDALSTD', 'Colleyville Dermatology', 'Gabriela', 'M', 'Blanco', 'MD', 'Dermatology', '', '', NULL, 'O', '5209 Heritage Ave Ste 220', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', '5209 Heritage Ave Ste 220', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-08', 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1710186960', 0, 'N', 0, '2014-05-08', NULL, NULL, 32.8849, -97.1054, NULL, NULL),
('751658366', 'SPA200056', 'SPA200056', 'TXDALSTD', 'Ronald G Bristow MD', 'Ronald', 'G', 'Bristow', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1110 N Buckner Blvd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143288200', NULL, '1110 N Buckner Blvd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143288200', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1407819121', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8353, -96.704, NULL, NULL),
('752835366', 'SPA200098', 'SPA200098', 'TXDALSTD', 'Don Buford Jr MD', 'Don', '', 'Buford', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', NULL, '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720089899', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7974, -96.7743, NULL, NULL),
('203361094', 'SPA200118', 'SPA200118', 'TXDALSTD', 'Debra A Naylor MD', 'Mindy', 'L', 'Calandro', 'MD', 'Pediatrics', '', '', NULL, 'O', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1902018997', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0339, -97.0746, NULL, NULL),
('208289091', 'SPA200010', 'SPA200010', 'TXDALSTD', 'New Beginnings Surgical Group', 'Manuel', 'E', 'Castro', 'MD', 'General Surgery', '', '', NULL, 'O', '3920 W Wheatland Ste 124', 'Dallas', 'Dallas', 'TX', '75237', '2149480475', '2149486198', '3920 W Wheatland Ste 124', 'Dallas', 'Dallas', 'TX', '75237', '2149480475', '2149486198', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1073562484', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.6475, -96.8824, NULL, NULL),
('751693625', 'SPA200080', 'SPA200080', 'TXDALSTD', 'Huntly G Chapman MD', 'Huntly', '', 'Chapman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '16970 Dallas Pkwy Ste 500', 'Dallas', 'Dallas', 'TX', '75248', NULL, NULL, '16970 Dallas Pkwy Ste 500', 'Dallas', 'Dallas', 'TX', '75248', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639136781', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751693625', 'SPA200081', 'SPA200081', 'TXDALSTD', 'Huntly G Chapman MD', 'Huntly', '', 'Chapman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '411 N Washington Ste 7500', 'Dallas', 'Dallas', 'TX', '75246', '9722481303', '9722489656', '411 N Washington Ste 7500', 'Dallas', 'Dallas', 'TX', '75246', '9722481303', '9722489656', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639136781', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7885, -96.7752, NULL, NULL),
('751693625', 'SPA200082', 'SPA200082', 'TXDALSTD', 'Huntly G Chapman MD', 'Huntly', '', 'Chapman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9101 N Central Expy Ste 360', 'Dallas', 'Dallas', 'TX', '75231', '9723703535', NULL, '9101 N Central Expy Ste 360', 'Dallas', 'Dallas', 'TX', '75231', '9723703535', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639136781', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752286998', 'SPA200064', 'SPA200064', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Chris', 'W', 'Crawford', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', NULL, '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1447248281', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200062', 'SPA200062', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Chris', 'W', 'Crawford', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1447248281', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752286998', 'SPA200076', 'SPA200076', 'TXDALSTD', 'Dallas Associated Dermatologists', 'James', 'R', 'Davie', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609863612', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752949042', 'SPA200046', 'SPA200046', 'TXDALSTD', 'Mark A Deuber MD', 'Mark', 'A', 'Deuber', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '2801 Lemmon Ave W Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142202712', '2149690933', '2801 Lemmon Ave W Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142202712', '2149690933', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1356443964', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8042, -96.7963, NULL, NULL),
('20713074', 'SPA200003', 'SPA200003', 'TXDALSTD', 'Stonebridge Pediatrics', 'Kathleen', 'B', 'Dollins', 'MD', 'Pediatrics', '', '', NULL, 'O', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1023201449', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1986, -96.6892, NULL, NULL),
('752181163', 'SPA200110', 'SPA200110', 'TXDALSTD', 'Robert Dyo MD', 'Robert', 'K', 'Dyo', 'MD', 'Family Practice', '', '', NULL, 'O', '2821 E Pres George Bush Hwy Ste 510', 'Richardson', 'Dallas', 'TX', '75082', '9726640404', '9726649797', '2821 E Pres George Bush Hwy Ste 510', 'Richardson', 'Dallas', 'TX', '75082', '9726640404', '9726649797', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1821005646', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9863, -96.6734, NULL, NULL),
('752181163', 'SPA200109', 'SPA200109', 'TXDALSTD', 'Robert Dyo MD', 'Robert', 'K', 'Dyo', 'MD', 'Family Practice', '', '', NULL, 'B', '9101 LBJ Fwy Ste 510', 'Dallas', 'Dallas', 'TX', '75243', '972 792 5727', NULL, '9101 LBJ Fwy Ste 510', 'Dallas', 'Dallas', 'TX', '75243', '972 792 5727', '214 575 2245', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1821005646', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752286998', 'SPA200031', 'SPA200031', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Mary', 'E', 'Fleischli', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', NULL, '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1245228063', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200029', 'SPA200029', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Mary', 'E', 'Fleischli', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1245228063', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752385145', 'SPA200035', 'SPA200035', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Edward', '', 'Franko', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1316026412', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200034', 'SPA200034', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Edward', '', 'Franko', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1316026412', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('752385145', 'SPA200036', 'SPA200036', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Edward', '', 'Franko', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '777 Walter Reed Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '9724944548', NULL, '777 Walter Reed Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '9724944548', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1316026412', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.92, -96.6636, NULL, NULL),
('376169419', 'SPA200058', 'SPA200058', 'TXDALSTD', 'Jorge C Gabilondo MD', 'Jorge', 'C', 'Gabilondo', 'MD', 'Gastroenterology', '', '', NULL, 'O', '777 Walter Reed Blvd Ste 104', 'Garland', 'Dallas', 'TX', '75042', '9724943337', '9724879572', '777 Walter Reed Blvd Ste 104', 'Garland', 'Dallas', 'TX', '75042', '9724943337', '9724879572', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1407952096', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.92, -96.6636, NULL, NULL),
('205308618', 'SPA200066', 'SPA200066', 'TXDALSTD', 'Southern Endocrinology Associates', 'Sumana', '', 'Gangi', 'MD', 'Endocrinology', '', '', NULL, 'O', '1621 N Beltline Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', '9726825703', '1621 N Beltline Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', '9726825703', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487679213', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7863, -96.5959, NULL, NULL),
('205308618', 'SPA200067', 'SPA200067', 'TXDALSTD', 'Southern Endocrinology Associates', 'Sumana', '', 'Gangi', 'MD', 'Endocrinology', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 110', 'Rowlett', 'Dallas', 'TX', '75088', '9724127211', '9726825703', '7801 Lakeview Pkwy Ste 110', 'Rowlett', 'Dallas', 'TX', '75088', '9724127211', '9726825703', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487679213', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('205308618', 'SPA200065', 'SPA200065', 'TXDALSTD', 'Southern Endocrinology Associates', 'Sumana', '', 'Gangi', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 871834 Ste A', 'Mesquite', 'Dallas', 'TX', '75187', '9726825700', '9726825703', 'PO Box 871834 Ste A', 'Mesquite', 'Dallas', 'TX', '75187', '9726825700', '9726825703', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487679213', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752716714', 'SPA200072', 'SPA200072', 'TXDALSTD', 'Childgrove Pediatrics', 'Anne', '', 'Georgulas', 'MD', 'Pediatrics', '', '', NULL, 'O', '150 S Denton Tap Rd Ste 116', 'Coppell', 'Dallas', 'TX', '75019', '9723040091', '9723930959', '150 S Denton Tap Rd Ste 116', 'Coppell', 'Dallas', 'TX', '75019', '9723040091', '9723930959', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1538248091', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9657, -96.9935, NULL, NULL),
('133018874', 'SPA200070', 'SPA200070', 'TXDALSTD', 'Satish K Goyal MD', 'Satish', 'K', 'Goyal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2540 N Galloway Ste 205', 'Mesquite', 'Dallas', 'TX', '75150', '9726134185', '9726134788', '2540 N Galloway Ste 205', 'Mesquite', 'Dallas', 'TX', '75150', '9726134185', '9726134788', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1528056538', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8001, -96.6112, NULL, NULL),
('751770450', 'SPA200040', 'SPA200040', 'TXDALSTD', 'Woodhill Pediatrics', 'Larry', 'E', 'Gray', 'MD', 'Pediatrics', '', '', NULL, 'O', '8335 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2146960222', '2146963131', '8335 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2146960222', '2146963131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1326090069', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8834, -96.761, NULL, NULL),
('752385145', 'SPA200028', 'SPA200028', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Robert', 'M', 'Jacobson', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1205915378', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200027', 'SPA200027', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Robert', 'M', 'Jacobson', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1205915378', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751780220', 'SPA200007', 'SPA200007', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'John', 'L', 'Jay', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1151 N Buckner Ste 408', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', '1151 N Buckner Ste 408', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1033170196', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8347, -96.7036, NULL, NULL),
('751780220', 'SPA200006', 'SPA200006', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'John', 'L', 'Jay', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '221 W Colorado Blvd Ste 825', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', '221 W Colorado Blvd Ste 825', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1033170196', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7593, -96.8256, NULL, NULL),
('751780220', 'SPA200005', 'SPA200005', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'John', 'L', 'Jay', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', '8111 LBJ Frwy  Ste 825', 'Dallas', 'Dallas', 'TX', '75251', '9724372577', '9726443810', '8111 LBJ Frwy  Ste 825', 'Dallas', 'Dallas', 'TX', '75251', '9724372577', '9726443810', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1033170196', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('263026206', 'SPA200120', 'SPA200120', 'TXDALSTD', 'Hampton Clinic', 'Jimmy', 'D', 'Johnson', 'DO', 'Family Practice', '', '', NULL, 'O', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-12-31', 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1902867872', 0, 'N', 0, '2014-01-03', NULL, NULL, 32.7227, -96.8573, NULL, NULL),
('263026206', 'SPA200044', 'SPA200044', 'TXDALSTD', 'Hampton Clinic', 'Steven', '', 'Johnson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1356302277', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.723, -96.8571, NULL, NULL),
