INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('264333033', 'W12001245', 'W12001245', 'TX01', 'Institute for Womens Health', 'Joseph', 'R', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144210121', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001246', 'W12001246', 'TX01', 'Institute for Womens Health', 'Camilo', 'A', 'Gonima', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316964745', 0, 'Y', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001248', 'W12001248', 'TX01', 'Institute for Womens Health', 'Elizabeth', 'A', 'King', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184643769', 0, 'Y', 0, '2013-05-02', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001249', 'W12001249', 'TX01', 'Institute for Womens Health', 'Tammy', 'J', 'Murdock', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831124452', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001250', 'W12001250', 'TX01', 'Institute for Womens Health', 'Cameron', '', 'Powell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008243', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001251', 'W12001251', 'TX01', 'Institute for Womens Health', 'Eduardo', '', 'Raez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1255320404', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001252', 'W12001252', 'TX01', 'Institute for Womens Health', 'Evangeline', '', 'Ramos-Gonzales', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922097070', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001253', 'W12001253', 'TX01', 'Institute for Womens Health', 'Cesar', '', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801885959', 0, 'Y', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001254', 'W12001254', 'TX01', 'Institute for Womens Health', 'Jose', 'M', 'Ruiz III', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093705089', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001255', 'W12001255', 'TX01', 'Institute for Womens Health', 'Vincenzo', '', 'Sabella', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780601773', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001256', 'W12001256', 'TX01', 'Institute for Womens Health', 'Randall', 'K', 'Sadler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1720017601', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001257', 'W12001257', 'TX01', 'Institute for Womens Health', 'Ingrid', 'P', 'Skop', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275542698', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001258', 'W12001258', 'TX01', 'Institute for Womens Health', 'Orlando', 'J', 'Suris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471825', 0, 'Y', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001259', 'W12001259', 'TX01', 'Institute for Womens Health', 'Vernon', '', 'Theis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1952333213', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001260', 'W12001260', 'TX01', 'Institute for Womens Health', 'Bruce', 'H', 'Thompson', 'MD', 'Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457360844', 0, 'Y', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001261', 'W12001261', 'TX01', 'Institute for Womens Health', 'Mark', 'E', 'Thompson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821017484', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001262', 'W12001262', 'TX01', 'Institute for Womens Health', 'Michael', '', 'Troy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184613242', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001263', 'W12001263', 'TX01', 'Institute for Womens Health', 'Ronald', 'A', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841280849', 0, 'Y', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12001264', 'W12001264', 'TX01', 'Institute for Womens Health', 'Robin', 'L', 'Womack', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750370821', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12001273', 'W12001273', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'B', 'PO Box 281490 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12001143', 'W12001143', 'UT01', 'Ogden Clinic Skyline', 'Cindie', 'G', 'Dodenbier', 'C-FNP', 'Pain Management', 'Family Practice', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', NULL, '6112 S 1550 E  ', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578565263', 0, 'N', 0, '2011-11-15', NULL, NULL, 41.1523, -111.94, NULL, NULL),
('870395551', 'W12001276', 'W12001276', 'UT01', 'Zion Chiropractic Neurology Assoc', 'Justin', 'W', 'Salmon', 'DC', 'Chiropractic', '', '', NULL, 'O', '107 S 1470 E  102', 'St George', 'Washington', 'UT', '84790', '4356524476', '4356285999', '107 S 1470 E  102', 'St George', 'Washington', 'UT', '84790', '4356524476', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-04-15', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013993815', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12001277', 'W12001277', 'UT01', '', 'Justin', '', 'Traveller', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '301 N 200 Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-03-08', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386820975', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12001278', 'W12001278', 'UT01', '', 'Brian', 'T', 'Richey', 'DC', 'Chiropractic', '', '', NULL, 'O', '107 S 1470 E Ste 102', 'St George', 'Washington', 'UT', '84790', '4356524476', '4356285999', '107 S 1470 E Ste 102', 'St George', 'Washington', 'UT', '84790', '4356524476', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-04-15', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043296221', 0, 'N', 0, '2010-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12001279', 'W12001279', 'UT01', '', 'T', 'Brock', 'Kesterson', 'DC', 'Chiropractic', '', '', NULL, 'O', '107 S 1470 E Ste 102', 'St George', 'Washington', 'UT', '84790', '4356524476', '4356285