('753243324', 'SPA200014', 'SPA200014', 'TXDALSTD', 'Polina Kaloyanova MD', 'Polina', '', 'Kaloyanova', 'MD', 'Endocrinology', '', '', NULL, 'O', '7777 Forest Ln Ste C 206', 'Dallas', 'Dallas', 'TX', '75230', '9725667272', '9725667202', '7777 Forest Ln Ste C 206', 'Dallas', 'Dallas', 'TX', '75230', '9725667272', '9725667202', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1073707667', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752286998', 'SPA200019', 'SPA200019', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Abraham', '', 'Kuruvilla', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148241900', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148241900', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1124004080', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200018', 'SPA200018', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Abraham', '', 'Kuruvilla', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 710', 'Dallas', 'Dallas', 'TX', '75230', '2146926566', '2146920652', '5924 Royal Ln Ste 710', 'Dallas', 'Dallas', 'TX', '75230', '2146926566', '2146920652', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1124004080', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752385145', 'SPA200084', 'SPA200084', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Warren', '', 'Lichliter', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1639249253', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200083', 'SPA200083', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Warren', '', 'Lichliter', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1639249253', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752385145', 'SPA200085', 'SPA200085', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Warren', '', 'Lichliter', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '9323 Garland Rd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143276399', '2148239527', '9323 Garland Rd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143276399', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1639249253', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8317, -96.7051, NULL, NULL),
('43692740', 'SPA200050', 'SPA200050', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('43692740', 'SPA200049', 'SPA200049', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8349, -96.9592, NULL, NULL),
('43692740', 'SPA200048', 'SPA200048', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('870777048', 'SPA200008', 'SPA200008', 'TXDALSTD', 'Victoria McGrath DO', 'Victoria', 'E', 'McGrath', 'DO', 'Internal Medicine', '', '', NULL, 'O', '977 Raintree Cir Ste 220', 'Allen', 'Collin', 'TX', '75013', '9723590050', NULL, '977 Raintree Cir Ste 220', 'Allen', 'Collin', 'TX', '75013', '9723590050', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1053319541', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1111, -96.6793, NULL, NULL),
('203361094', 'SPA200116', 'SPA200116', 'TXDALSTD', 'Debra A Naylor MD', 'Debra', 'A', 'Naylor', 'MD', 'Pediatrics', '', '', NULL, 'O', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', NULL, 'HCFA|UB|', '1891791869', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0339, -97.0746, NULL, NULL),
('752710490', 'SPA200137', 'SPA200137', 'TXDALSTD', 'Contemporary OB GYN of Grapevine', 'Troy', 'Gerald', 'New', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1962408062', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('300699334', 'SPA200079', 'SPA200079', 'TXDALSTD', 'LOR Womens Health Care', 'Fariba', '', 'Pajoohi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '403 W Campbell Rd Ste 305', 'Richardson', 'Dallas', 'TX', '75080', '9724791222', '9724791223', '403 W Campbell Rd Ste 305', 'Richardson', 'Dallas', 'TX', '75080', '9724791222', '9724791223', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', '', '', '', 'HCFA|UB|', '1619196912', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.9754, -96.7254, NULL, NULL),
('300699334', 'SPA200078', 'SPA200078', 'TXDALSTD', 'LOR Womens Health Care', 'Fariba', '', 'Pajoohi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 11185 Ste 305', 'Belfast', 'Waldo', 'MA', '04915', NULL, NULL, 'PO Box 11185 Ste 305', 'Belfast', 'Waldo', 'MA', '04915', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', '', '', '', 'HCFA|UB|', '1619196912', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('204870046', 'SPA200122', 'SPA200122', 'TXDALSTD', 'Rajashritil MD', 'Rajashri', '', 'Patil', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8210 Walnut Hill Ln Ste 306', 'Dallas', 'Dallas', 'TX', '75231', '2143064030', NULL, '8210 Walnut Hill Ln Ste 306', 'Dallas', 'Dallas', 'TX', '75231', '2143064030', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1912943960', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8832, -96.7632, NULL, NULL),
('752385145', 'SPA200127', 'SPA200127', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Michael', 'J', 'Pendola', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932279577', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200126', 'SPA200126', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Michael', 'J', 'Pendola', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932279577', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('752385145', 'SPA200128', 'SPA200128', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Michael', 'J', 'Pendola', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '777 Walter Reed Blvd Ste 103', 'Garland', 'Dallas', 'TX', '75042', '9724944548', '9724878041', '777 Walter Reed Blvd Ste 103', 'Garland', 'Dallas', 'TX', '75042', '9724944548', '9724878041', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932279577', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.92, -96.6636, NULL, NULL),
('203874327', 'SPA200108', 'SPA200108', 'TXDALSTD', 'Mihaela Perijoc MD', 'Mihaela', '', 'Perijoc', 'MD', 'Hospitalist', '', '', NULL, 'O', '6300 W Parker Rd  Ste 222', 'Plano', 'Collin', 'TX', '75093', '2147906428', '2147852938', '6300 W Parker Rd  Ste 222', 'Plano', 'Collin', 'TX', '75093', '2147906428', '2147852938', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1811933302', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0451, -96.8374, NULL, NULL),
('203874327', 'SPA200107', 'SPA200107', 'TXDALSTD', 'Mihaela Perijoc MD', 'Mihaela', '', 'Perijoc', 'MD', 'Hospitalist', '', '', NULL, 'B', '9603 White Rock Tr Ste 222', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', '9726448056', '9603 White Rock Tr Ste 222', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', '9726448056', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1811933302', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12046960', 'W12046960', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Randi', 'L', 'Luxmore', 'AUD', 'Audiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6302648560', '6302648484', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6302648560', '6302648484', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710235205', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('751773475', 'SPA200138', 'SPA200138', 'TXDALSTD', 'J Michael Putman MD', 'John', 'Michael', 'Putman', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'O', '3900 Junius St Ste 610', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148878244', '3900 Junius St Ste 610', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148878244', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962411785', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752896338', 'SPA200055', 'SPA200055', 'TXDALSTD', 'Ramon Quinones MD', 'Ramon', '', 'Quinones', 'MD', 'General Surgery', '', '', NULL, 'O', '122 N International Rd Ste C', 'Garland', 'Dallas', 'TX', '75042', '9724855814', '9724855674', '122 N International Rd Ste C', 'Garland', 'Dallas', 'TX', '75042', '9724855814', '9724855674', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1396759825', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.914, -96.6727, NULL, NULL),
('752896338', 'SPA200054', 'SPA200054', 'TXDALSTD', 'Ramon Quinones MD', 'Ramon', '', 'Quinones', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 550335 Ste C', 'Dallas', 'Dallas', 'TX', '75355', '9035643243', '9035643403', 'PO Box 550335 Ste C', 'Dallas', 'Dallas', 'TX', '75355', '9035643243', '9035643403', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1396759825', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('270923278', 'SPA200100', 'SPA200100', 'TXDALSTD', 'Sterling Pain Medicine', 'Radhika', '', 'Ravula', 'MD', 'Pain Management', '', '', NULL, 'O', '2520 N Central Expy Ste 400', 'Richardson', 'Dallas', 'TX', '75080', '9722311591', NULL, '2520 N Central Expy Ste 400', 'Richardson', 'Dallas', 'TX', '75080', '9722311591', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1750368445', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.986, -96.7108, NULL, NULL),
('270923278', 'SPA200102', 'SPA200102', 'TXDALSTD', 'Sterling Pain Medicine', 'Radhika', '', 'Ravula', 'MD', 'Pain Management', '', '', NULL, 'O', '600 Cooper Dr Ste 110', 'Richardson', 'Collin', 'TX', '75098', '9722311591', NULL, '600 Cooper Dr Ste 110', 'Richardson', 'Collin', 'TX', '75098', '9722311591', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1750368445', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0092, -96.5443, NULL, NULL),
('20713074', 'SPA200089', 'SPA200089', 'TXDALSTD', 'Stonebridge Pediatrics', 'Paul', 'H', 'Reyes', 'MD', 'Pediatrics', '', '', NULL, 'O', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1689636631', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.1986, -96.6892, NULL, NULL),
('270619832', 'SPA200129', 'SPA200129', 'TXDALSTD', 'Medical Family Circle', 'Cory', '', 'Rice', 'DO', 'Internal Medicine', '', '', NULL, 'O', '992 E US Hwy 80 Ste C', 'Forney', 'Kaufman', 'TX', '75126', '9725522920', NULL, '992 E US Hwy 80 Ste C', 'Forney', 'Kaufman', 'TX', '75126', '9725522920', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932301850', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.7559, -96.4669, NULL, NULL),
('43692740', 'SPA200039', 'SPA200039', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('43692740', 'SPA200038', 'SPA200038', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8349, -96.9592, NULL, NULL),
('43692740', 'SPA200037', 'SPA200037', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('752385145', 'SPA200069', 'SPA200069', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Roberto', '', 'Rodriguez Ruesga', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1487724928', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200068', 'SPA200068', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Roberto', '', 'Rodriguez Ruesga', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1487724928', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752286998', 'SPA200087', 'SPA200087', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Frank', 'C', 'Saporito', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148241900', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148241900', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1679538763', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200086', 'SPA200086', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Frank', 'C', 'Saporito', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 710', 'Dallas', 'Dallas', 'TX', '75230', '2146926566', '2146920652', '5924 Royal Ln Ste 710', 'Dallas', 'Dallas', 'TX', '75230', '2146926566', '2146920652', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1679538763', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752286998', 'SPA200053', 'SPA200053', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Sarah', 'R', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', NULL, '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1376592626', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200051', 'SPA200051', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Sarah', 'R', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1376592626', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('752286998', 'SPA200135', 'SPA200135', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Laura', 'L', 'Sears', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', NULL, '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1942298708', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200133', 'SPA200133', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Laura', 'L', 'Sears', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1942298708', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('223862888', 'SPA200124', 'SPA200124', 'TXDALSTD', 'Dallas E and W OB Gyn Clinic', 'Wenliang', '', 'Shi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 Midway Ste 169', 'Plano', 'Collin', 'TX', '75093', '9723789666', NULL, '3100 Midway Ste 169', 'Plano', 'Collin', 'TX', '75093', '9723789666', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1922010818', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0415, -96.8391, NULL, NULL),
('752286998', 'SPA200113', 'SPA200113', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Jerald', 'L', 'Sklar', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', NULL, '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1821086679', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'SPA200111', 'SPA200111', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Jerald', 'L', 'Sklar', 'MD', 'Dermatology', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', NULL, '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1821086679', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8948, -96.8065, NULL, NULL),
('20713074', 'SPA200103', 'SPA200103', 'TXDALSTD', 'Stonebridge Pediatrics', 'Christine', 'M', 'Smith', 'MD', 'Pediatrics', '', '', NULL, 'O', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', '5561 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '2145442555', '2145442550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1770746216', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.1986, -96.6892, NULL, NULL),
('264750355', 'SPA200114', 'SPA200114', 'TXDALSTD', 'Dermatology and Skin Surg Institute of N TX', 'Brent', 'A', 'Spencer', 'MD', 'Dermatology', '', '', NULL, 'O', '7044 Lebanon Rd Ste 102', 'Frisco', 'Denton', 'TX', '75034', '9727125100', '9727125113', '7044 Lebanon Rd Ste 102', 'Frisco', 'Denton', 'TX', '75034', '9727125100', '9727125113', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1861650947', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1233, -96.8245, NULL, NULL),
('272578279', 'SPA200075', 'SPA200075', 'TXDALSTD', 'North Texas Movement Disorders Institute', 'Madhavi', '', 'Thomas', 'MD', 'Neurology', '', '', NULL, 'O', '2004 Bedford Rd Ste 100', 'Bedford', 'Tarrant', 'TX', '76021', '2144327549', '2144326137', '2004 Bedford Rd Ste 100', 'Bedford', 'Tarrant', 'TX', '76021', '2144327549', '2144326137', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1558337238', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8448, -97.1363, NULL, NULL),
('272578279', 'SPA200074', 'SPA200074', 'TXDALSTD', 'North Texas Movement Disorders Institute', 'Madhavi', '', 'Thomas', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 2134 Ste 100', 'Grapevine', 'Tarrant', 'TX', '76099', NULL, NULL, 'PO Box 2134 Ste 100', 'Grapevine', 'Tarrant', 'TX', '76099', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1558337238', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('510602325', 'SPA200096', 'SPA200096', 'TXDALSTD', 'Anh Healthcare', 'Loc Hoang', '', 'Trieu', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12200 Park Central Dr Ste 110', 'Dallas', 'Dallas', 'TX', '75251', '9727010199', NULL, '12200 Park Central Dr Ste 110', 'Dallas', 'Dallas', 'TX', '75251', '9727010199', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720068174', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9142, -96.7757, NULL, NULL),
('752385145', 'SPA200026', 'SPA200026', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Paitoon', '', 'Tulanon', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1154491504', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200025', 'SPA200025', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Paitoon', '', 'Tulanon', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1154491504', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('270619832', 'SPA200060', 'SPA200060', 'TXDALSTD', 'Medical Family Circle', 'Carol', 'K', 'Villanueva', 'DO', 'Internal Medicine', '', '', NULL, 'O', '992 E US Hwy 80 Ste C', 'Forney', 'Kaufman', 'TX', '75126', '9725522920', NULL, '992 E US Hwy 80 Ste C', 'Forney', 'Kaufman', 'TX', '75126', '9725522920', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1427269802', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7559, -96.4669, NULL, NULL),
('752385145', 'SPA200106', 'SPA200106', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Daniel', 'E', 'Wandrey', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', '3409 Worth St Ste 600', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148217756', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1790903359', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752385145', 'SPA200105', 'SPA200105', 'TXDALSTD', 'North Texas Colon and Rectal Associates', 'Daniel', 'E', 'Wandrey', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', '3701 Junius St Ste H015', 'Dallas', 'Dallas', 'TX', '75246', '2148241730', '2148239527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1790903359', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('481300848', 'SPA200001', 'SPA200001', 'TXDALSTD', 'Dallas Foot and Ankle Specialists', 'Peter', 'B', 'Wood', 'DPM', 'Podiatry', '', '', NULL, 'O', '3600 Gaston Ave Ste 402', 'Dallas', 'Dallas', 'TX', '75246', '2148247100', '2148239310', '3600 Gaston Ave Ste 402', 'Dallas', 'Dallas', 'TX', '75246', '2148247100', '2148239310', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003865890', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('751453852', 'SPA300130', 'SPA300130', 'TXDALSTD', 'Retina Institute of Texas', 'Gregory', 'F', 'Kozielec', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1053379081', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'SPA300128', 'SPA300128', 'TXDALSTD', 'Retina Institute of Texas', 'Gregory', 'F', 'Kozielec', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1053379081', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8041, -96.7976, NULL, NULL),
('751453852', 'SPA300129', 'SPA300129', 'TXDALSTD', 'Retina Institute of Texas', 'Gregory', 'F', 'Kozielec', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1053379081', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('751453852', 'SPA300111', 'SPA300111', 'TXDALSTD', 'Retina Institute of Texas', 'Marcus', 'L', 'Allen', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1164481297', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'SPA300108', 'SPA300108', 'TXDALSTD', 'Retina Institute of Texas', 'Marcus', 'L', 'Allen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1164481297', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8041, -96.7976, NULL, NULL),
('751453852', 'SPA300109', 'SPA300109', 'TXDALSTD', 'Retina Institute of Texas', 'Marcus', 'L', 'Allen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1164481297', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('751453852', 'SPA300087', 'SPA300087', 'TXDALSTD', 'Retina Institute of Texas', 'Maurice', 'G', 'Syrquin', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1376501635', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'SPA300085', 'SPA300085', 'TXDALSTD', 'Retina Institute of Texas', 'Maurice', 'G', 'Syrquin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1376501635', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8041, -96.7976, NULL, NULL),
('751453852', 'SPA300086', 'SPA300086', 'TXDALSTD', 'Retina Institute of Texas', 'Maurice', 'G', 'Syrquin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1376501635', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('202186142', 'SPA300021', 'SPA300021', 'TXDALSTD', 'Pradip Kanani and Harini Kanani MD', 'Pradip', '', 'Kanani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831107416', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8012, -96.6111, NULL, NULL),
('202186142', 'SPA300022', 'SPA300022', 'TXDALSTD', 'Pradip Kanani and Harini Kanani MD', 'Pradip', '', 'Kanani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '410 Pinson Rd', 'Forney', 'Dallas', 'TX', '75216', '9725649380', '2143192887', '410 Pinson Rd', 'Forney', 'Dallas', 'TX', '75216', '9725649380', '2143192887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831107416', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7528, -96.4715, NULL, NULL),
('201013664', 'SPA300137', 'SPA300137', 'TXDALSTD', 'Richard L Vera MD', 'Richard', 'L', 'Vera', 'MD', 'Pain Management', '', '', NULL, 'B', '804 Scott Nixon Memorial Dr', 'Augusta', 'Columbia', 'GA', '30907', '8008359064', NULL, '804 Scott Nixon Memorial Dr', 'Augusta', 'Columbia', 'GA', '30907', '8008359064', '706 650 10', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1003866377', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('201013664', 'SPA300134', 'SPA300134', 'TXDALSTD', 'Richard L Vera MD', 'Richard', 'L', 'Vera', 'MD', 'Pain Management', '', '', NULL, 'O', '1615 Lancaster Dr Ste 150', 'Grapevine', 'Tarrant', 'TX', '76051', '8174210279', '8174421034', '1615 Lancaster Dr Ste 150', 'Grapevine', 'Tarrant', 'TX', '76051', '8174210279', '8174421034', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1003866377', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9342, -97.0915, NULL, NULL),
('201013664', 'SPA300135', 'SPA300135', 'TXDALSTD', 'Richard L Vera MD', 'Richard', 'L', 'Vera', 'MD', 'Pain Management', '', '', NULL, 'O', '5575 Warren Pkwy Ste 220', 'Frisco', 'Denton', 'TX', '75034', '2146183686', '2146183956', '5575 Warren Pkwy Ste 220', 'Frisco', 'Denton', 'TX', '75034', '2146183686', '2146183956', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1003866377', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1067, -96.8401, NULL, NULL),
('201796939', 'SPA300092', 'SPA300092', 'TXDALSTD', 'North Texas Allergy and Asthma Associates', 'Sandeep', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', '2143691905', '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', '2143691905', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336193069', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8832, -96.7604, NULL, NULL),
('201796939', 'SPA300091', 'SPA300091', 'TXDALSTD', 'North Texas Allergy and Asthma Associates', 'Sandeep', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 485', 'Plano', 'Collin', 'TX', '75093', '9725964383', '9725964325', '4708 Alliance Blvd Ste 485', 'Plano', 'Collin', 'TX', '75093', '9725964383', '9725964325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336193069', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('751453852', 'SPA300042', 'SPA300042', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'PO Box 848375', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'SPA300040', 'SPA300040', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8041, -96.7976, 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
('751453852', 'SPA300041', 'SPA300041', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', '400 W I 635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('260413564', 'SPA300071', 'SPA300071', 'TXDALSTD', 'Apollo Medical Associates', 'Snehal', '', 'Kolhe', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1515', 'Allen', 'Collin', 'TX', '75013', '          ', NULL, 'PO Box 1515', 'Allen', 'Collin', 'TX', '75013', '          ', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417984428', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('260413564', 'SPA300070', 'SPA300070', 'TXDALSTD', 'Apollo Medical Associates', 'Snehal', '', 'Kolhe', 'MD', 'Internal Medicine', '', '', NULL, 'O', '431 E Stacy Rd Ste 107', 'Fairview', 'Collin', 'TX', '75069', '2145470700', '9729922428', '431 E Stacy Rd Ste 107', 'Fairview', 'Collin', 'TX', '75069', '2145470700', '9729922428', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417984428', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1296, -96.6421, NULL, NULL),
('752660876', 'SPA300039', 'SPA300039', 'TXDALSTD', 'Trostel Obstetrics and Gynecology Associates', 'Steven', 'G', 'Trostel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3880 Parkwood Blvd Bldg 4 Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '2146183208', '3880 Parkwood Blvd Bldg 4 Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '2146183208', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1689667735', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.112, -96.8158, NULL, NULL),
('752694558', 'SPA300124', 'SPA300124', 'TXDALSTD', 'Advanced Heart Care', 'Venkata', 'R', 'Aligeti', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expy  Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '2142210022', '2146918292', '8150 N Central Expy  Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '2142210022', '2146918292', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1093731267', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752694558', 'SPA300122', 'SPA300122', 'TXDALSTD', 'Advanced Heart Care', 'Venkata', 'R', 'Aligeti', 'MD', 'Cardiology', '', '', NULL, 'O', '2401 S FM 51 Ste 200', 'Decatur', 'Wise', 'TX', '76234', '9406270044', '9406270275', '2401 S FM 51 Ste 200', 'Decatur', 'Wise', 'TX', '76234', '9406270044', '9406270275', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1093731267', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2035, -97.6028, NULL, NULL),
('752694558', 'SPA300123', 'SPA300123', 'TXDALSTD', 'Advanced Heart Care', 'Venkata', 'R', 'Aligeti', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '4693262630', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '4693262630', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1093731267', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('201547087', 'SPA300061', 'SPA300061', 'TXDALSTD', 'Frisco Heart and Vascular Institute', 'Vishnu', 'Varma', 'Kalidindi', 'MD', 'Cardiology', '', '', NULL, 'O', '8000 Warren Pkwy Ste 104', 'Frisco', 'Collin', 'TX', '75035', '9723944646', '9723940707', '8000 Warren Pkwy Ste 104', 'Frisco', 'Collin', 'TX', '75035', '9723944646', '9723940707', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, '', '', 'HCFA|UB|', '1487611273', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1073, -96.8157, NULL, NULL),
('201547087', 'SPA300062', 'SPA300062', 'TXDALSTD', 'Frisco Heart and Vascular Institute', 'Vishnu', 'Varma', 'Kalidindi', 'MD', 'Cardiology', '', '', NULL, 'B', '5963 Dripping Springs Dr', 'Frisco', 'Denton', 'TX', '75034', '', NULL, '5963 Dripping Springs Dr', 'Frisco', 'Denton', 'TX', '75034', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, '', '', 'HCFA|UB|', '1487611273', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('841653928', 'SPA300031', 'SPA300031', 'TXDALSTD', 'Eduardo Aguirre DO', 'Eduardo', '', 'Aguirre', 'DO', 'Family Practice', '', '', NULL, 'O', '525 S Loop 288 Ste D', 'Denton', 'Denton', 'TX', '76205', '9404426500', '9404426574', '525 S Loop 288 Ste D', 'Denton', 'Denton', 'TX', '76205', '9404426500', '9404426574', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1730157991', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.2065, -97.0908, NULL, NULL),
('841653928', 'SPA300032', 'SPA300032', 'TXDALSTD', 'Eduardo Aguirre DO', 'Eduardo', '', 'Aguirre', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 678326', 'Dallas', 'Dallas', 'TX', '75267', '9404426500', '9404426574', 'PO Box 678326', 'Dallas', 'Dallas', 'TX', '75267', '9404426500', '9404426574', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1730157991', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752950140', 'SPA300057', 'SPA300057', 'TXDALSTD', 'North Dallas Primary Care', 'Shahab', '', 'Ahmad', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2100 N Collins Ste 315', 'Richardson', 'Dallas', 'TX', '75080', '9722352304', '9722358442', '2100 N Collins Ste 315', 'Richardson', 'Dallas', 'TX', '75080', '9722352304', '9722358442', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1558329979', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9777, -96.7185, NULL, NULL),
('752950140', 'SPA300058', 'SPA300058', 'TXDALSTD', 'North Dallas Primary Care', 'Shahab', '', 'Ahmad', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 830458', 'Richardson', 'Dallas', 'TX', '75083', '9722352304', '9722358442', 'PO Box 830458', 'Richardson', 'Dallas', 'TX', '75083', '9722352304', '9722358442', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1558329979', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752961148', 'SPA300018', 'SPA300018', 'TXDALSTD', 'Carrollton Pediatrics', 'Qamar', '', 'Aslam', 'MD', 'Pediatrics', '', '', NULL, 'O', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '2144833292', '2144833286', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '2144833292', '2144833286', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1871543082', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0272, -96.8847, NULL, NULL),
('203943431', 'SPA300106', 'SPA300106', 'TXDALSTD', 'Texas Neurosurgery', 'David', 'W', 'Barnett', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245251743', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('263026206', 'SPA300121', 'SPA300121', 'TXDALSTD', 'Hampton Clinic', 'Melody', '', 'Bellinghausen', 'DO', 'Family Practice', '', '', NULL, 'O', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', '2301 S Hampton Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75224', '2143309201', '2143399577', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1093784035', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.723, -96.8571, NULL, NULL),
('203943431', 'SPA300104', 'SPA300104', 'TXDALSTD', 'Texas Neurosurgery', 'Shaad', 'B', 'Bidiwala', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255350104', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('201060956', 'SPA300003', 'SPA300003', 'TXDALSTD', 'Visual Images Ophthalmology', 'Michelle', 'L', 'Brochner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 825', 'Plano', 'Collin', 'TX', '75093', '9725961300', '9725961349', '4708 Alliance Blvd Ste 825', 'Plano', 'Collin', 'TX', '75093', '9725961300', '9725961349', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1962401273', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('208773398', 'SPA300004', 'SPA300004', 'TXDALSTD', 'Richard L Brooks MD', 'Richard', 'L', 'Brooks', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2504 Ridge Rd Ste 101', 'Rockwall', 'Rockwall', 'TX', '75087', '9727712018', '9727714190', '2504 Ridge Rd Ste 101', 'Rockwall', 'Rockwall', 'TX', '75087', '9727712018', '9727714190', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1952370363', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.9002, -96.4681, NULL, NULL),
('751491807', 'SPA300005', 'SPA300005', 'TXDALSTD', 'Richard L Brooks MD', 'Richard', 'L', 'Brooks', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2504 Ridge Rd Ste 101', 'Rockwall', 'Rockwall', 'TX', '75087', '9727712018', '9727714190', '2504 Ridge Rd Ste 101', 'Rockwall', 'Rockwall', 'TX', '75087', '9727712018', '9727714190', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1952370363', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.9002, -96.4681, NULL, NULL),
('751491807', 'SPA300006', 'SPA300006', 'TXDALSTD', 'Richard L Brooks MD', 'Richard', 'L', 'Brooks', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 671107', 'Dallas', 'Dallas', 'TX', '75267', '', NULL, 'PO Box 671107', 'Dallas', 'Dallas', 'TX', '75267', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1952370363', 0, 'Y', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('751308110', 'SPA300116', 'SPA300116', 'TXDALSTD', 'Surgical Associates of Dallas', 'Hassan', 'I', 'Bukhari', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144264847', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('751308110', 'SPA300107', 'SPA300107', 'TXDALSTD', 'Surgical Associates of Dallas', 'Rizwan', 'H', 'Bukhari', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225076227', 0, 'N', 0, '2014-02-24', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('200016860', 'SPA300064', 'SPA300064', 'TXDALSTD', 'Denise M Casper DO', 'Denise', 'M', 'Casper', 'DO', 'Family Practice', '', '', NULL, 'O', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406833223', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406833223', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477504173', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2219, -97.7597, NULL, NULL),
('204706203', 'SPA300027', 'SPA300027', 'TXDALSTD', 'White Rock Family Health', 'Michael', '', 'Cheng', 'MD', 'Family Practice', '', '', NULL, 'O', '9015 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2147478800', '2147478801', '9015 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2147478800', '2147478801', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1750365581', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8278, -96.7097, NULL, NULL),
('752937560', 'SPA300069', 'SPA300069', 'TXDALSTD', 'Edson Cheung MD', 'Edson', '', 'Cheung', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Heart and Vascular Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437110103', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('751308110', 'SPA300045', 'SPA300045', 'TXDALSTD', 'Surgical Associates of Dallas', 'Tuan Hung', '', 'Chu', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609075860', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('751308110', 'SPA300046', 'SPA300046', 'TXDALSTD', 'Surgical Associates of Dallas', 'Tuan Hung', '', 'Chu', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '9330 Poppy Dr Ste 500', 'Dallas', 'Dallas', 'TX', '75218', '2146352740', '2146352745', '9330 Poppy Dr Ste 500', 'Dallas', 'Dallas', 'TX', '75218', '2146352740', '2146352745', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609075860', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8353, -96.7055, NULL, NULL),
('202451034', 'SPA300119', 'SPA300119', 'TXDALSTD', 'Frisco Dermatology Laser and Surgery Center', 'Nancy', 'M', 'Chung', 'MD', 'Dermatology', '', '', NULL, 'O', '3317 Unicorn Lake Blvd Bldg 4 Ste 142', 'Denton', 'Denton', 'TX', '76210', '9402223724', '9727127171', '3317 Unicorn Lake Blvd Bldg 4 Ste 142', 'Denton', 'Denton', 'TX', '76210', '9402223724', '9727127171', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1124240080', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1754, -97.0981, NULL, NULL),
('202451034', 'SPA300120', 'SPA300120', 'TXDALSTD', 'Frisco Dermatology Laser and Surgery Center', 'Nancy', 'M', 'Chung', 'MD', 'Dermatology', '', '', NULL, 'O', '9191 Kyser Way Bldg 3 Ste B', 'Frisco', 'Denton', 'TX', '75033', '9727123131', '9727127171', '9191 Kyser Way Bldg 3 Ste B', 'Frisco', 'Denton', 'TX', '75033', '9727123131', '9727127171', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1124240080', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1737, -96.87, NULL, NULL),
('43692740', 'SPA300033', 'SPA300033', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('43692740', 'SPA300034', 'SPA300034', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8349, -96.9592, NULL, NULL),
('43692740', 'SPA300035', 'SPA300035', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('200161313', 'SPA300101', 'SPA300101', 'TXDALSTD', 'Jon W Copeland DO', 'Jon', 'W', 'Copeland', 'DO', 'Family Practice', '', '', NULL, 'O', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406835009', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406835009', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265484968', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2219, -97.7597, NULL, NULL),
('752457768', 'SPA300054', 'SPA300054', 'TXDALSTD', 'Shashi Dharma MD', 'Shashi', '', 'Dharma', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3504 Corinth Pkwy Ste 140', 'Corinth', 'Dallas', 'TX', '75039', '9725705884', '9725700779', '3504 Corinth Pkwy Ste 140', 'Corinth', 'Dallas', 'TX', '75039', '9725705884', '9725700779', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1558378307', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1533, -97.0471, NULL, NULL),
('752457768', 'SPA300055', 'SPA300055', 'TXDALSTD', 'Shashi Dharma MD', 'Shashi', '', 'Dharma', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6500 Sierra Dr Ste 170', 'Irving', 'Dallas', 'TX', '75039', '9725705884', '9725700779', '6500 Sierra Dr Ste 170', 'Irving', 'Dallas', 'TX', '75039', '9725705884', '9725700779', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1558378307', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8981, -96.963, NULL, NULL),
('752457768', 'SPA300056', 'SPA300056', 'TXDALSTD', 'Shashi Dharma MD', 'Shashi', '', 'Dharma', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 841303', 'Dallas', 'Dallas', 'TX', '75284', '', NULL, 'PO Box 841303', 'Dallas', 'Dallas', 'TX', '75284', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1558378307', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752175749', 'SPA300082', 'SPA300082', 'TXDALSTD', 'Texas Urology', 'John', 'L', 'Fairbanks', 'MD', 'Urology', '', '', NULL, 'O', '4333 N Josey Ln Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723944500', '9723948180', '4333 N Josey Ln Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723944500', '9723948180', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1376645283', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0278, -96.8847, NULL, NULL),
('752175749', 'SPA300083', 'SPA300083', 'TXDALSTD', 'Texas Urology', 'John', 'L', 'Fairbanks', 'MD', 'Urology', '', '', NULL, 'O', '541 W Main St Ste 150', 'Lewisville', 'Denton', 'TX', '75057', '9724208500', '9722216302', '541 W Main St Ste 150', 'Lewisville', 'Denton', 'TX', '75057', '9724208500', '9722216302', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1376645283', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0464, -97.0058, NULL, NULL),
('752175749', 'SPA300084', 'SPA300084', 'TXDALSTD', 'Texas Urology', 'John', 'L', 'Fairbanks', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 678060', 'Dallas', 'Dallas', 'TX', '75267', '9724208500', '9722216302', 'PO Box 678060', 'Dallas', 'Dallas', 'TX', '75267', '9724208500', '9722216302', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1376645283', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('460560074', 'SPA300043', 'SPA300043', 'TXDALSTD', 'Collins Street Pediatrics', 'Chimene', 'W', 'Fikkert', 'DO', 'Pediatrics', '', '', NULL, 'O', '4907 S Collins St Ste 121', 'Arlington', 'Tarrant', 'TX', '76018', '8174179001', '8174179008', '4907 S Collins St Ste 121', 'Arlington', 'Tarrant', 'TX', '76018', '8174179001', '8174179008', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609819838', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.6647, -97.0904, NULL, NULL),
('460560074', 'SPA300044', 'SPA300044', 'TXDALSTD', 'Collins Street Pediatrics', 'Chimene', 'W', 'Fikkert', 'DO', 'Pediatrics', '', '', NULL, 'B', '901 W Wall St Ste 101', 'Grapevine', 'Tarrant', 'TX', '76051', '', NULL, '901 W Wall St Ste 101', 'Grapevine', 'Tarrant', 'TX', '76051', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609819838', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9399, -97.0852, NULL, NULL),
('752877778', 'SPA300001', 'SPA300001', 'TXDALSTD', 'Konen and Associates', 'Brian', 'K', 'Flanagan', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962489930', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752877778', 'SPA300002', 'SPA300002', 'TXDALSTD', 'Konen and Associates', 'Brian', 'K', 'Flanagan', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 650444 Dept 111', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'PO Box 650444 Dept 111', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962489930', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('752500072', 'SPA300099', 'SPA300099', 'TXDALSTD', 'North Texas Internal Medicine Associates', 'Christopher', '', 'Foster', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285771410', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752893472', 'SPA300133', 'SPA300133', 'TXDALSTD', 'North Texas Vein Partners', 'Travis', 'A', 'Foster', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179275627', '8179277568', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179275627', '8179277568', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1013962349', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7118, -97.3859, NULL, NULL),
('460560074', 'SPA300118', 'SPA300118', 'TXDALSTD', 'Collins Street Pediatrics', 'Stacey', 'L', 'Gibson Hull', 'MD', 'Pediatrics', '', '', NULL, 'B', '2301 S Hampton Rd Ste 101', 'Grapevine', 'Tarrant', 'TX', '76051', '', NULL, '2301 S Hampton Rd Ste 101', 'Grapevine', 'Tarrant', 'TX', '76051', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144264094', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('460560074', 'SPA300117', 'SPA300117', 'TXDALSTD', 'Collins Street Pediatrics', 'Stacey', 'L', 'Gibson Hull', 'MD', 'Pediatrics', '', '', NULL, 'O', '4907 S Collins St Ste 121', 'Arlington', 'Tarrant', 'TX', '76018', '8174179001', '8174179008', '4907 S Collins St Ste 121', 'Arlington', 'Tarrant', 'TX', '76018', '8174179001', '8174179008', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144264094', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.6647, -97.0904, NULL, NULL),
('752175749', 'SPA300047', 'SPA300047', 'TXDALSTD', 'Texas Urology', 'Kenneth', 'A', 'Goldberg', 'MD', 'Urology', '', '', NULL, 'O', '4333 N Josey Ln Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723944500', '9723948180', '4333 N Josey Ln Ste 104', 'Carrollton', 'Denton', 'TX', '75010', '9723944500', '9723948180', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Medical Center at Uptown', NULL, NULL, 'HCFA|UB|', '1598867616', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0278, -96.8847, NULL, NULL),
('752175749', 'SPA300048', 'SPA300048', 'TXDALSTD', 'Texas Urology', 'Kenneth', 'A', 'Goldberg', 'MD', 'Urology', '', '', NULL, 'O', '541 W Main St Ste 150', 'Lewisville', 'Denton', 'TX', '75057', '9724208500', '9722216302', '541 W Main St Ste 150', 'Lewisville', 'Denton', 'TX', '75057', '9724208500', '9722216302', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Medical Center at Uptown', NULL, NULL, 'HCFA|UB|', '1598867616', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0464, -97.0058, NULL, NULL),
('752175749', 'SPA300049', 'SPA300049', 'TXDALSTD', 'Texas Urology', 'Kenneth', 'A', 'Goldberg', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 678060', 'Dallas', 'Dallas', 'TX', '75267', '9724208500', '9722216302', 'PO Box 678060', 'Dallas', 'Dallas', 'TX', '75267', '9724208500', '9722216302', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Medical Center at Uptown', NULL, NULL, 'HCFA|UB|', '1598867616', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752500072', 'SPA300068', 'SPA300068', 'TXDALSTD', 'North Texas Internal Medicine Associates', 'Jaime', '', 'Gomez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437296654', 0, 'N', 0, '2014-02-19', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('742907553', 'SPA300093', 'SPA300093', 'TXDALSTD', 'Baylor College of Dentistry', 'Marianela', '', 'Gonzalez', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1316138803', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7895, -96.7821, NULL, NULL),
('742907553', 'SPA300094', 'SPA300094', 'TXDALSTD', 'Baylor College of Dentistry', 'Marianela', '', 'Gonzalez', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'B', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1316138803', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752895204', 'SPA300088', 'SPA300088', 'TXDALSTD', 'Audrey L Graham MD', 'Audrey', 'L', 'Graham', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148218190', '2148219040', '3100 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148218190', '2148219040', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Heart and Vascular Hospital', NULL, '', '', 'HCFA|UB|', '1356362891', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7896, -96.7843, NULL, NULL),
('200611876', 'SPA300009', 'SPA300009', 'TXDALSTD', 'BestNest Pediatrics', 'Laura', 'K', 'Harn', 'MD', 'Pediatrics', '', '', NULL, 'O', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1922060789', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1127, -96.8393, NULL, NULL),
('751971737', 'SPA300098', 'SPA300098', 'TXDALSTD', 'Robert F Hebler Jr MD', 'Robert', 'F', 'Hebeler', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Heart and Vascular Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295794584', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752935705', 'SPA300060', 'SPA300060', 'TXDALSTD', 'A Carl Henry MD', 'Albert', 'Carl', 'Henry ', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', '3409 Worth St Ste 720', 'Dallas', 'Dallas', 'TX', '75246', '2148213603', '2148231317', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Heart and Vascular Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518927557', 0, 'N', 0, '2014-02-12', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('201197904', 'SPA300105', 'SPA300105', 'TXDALSTD', 'David D Kim MD', 'Bridget', 'K', 'Holden', 'MD', 'General Surgery', '', '', NULL, 'O', '5204 Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175816100', '8175816127', '5204 Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175816100', '8175816127', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1245285782', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8848, -97.1529, NULL, NULL),
('752574253', 'SPA300015', 'SPA300015', 'TXDALSTD', 'Elizabeth Jekot MD', 'Elizabeth', '', 'Jekot', 'MD', 'Radiology', '', '', NULL, 'O', '3301 E Renner Rd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '2144427050', '2144427075', '3301 E Renner Rd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '2144427050', '2144427075', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1891773933', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9971, -96.6623, NULL, NULL),
('752574253', 'SPA300016', 'SPA300016', 'TXDALSTD', 'Elizabeth Jekot MD', 'Elizabeth', '', 'Jekot', 'MD', 'Radiology', '', '', NULL, 'O', '4708 Alliance Blvd 4th Floor', 'Plano', 'Collin', 'TX', '75093', '9724988601', '9724988605', '4708 Alliance Blvd 4th Floor', 'Plano', 'Collin', 'TX', '75093', '9724988601', '9724988605', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1891773933', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752574253', 'SPA300017', 'SPA300017', 'TXDALSTD', 'Elizabeth Jekot MD', 'Elizabeth', '', 'Jekot', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 832265', 'Richardson', 'Dallas', 'TX', '75083', '2144427050', '2144427075', 'PO Box 832265', 'Richardson', 'Dallas', 'TX', '75083', '2144427050', '2144427075', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1891773933', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('203577037', 'SPA300125', 'SPA300125', 'TXDALSTD', 'Dallas Sleep ', 'Rajdeep', '', 'Kakar', 'MD', 'Sleep Medicine', 'Internal Medicine', '', NULL, 'O', '11617 N Central Expy Ste 250', 'Dallas', 'Dallas', 'TX', '75243', '9724737300', '9724737750', '11617 N Central Expy Ste 250', 'Dallas', 'Dallas', 'TX', '75243', '9724737300', '9724737750', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1073430986', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9066, -96.7694, NULL, NULL),
('203577037', 'SPA300126', 'SPA300126', 'TXDALSTD', 'Dallas Sleep ', 'Rajdeep', '', 'Kakar', 'MD', 'Sleep Medicine', 'Internal Medicine', '', NULL, 'O', '6313 Preston Rd Ste 400', 'Plano', 'Collin', 'TX', '75024', '9724737474', '9724737750', '6313 Preston Rd Ste 400', 'Plano', 'Collin', 'TX', '75024', '9724737474', '9724737750', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1073430986', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0593, -96.7961, NULL, NULL),
('203577037', 'SPA300127', 'SPA300127', 'TXDALSTD', 'Dallas Sleep ', 'Rajdeep', '', 'Kakar', 'MD', 'Sleep Medicine', 'Internal Medicine', '', NULL, 'B', 'PO Box 678085', 'Dallas', 'Dallas', 'TX', '75267', '          ', NULL, 'PO Box 678085', 'Dallas', 'Dallas', 'TX', '75267', '          ', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1073430986', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('43845677', 'SPA300051', 'SPA300051', 'TXDALSTD', 'Kare Family Clinic', 'R Paul', '', 'Kare', 'MD', 'Family Practice', '', '', NULL, 'O', '120 S Grand Ave Ste 2', 'Waxahachie', 'Ellis', 'TX', '75165', '9729380100', '9729379073', '120 S Grand Ave Ste 2', 'Waxahachie', 'Ellis', 'TX', '75165', '9729380100', '9729379073', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1568553139', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3968, -96.8631, NULL, NULL),
('200611876', 'SPA300059', 'SPA300059', 'TXDALSTD', 'BestNest Pediatrics', 'Mee Yung', '', 'Knapp', 'MD', 'Pediatrics', '', '', NULL, 'O', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1548402233', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1127, -96.8393, NULL, NULL),
('752877778', 'SPA300065', 'SPA300065', 'TXDALSTD', 'Konen and Associates', 'Andrew', 'A', 'Konen', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467439166', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752877778', 'SPA300066', 'SPA300066', 'TXDALSTD', 'Konen and Associates', 'Andrew', 'A', 'Konen', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 650444 Dept 111', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'PO Box 650444 Dept 111', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467439166', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('262933572', 'SPA300050', 'SPA300050', 'TXDALSTD', 'Sumit Kumar MD', 'Sumit', '', 'Kumar', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1598743098', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8827, -96.7697, NULL, NULL),
('481292753', 'SPA300081', 'SPA300081', 'TXDALSTD', 'Jane Lee MD', 'Jane', '', 'Lee', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '411 N Washington Ave Ste 2400', 'Dallas', 'Dallas', 'TX', '75246', '2143705700', '2143584324', '411 N Washington Ave Ste 2400', 'Dallas', 'Dallas', 'TX', '75246', '2143705700', '2143584324', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396888194', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7885, -96.7752, NULL, NULL),
('751308110', 'SPA300038', 'SPA300038', 'TXDALSTD', 'Surgical Associates of Dallas', 'Christopher', 'D', 'Leville', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699776310', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('202451034', 'SPA300112', 'SPA300112', 'TXDALSTD', 'Frisco Dermatology Laser and Surgery Center', 'Lucy', '', 'Li', 'MD', 'Dermatology', '', '', NULL, 'O', '580 S Denton Tap Rd Ste 290', 'Coppell', 'Dallas', 'TX', '75019', '9727123131', '9727127171', '580 S Denton Tap Rd Ste 290', 'Coppell', 'Dallas', 'TX', '75019', '9727123131', '9727127171', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1164419701', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.9578, -96.9934, NULL, NULL),
('202451034', 'SPA300113', 'SPA300113', 'TXDALSTD', 'Frisco Dermatology Laser and Surgery Center', 'Lucy', '', 'Li', 'MD', 'Dermatology', '', '', NULL, 'O', '9191 Kyser Way  Bldg 3 Ste B', 'Frisco', 'Denton', 'TX', '75033', '9727123131', '9727127171', '9191 Kyser Way  Bldg 3 Ste B', 'Frisco', 'Denton', 'TX', '75033', '9727123131', '9727127171', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1164419701', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.1737, -96.87, NULL, NULL),
('752500072', 'SPA300100', 'SPA300100', 'TXDALSTD', 'North Texas Internal Medicine Associates', 'Kyle', 'L', 'Lloyd', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275679508', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752942548', 'SPA300011', 'SPA300011', 'TXDALSTD', 'Comprehensive Orthopaedics and Rehabilitation', 'Sacheen', 'H', 'Mehta', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1120 W Campbell Rd Ste 109', 'Richardson', 'Dallas', 'TX', '75080', '2145752663', '2145752664', '1120 W Campbell Rd Ste 109', 'Richardson', 'Dallas', 'TX', '75080', '2145752663', '2145752664', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1912931049', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9783, -96.7585, NULL, NULL),
('752942548', 'SPA300012', 'SPA300012', 'TXDALSTD', 'Comprehensive Orthopaedics and Rehabilitation', 'Sacheen', 'H', 'Mehta', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 848221', 'Boston', 'Suffolk', 'MA', '02284', '', NULL, 'PO Box 848221', 'Boston', 'Suffolk', 'MA', '02284', '', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1912931049', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('203943431', 'SPA300072', 'SPA300072', 'TXDALSTD', 'Texas Neurosurgery', 'Christopher', 'B', 'Michael', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', '3600 Gaston Ave Ste 907', 'Dallas', 'Dallas', 'TX', '75246', '2148232052', '2148233797', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417978016', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('830468761', 'SPA300026', 'SPA300026', 'TXDALSTD', 'Lauren Michelsen DO', 'Lauren', '', 'Michelsen', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4461 Coit Rd Ste 401', 'Frisco', 'Collin', 'TX', '75035', '9723351490', '9723351491', '4461 Coit Rd Ste 401', 'Frisco', 'Collin', 'TX', '75035', '9723351490', '9723351491', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1770691909', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1138, -96.7682, NULL, NULL),
('751891732', 'SPA300020', 'SPA300020', 'TXDALSTD', 'Pedro Nosnik MD', 'Thomas', 'A', 'Mitchell', 'MD', 'Neurology', '', '', NULL, 'M', '1314 W McDermott Dr Ste 106804', 'Allen', 'Collin', 'TX', '75093', '          ', NULL, '1314 W McDermott Dr Ste 106804', 'Allen', 'Collin', 'TX', '75093', '          ', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-23', 0, 0, 0, 'Baylor Medical Center at Frisco', 'Baylor Medical Center Carrollton', NULL, NULL, 'HCFA|UB|', '1831128297', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751891732', 'SPA300019', 'SPA300019', 'TXDALSTD', 'Pedro Nosnik MD', 'Thomas', 'A', 'Mitchell', 'MD', 'Neurology', '', '', NULL, 'O', '4100 W 15th St Ste 206', 'Plano', 'Collin', 'TX', '75093', '9729859048', '9728672051', '4100 W 15th St Ste 206', 'Plano', 'Collin', 'TX', '75093', '9729859048', '9728672051', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-02-28', 0, 0, 0, 'Baylor Medical Center at Frisco', 'Baylor Medical Center Carrollton', NULL, NULL, 'HCFA|UB|', '1831128297', 0, 'N', 0, '2014-04-21', NULL, NULL, 33.0177, -96.7708, NULL, NULL),
('752608617', 'SPA300013', 'SPA300013', 'TXDALSTD', 'Christian L Moncrief MD', 'Christian', 'L', 'Moncrief', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4708 Alliance Blvd Ste 770', 'Plano', 'Collin', 'TX', '75093', '2146370640', '2143619533', '4708 Alliance Blvd Ste 770', 'Plano', 'Collin', 'TX', '75093', '2146370640', '2143619533', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1891889804', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752608617', 'SPA300014', 'SPA300014', 'TXDALSTD', 'Christian L Moncrief MD', 'Christian', 'L', 'Moncrief', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6124 W Parker Rd Ste 530', 'Plano', 'Collin', 'TX', '75093', '2146370640', '2143619533', '6124 W Parker Rd Ste 530', 'Plano', 'Collin', 'TX', '75093', '2146370640', '2143619533', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1891889804', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('454224395', 'SPA300067', 'SPA300067', 'TXDALSTD', 'Sajida Naeem MD', 'Sajida', '', 'Naeem', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5311 Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175030223', '8175032340', '5311 Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175030223', '8175032340', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', NULL, 'HCFA|UB|', '1447408802', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8874, -97.1512, NULL, NULL),
('752906860', 'SPA300007', 'SPA300007', 'TXDALSTD', 'NeighborCare Clinic', 'Howard', 'H', 'Nguyen', 'DO', 'Family Practice', '', '', NULL, 'O', '2261 Singleton Blvd Ste 101', 'Dallas', 'Dallas', 'TX', '75212', '2146309559', '2146304992', '2261 Singleton Blvd Ste 101', 'Dallas', 'Dallas', 'TX', '75212', '2146309559', '2146304992', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932174711', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7788, -96.8595, NULL, NULL),
('752906860', 'SPA300008', 'SPA300008', 'TXDALSTD', 'NeighborCare Clinic', 'Howard', 'H', 'Nguyen', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 630615', 'Irving', 'Dallas', 'TX', '75063', '2146309559', '2146304992', 'PO Box 630615', 'Irving', 'Dallas', 'TX', '75063', '2146309559', '2146304992', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932174711', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('271933345', 'SPA300028', 'SPA300028', 'TXDALSTD', 'Premier Care Gastroenterology', 'Syed', '', 'Oqail', 'MD', 'Gastroenterology', '', '', NULL, 'O', '929 N Galloway Ste 108', 'Mesquite', 'Dallas', 'TX', '75149', '2143207680', '2143207681', '929 N Galloway Ste 108', 'Mesquite', 'Dallas', 'TX', '75149', '2143207680', '2143207681', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1750326369', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.776, -96.5993, NULL, NULL),
('271933345', 'SPA300029', 'SPA300029', 'TXDALSTD', 'Premier Care Gastroenterology', 'Syed', '', 'Oqail', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 741184', 'Atlanta', NULL, 'GA', '30784', '2143207680', '2143207681', 'PO Box 741184', 'Atlanta', '', 'GA', '30784', '2143207680', '2143207681', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1750326369', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('202282193', 'SPA300131', 'SPA300131', 'TXDALSTD', 'Kwaku Osafo Mensah MD FCCP DABSM', 'Kwaku', 'A', 'Osafo Mensah', 'MD', 'Pulmonary', 'Internal Medicine', '', NULL, 'O', '800 8th Ave Ste 124', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173489015', '8173489017', '800 8th Ave Ste 124', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173489015', '8173489017', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Park City Medical Center', NULL, 'Baylor All Saints Medical Center', NULL, 'HCFA|UB|', '1053313882', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7365, -97.3437, NULL, NULL),
('752500072', 'SPA300063', 'SPA300063', 'TXDALSTD', 'North Texas Internal Medicine Associates', 'James', '', 'Otto', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148282889', '2148289530', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-03-31', 0, 0, 0, 'Baylor University Medical Center', '', NULL, NULL, 'HCFA|UB|', '1477690766', 0, 'N', 0, '2014-04-21', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('262933572', 'SPA300140', 'SPA300140', 'TXDALSTD', 'Sumit Kumar MD', 'Uma', '', 'Pakkivenkata', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1003003609', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8827, -96.7697, NULL, NULL),
('203021064', 'SPA300037', 'SPA300037', 'TXDALSTD', 'Foot Specialists of Tri County', 'Lanhuong', '', 'Pham', 'DPM', 'Podiatry', '', '', NULL, 'O', '719 W Coke Rd Ste 4', 'Winnsboro', 'Wood', 'TX', '75494', '9033471201', '9033471207', '719 W Coke Rd Ste 4', 'Winnsboro', 'Wood', 'TX', '75494', '9033471201', '9033471207', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1710952734', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9465, -95.3094, NULL, NULL),
('752867904', 'SPA300036', 'SPA300036', 'TXDALSTD', 'Family Clinic', 'David', 'A', 'Ray', 'DO', 'Family Practice', '', '', NULL, 'O', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406836417', '808 Woodrow Wilson Ray Cir', 'Bridgeport', 'Wise', 'TX', '76426', '9406832297', '9406836417', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1720062698', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2219, -97.7597, NULL, NULL),
('320359358', 'SPA300023', 'SPA300023', 'TXDALSTD', 'Texas Center for Urology', 'David', 'R', 'Rittenhouse', 'DO', 'Urology', '', '', NULL, 'O', '1001 12th St Ste 140', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178719069', '8178719067', '1001 12th St Ste 140', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178719069', '8178719067', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811950397', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('320359358', 'SPA300024', 'SPA300024', 'TXDALSTD', 'Texas Center for Urology', 'David', 'R', 'Rittenhouse', 'DO', 'Urology', '', '', NULL, 'O', '11797 S Freeway Ste 226', 'Burleson', 'Johnson', 'TX', '76028', '8177693370', '8177693377', '11797 S Freeway Ste 226', 'Burleson', 'Johnson', 'TX', '76028', '8177693370', '8177693377', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811950397', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5867, -97.3191, NULL, NULL),
('201796939', 'SPA300114', 'SPA300114', 'TXDALSTD', 'North Texas Allergy and Asthma Associates', 'Nastaran', '', 'Safdarian', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '4708 Alliance Blvd Ste 485', 'Plano', 'Collin', 'TX', '75093', '9725964383', '2143691905', '4708 Alliance Blvd Ste 485', 'Plano', 'Collin', 'TX', '75093', '9725964383', '2143691905', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1144414434', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('201796939', 'SPA300115', 'SPA300115', 'TXDALSTD', 'North Texas Allergy and Asthma Associates', 'Nastaran', '', 'Safdarian', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', '2143691905', '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', '2143691905', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1144414434', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8833, -96.7628, NULL, NULL),
('204706203', 'SPA300010', 'SPA300010', 'TXDALSTD', 'White Rock Family Health', 'Angel', '', 'Salazar', 'MD', 'Family Practice', '', '', NULL, 'O', '9015 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2147478800', '2147478801', '9015 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2147478800', '2147478801', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912981721', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8278, -96.7097, NULL, NULL),
('742907553', 'SPA300075', 'SPA300075', 'TXDALSTD', 'Baylor College of Dentistry', 'Sterling', 'R', 'Schow', 'DMD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', '', '', 'HCFA|UB|', '1417907734', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7895, -96.7821, NULL, NULL),
('742907553', 'SPA300076', 'SPA300076', 'TXDALSTD', 'Baylor College of Dentistry', 'Sterling', 'R', 'Schow', 'DMD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'B', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', '', '', 'HCFA|UB|', '1417907734', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('203625141', 'SPA300097', 'SPA300097', 'TXDALSTD', 'Premier Med Care', 'Anuradha', 'R', 'Tavarekere', 'MD', 'Internal Medicine', '', '', NULL, 'O', '724 W Main St Ste 160', 'Lewisville', 'Denton', 'TX', '75067', '9722192300', '9722192335', '724 W Main St Ste 160', 'Lewisville', 'Denton', 'TX', '75067', '9722192300', '9722192335', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1295816510', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0459, -97.0115, NULL, NULL),
('752116977', 'SPA300132', 'SPA300132', 'TXDALSTD', 'David P Taylor MD', 'David', 'P', 'Taylor', 'MD', 'Plastic Surgery', 'Surgery Hand', '', NULL, 'O', '3600 Gaston Ave Ste 458', 'Dallas', 'Dallas', 'TX', '75246', '2148233571', '2148203573', '3600 Gaston Ave Ste 458', 'Dallas', 'Dallas', 'TX', '75246', '2148233571', '2148203573', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013975176', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('200611876', 'SPA300074', 'SPA300074', 'TXDALSTD', 'BestNest Pediatrics', 'Stacy', 'L', 'Terry', 'MD', 'Pediatrics', '', '', NULL, 'O', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', '4040 Legacy Dr Ste 201', 'Frisco', 'Denton', 'TX', '75034', '9726686705', '9726687308', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1417921008', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1127, -96.8393, NULL, NULL),
('752877778', 'SPA300089', 'SPA300089', 'TXDALSTD', 'Konen and Associates', 'Amanda', '', 'Toye', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', '3600 Gaston Ave Ste 360', 'Dallas', 'Dallas', 'TX', '75246', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346440914', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752877778', 'SPA300090', 'SPA300090', 'TXDALSTD', 'Konen and Associates', 'Amanda', '', 'Toye', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 650444', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'PO Box 650444', 'Dallas', 'Dallas', 'TX', '75265', '2148207246', '2143613562', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346440914', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('264052650', 'SPA300077', 'SPA300077', 'TXDALSTD', 'Center for Dermatology and Cosmetic Laser Surgery', 'Kien', 'T', 'Tran', 'MD', 'Dermatology', '', '', NULL, 'O', '5044 Tennyson Pkwy Ste B', 'Plano', 'Collin', 'TX', '75024', '9729859003', '9729851176', '5044 Tennyson Pkwy Ste B', 'Plano', 'Collin', 'TX', '75024', '9729859003', '9729851176', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417158833', 0, 'N', 0, '2014-03-31', NULL, NULL, 33.0646, -96.7984, NULL, NULL),
('870629575', 'W12046159', 'W12046159', 'UT01', 'Central Utah Pathology', 'Beverly', '', 'Lynch', 'MD', 'Pathology', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012630810', '8012708170', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012630810', '8012708170', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962441410', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('452230140', 'SPA300078', 'SPA300078', 'TXDALSTD', 'Liberty Dermatology', 'Kien', 'T', 'Tran', 'MD', 'Dermatology', '', '', NULL, 'O', '6800 Heritage Pkwy Ste 100', 'Rockwall', 'Rockwall', 'TX', '75087', '9724755300', '9724755303', '6800 Heritage Pkwy Ste 100', 'Rockwall', 'Rockwall', 'TX', '75087', '9724755300', '9724755303', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417158833', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.9193, -96.5067, NULL, NULL),
('452230140', 'SPA300079', 'SPA300079', 'TXDALSTD', 'Liberty Dermatology', 'Kien', 'T', 'Tran', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 601522', 'Dallas', 'Rockwall', 'TX', '75087', '          ', NULL, 'PO Box 601522', 'Dallas', 'Rockwall', 'TX', '75087', '          ', '', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417158833', 0, 'Y', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('751710152', 'SPA300138', 'SPA300138', 'TXDALSTD', 'JoAnn F Travis MD', 'JoAnn', 'F', 'Travis', 'MD', 'Anesthesiology', '', '', NULL, 'O', '7111 Cliffbrook Dr', 'Dallas', 'Dallas', 'TX', '75240', '9722393373', '4693279314', '7111 Cliffbrook Dr', 'Dallas', 'Dallas', 'TX', '75240', '9722393373', '4693279314', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Mary Shiels Hospital', NULL, NULL, 'HCFA|UB|', '1003864943', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9448, -96.7817, NULL, NULL),
('751710152', 'SPA300139', 'SPA300139', 'TXDALSTD', 'JoAnn F Travis MD', 'JoAnn', 'F', 'Travis', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 140651', 'Dallas', 'Dallas', 'TX', '75214', '9722392896', '9722390915', 'PO Box 140651', 'Dallas', 'Dallas', 'TX', '75214', '9722392896', '9722390915', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Mary Shiels Hospital', NULL, NULL, 'HCFA|UB|', '1003864943', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('742907553', 'SPA300102', 'SPA300102', 'TXDALSTD', 'Baylor College of Dentistry', 'Robert', 'Gilbert', 'Triplett', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', '3302 Gaston Ave Dept Oral Max Surg', 'Dallas', 'Dallas', 'TX', '75246', '2148288103', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1255380119', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7895, -96.7821, NULL, NULL),
('742907553', 'SPA300103', 'SPA300103', 'TXDALSTD', 'Baylor College of Dentistry', 'Robert', 'Gilbert', 'Triplett', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'B', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'PO Box 660677', 'Dallas', 'Dallas', 'TX', '75266', '2148288104', '2148288382', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1255380119', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752128914', 'SPA300095', 'SPA300095', 'TXDALSTD', 'Care First Clinic  American Medical Group', 'Henry', 'L', 'Underwood', 'DO', 'Family Practice', '', '', NULL, 'O', '3800 Joe Ramsey Blvd Ste A', 'Greenville', 'Hunt', 'TX', '75401', '9034558000', '9034543577', '3800 Joe Ramsey Blvd Ste A', 'Greenville', 'Hunt', 'TX', '75401', '9034558000', '9034543577', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316009947', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1224, -96.1203, NULL, NULL),
('752128914', 'SPA300096', 'SPA300096', 'TXDALSTD', 'Care First Clinic  American Medical Group', 'Henry', 'L', 'Underwood', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 911', 'Greenville', 'Hunt', 'TX', '75401', '9034558000', '9034543577', 'PO Box 911', 'Greenville', 'Hunt', 'TX', '75401', '9034558000', '9034543577', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316009947', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('830338695', 'SPA300073', 'SPA300073', 'TXDALSTD', 'Harvey Guyton VanDell IV MD', 'Harvey Guyton', '', 'VanDell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2980 Long Prairie Rd Ste E', 'Flower Mound', 'Denton', 'TX', '75022', '9728999787', '9728999786', '2980 Long Prairie Rd Ste E', 'Flower Mound', 'Denton', 'TX', '75022', '9728999787', '9728999786', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', NULL, 'HCFA|UB|', '1417952060', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0269, -97.0707, NULL, NULL),
('751308110', 'SPA300030', 'SPA300030', 'TXDALSTD', 'Surgical Associates of Dallas', 'Javier', '', 'Vasquez', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', '621 N Hall St Ste 520', 'Dallas', 'Dallas', 'TX', '75226', '2148262114', '2148219325', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750324166', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('320359358', 'SPA300052', 'SPA300052', 'TXDALSTD', 'Texas Center for Urology', 'Todd', 'E', 'Young', 'DO', 'Urology', '', '', NULL, 'O', '1001 12th St Ste 140', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178719069', '8178719067', '1001 12th St Ste 140', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178719069', '8178719067', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1568425064', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('320359358', 'SPA300053', 'SPA300053', 'TXDALSTD', 'Texas Center for Urology', 'Todd', 'E', 'Young', 'DO', 'Urology', '', '', NULL, 'O', '11797 S Freeway Ste 226', 'Burleson', 'Johnson', 'TX', '76028', '8177693370', '8177693377', '11797 S Freeway Ste 226', 'Burleson', 'Johnson', 'TX', '76028', '8177693370', '8177693377', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1568425064', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.5867, -97.3191, NULL, NULL),
('320087943', 'SPA300025', 'SPA300025', 'TXDALSTD', 'Robert T Zwernemann MD', 'Robert', 'T', 'Zwernemann', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '851 W Terrell Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178702258', '8179165811', '851 W Terrell Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178702258', '8179165811', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780632943', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7356, -97.3333, NULL, NULL),
('752536818', 'W12035866', 'W12035866', 'TXDALSTD', 'Baylor Family Medicine at Ennis', 'Jesus', '', 'Trejo', 'MD', 'Family Practice', '', '', NULL, 'O', '1405 W Jefferson St Ste 506', 'Waxahachie', 'Ellis', 'TX', '75165', '8555039900', '8555039910', '1405 W Jefferson St Ste 506', 'Waxahachie', 'Ellis', 'TX', '75165', '8555039900', '8555039910', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|', '1336434125', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('752547135', 'W12035867', 'W12035867', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Ronney', '', 'Stadler', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '4370 Medical Arts Dr Ste 265', 'Flower Mound', 'Denton', 'TX', '75028', '2143438565', '9727592045', '4370 Medical Arts Dr Ste 265', 'Flower Mound', 'Denton', 'TX', '75028', '2143438565', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1356372098', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('752788839', 'W12035868', 'W12035868', 'TXDALSTD', 'Urology Clinics of North Texas', 'Michael', 'B', 'Gross', 'MD', 'Urology', '', '', NULL, 'O', '1105 N Central Expressway Ste 360', 'Allen', 'Collin', 'TX', '75013', '2146911902', '2149871945', '1105 N Central Expressway Ste 360', 'Allen', 'Collin', 'TX', '75013', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447207493', 0, 'Y', 0, '2014-04-28', NULL, NULL, 33.1161, -96.6711, NULL, NULL),
('261891316', 'W12035869', 'W12035869', 'TXHOUSTD', 'Pediatric Surgery Associates of Clear Lake', 'Stephen', '', 'Kimmel', 'MD', 'General Surgery', 'Pediatrics', '', NULL, 'O', '500 Medical Ctr Blvd Ste. 600', 'Webster', 'Harris', 'TX', '77598', '2815541690', '8662380423', '500 Medical Ctr Blvd Ste. 600', 'Webster', 'Harris', 'TX', '77598', '2815541690', '8662380423', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1700892148', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5411, -95.1263, NULL, NULL),
('760469306', 'W12035870', 'W12035870', 'TXHOUSTD', 'Texas Eye Institute', 'William', 'Michael', 'Hipps', 'MD', 'Ophthalmology', '', '', NULL, 'O', '403 W Grand Pkwy S Ste E', 'Katy', 'Fort Bend', 'TX', '77494', '2814847171', '0000000000', '403 W Grand Pkwy S Ste E', 'Katy', 'Fort Bend', 'TX', '77494', '2814847171', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891745618', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7779, -95.7767, NULL, NULL),
('760540476', 'W12035871', 'W12035871', 'TXHOUSTD', 'Oakbend Medical Group', 'Owen', 'C', 'Capocyan', 'MD', 'Family Practice', 'Geriatrics', '', NULL, 'O', '22001 Southwest Freeway Ste 210', 'Richmond', 'Fort Bend', 'TX', '77469', '2814913335', '2816344933', '22001 Southwest Freeway Ste 210', 'Richmond', 'Fort Bend', 'TX', '77469', '2814913335', '2816344933', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063695328', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5541, -95.7169, NULL, NULL),
('760540476', 'W12035872', 'W12035872', 'TXHOUSTD', 'Oakbend Medical Group', 'David', 'M', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '22001 Southwest Freeway Ste 210', 'Richmond', 'Fort Bend', 'TX', '77469', '2814913335', '2816334943', '22001 Southwest Freeway Ste 210', 'Richmond', 'Fort Bend', 'TX', '77469', '2814913335', '2816334943', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437349479', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5541, -95.7169, NULL, NULL),
('760564528', 'W12035873', 'W12035873', 'TXBEAUSTD', 'Advanced Cardiovascular Specialists', 'Steven', 'K', 'Sooudi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3080 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098921192', '4099247511', '3080 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098921192', '4099247511', 'BEAUMONT2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790756047', 0, 'N', 0, '2013-07-31', NULL, NULL, 30.0685, -94.1196, NULL, NULL),
('760352783', 'W12035874', 'W12035874', 'TXHOUSTD', 'Shat, Atul', 'Atul', 'T', 'Shah', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4002 Garth Rd Ste 120', 'Baytown', 'Harris', 'TX', '77521', '2814227970', '2814227960', '4002 Garth Rd Ste 120', 'Baytown', 'Harris', 'TX', '77521', '2814227970', '2814227960', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, '', '', 'HCFA|UB|', '1083735021', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7673, -94.9775, NULL, NULL),
('201300128', 'W12035875', 'W12035875', 'ID01', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', NULL, '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.613, -116.195, NULL, NULL),
('201300128', 'W12035876', 'W12035876', 'ID01', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '890 N 6th E', 'Boise', 'Ada', 'ID', '86347', '2086394900', NULL, '890 N 6th E', 'Boise', 'Ada', 'ID', '86347', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W12035877', 'W12035877', 'IDBOISTD', 'Idaho Urologic Institute', 'Stephen', 'J', 'Miller', 'MD', 'Urology', '', '', NULL, 'O', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', '2086394901', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1164474664', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.613, -116.195, NULL, NULL),
('201300128', 'W12035878', 'W12035878', 'ID01', 'Idaho Urologic Institute', 'Stephen', 'J', 'Miller', 'MD', 'Urology', '', '', NULL, 'O', '890 N 6th E', 'Boise', 'Ada', 'ID', '86347', '2086394900', NULL, '890 N 6th E', 'Boise', 'Ada', 'ID', '86347', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1164474664', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W12035879', 'W12035879', 'ID01', 'Idaho Urologic Institute', 'Joseph', 'H', 'Williams', 'MD', 'Urology', '', '', NULL, 'O', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', NULL, '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2083437736', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1194777060', 0, 'N', 0, '2013-07-30', NULL, NULL, 43.613, -116.195, NULL, NULL),
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('820483425', 'W12035911', 'W12035911', 'IDBOISTD', 'Idaho Surgical Partners', 'Matthew', 'R', 'Macha', 'MD', 'General Surgery', '', '', NULL, 'O', '1024 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', NULL, '1024 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730190836', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.8791, -116.487, NULL, NULL),
('820491054', 'W12035912', 'W12035912', 'IDBOISTD', 'Scott L Christensen', 'Scott', 'L', 'Christensen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '520 S Eagle Rd Ste. 1245', 'Meridian', 'Ada', 'ID', '83642', '2083453136', NULL, '520 S Eagle Rd Ste. 1245', 'Meridian', 'Ada', 'ID', '83642', '2083453136', '          ', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1386672228', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.5994, -116.355, NULL, NULL),
('820491054', 'W12035913', 'W12035913', 'SACN', '', 'Scott', 'L', 'Christensen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1245', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2083453136', NULL, '520 S Eagle Rd Ste 1245', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2083453136', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1386672228', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12035914', 'W12035914', 'IDBOISTD', 'Southwest Idaho ENT ', 'Eric', 'T', 'Garner', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1000 State St', 'Mccall', 'Valley', 'ID', '83638', '2083673320', '          ', '1000 State St', 'Mccall', 'Valley', 'ID', '83638', '2083673320', '          ', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1225011893', 0, 'N', 0, '2014-06-26', NULL, NULL, 44.9086, -116.11, NULL, NULL),
('841394139', 'W12035915', 'W12035915', 'SACN', 'Southwest Idaho ENT ', 'Eric', 'T', 'Garner', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1000 State St', 'Mccall', 'Valley', 'ID', '83638', '2083673320', '          ', '1000 State St', 'Mccall', 'Valley', 'ID', '83638', '2083673320', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 6, '2013-07-29', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1225011893', 0, 'N', 0, '2014-06-26', NULL, NULL, 44.9094, -116.11, NULL, NULL),
('208515551', 'W12035916', 'W12035916', 'ID02', 'West Valley Medical Group', 'J Cinda', 'J', 'Bitters', 'MD', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104089556', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('208515551', 'W12035917', 'W12035917', 'ID02', 'West Valley Medical Center', 'Steven', 'T', 'Koga', 'MD', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '8013529500', NULL, '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '8013529500', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144275512', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12035918', 'W12035918', 'IDBOISTD', 'Caldwell Internal Medicine Group', 'John', '', 'Pearce', 'DO', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306880844', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6552, -116.697, 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
('870767026', 'W12035919', 'W12035919', 'IDBOISTD', 'Caldwell Medical Clinics', 'Melissa', 'L', 'Park', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', NULL, '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1386676039', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.6125, -116.594, NULL, NULL),
('363525049', 'W12035920', 'W12035920', 'ID02', 'West Valley Clinic at Middleton', 'Steven', 'B', 'Ollie', 'MD', 'Family Practice', '', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2085856221', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2013-07-29', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568432888', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12035921', 'W12035921', 'IDBOISTD', 'Caldwell Internal Medicine Group', 'Steven', 'B', 'Ollie', 'MD', 'Family Practice', '', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', NULL, '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568432888', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6125, -116.594, NULL, NULL),
('870639748', 'W12035927', 'W12035927', 'UT01', 'Hoopes Vision Correction Center', 'Weston', 'T', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '105 E South Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E South Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427210269', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035928', 'W12035928', 'UT01', 'Hoopes Vision Correction Center', 'Michael', 'J', 'Bradley', 'MD', 'Ophthalmology', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1225131444', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035929', 'W12035929', 'UT01', 'Hoopes Vision Correction Center', 'Thomas', 'P', 'Dutson', 'OD', 'Optometry', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225195548', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035930', 'W12035930', 'UT01', 'Hoopes Vision Correction Center', 'Phillip', 'C', 'Hoopes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '105 E South Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E South Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1629067921', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035931', 'W12035931', 'UT01', 'Hoopes Vision Correction Center', 'Steven', 'H', 'Linn', 'OD', 'Optometry', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508006487', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035932', 'W12035932', 'UT01', 'Hoopes Vision Correction Center', 'Renee', 'A', 'McIntosh', 'OD', 'Optometry', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003057894', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035933', 'W12035933', 'UT01', 'Hoopes Vision Correction Center', 'David', 'M', 'Parkinson', 'OD', 'Optometry', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568797652', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035934', 'W12035934', 'UT01', 'Hoopes Vision Correction Center', 'Robert', 'P', 'Rivera', 'MD', 'Ophthalmology', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982759122', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12035935', 'W12035935', 'UT01', 'Hoopes Vision Correction Center', 'Richard', '', 'Yardley', 'OD', 'Ophthalmology', '', '', NULL, 'O', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', '105 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013018084', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12035945', 'W12035945', 'ILCHIGSTD', 'Dreyer Clinic', 'LaShaunda', 'T', 'Purefoy', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', '2013-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164744827', 0, 'N', 0, '2013-11-14', NULL, NULL, 41.7625, -88.3623, NULL, NULL),
('364088232', 'W12035944', 'W12035944', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'LaShaunda', 'T', 'Purefoy', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', '2013-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164744827', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12035946', 'W12035946', 'ILCHIGSTD', 'Dreyer Clinic', 'LaShaunda', 'T', 'Purefoy', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', '2013-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164744827', 0, 'N', 0, '2013-11-14', NULL, NULL, 41.7828, -88.3276, NULL, NULL),
('364088232', 'W12035947', 'W12035947', 'ILCHIGSTD', 'Dreyer Clinic', 'LaShaunda', 'T', 'Purefoy', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', '2013-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164744827', 0, 'N', 0, '2013-11-14', NULL, NULL, 41.8641, -88.3512, NULL, NULL),
('364088232', 'W12035948', 'W12035948', 'ILCHIGSTD', 'Dreyer Clinic', 'LaShaunda', 'T', 'Purefoy', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', '2013-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164744827', 0, 'N', 0, '2013-11-14', NULL, NULL, 41.6735, -88.343, NULL, NULL),
('364088232', 'W12035951', 'W12035951', 'ILCHIGSTD', 'Dreyer Clinic', 'Jennifer', 'L', 'Vallone', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786690', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786690', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-18', '2013-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477718955', 0, 'N', 0, '2013-10-04', NULL, NULL, 41.7524, -88.2148, NULL, NULL),
('364088232', 'W12035950', 'W12035950', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jennifer', 'L', 'Vallone', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477718955', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12035952', 'W12035952', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-25', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('200100106', 'W12035964', 'W12035964', 'ID01', 'Hearts for Hospice', '', '', 'Hearts for Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '4869 Malad St Ste D', 'Boise', 'Ada', 'ID', '83705', '2083892276', '2083892282', '4869 Malad St Ste D', 'Boise', 'Ada', 'ID', '83705', '2083892276', '2083892282', '', '', '4', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942290960', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('454788960', 'W12035972', 'W12035972', 'UT01', 'Utah Neuro Rehabilitation', 'Beverly', 'A', 'Krensky', 'APRN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '5770 S 250 E Ste 405', 'Murray', 'Salt Lake', 'UT', '84107', '8013142100', '8013142105', '5770 S 250 E Ste 405', 'Murray', 'Salt Lake', 'UT', '84107', '8013142100', '8013142105', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA', '1669471421', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('454788960', 'W12035973', 'W12035973', 'UT01', 'Utah Neuro Rehabilitation', 'Beverly', 'A', 'Krensky', 'APRN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8013142100', '8013142105', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8013142100', '8013142105', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA', '1669471421', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('752252301', 'W12035976', 'W12035976', 'TXDALSTD', 'Mid Cities Allergy and Asthma', 'Eugene', 'R', 'Posnock', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2305 Central Park Blvd', 'Bedford', 'Tarrant', 'TX', '76022', '8175716622', '8178681962', '2305 Central Park Blvd', 'Bedford', 'Tarrant', 'TX', '76022', '8175716622', '8178681962', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB', '1578780284', 0, 'N', 0, '2013-08-09', NULL, NULL, 32.8336, -97.1316, NULL, NULL),
('453579596', 'W12035980', 'W12035980', 'UT01', 'Carl T Bell MD PC', 'Carl', 'T', 'Bell', 'MD', 'General Practice', '', '', NULL, 'O', '1206 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8016150317', '8014651445', '1206 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8016150317', '8014651445', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1528309168', 0, 'N', 1, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
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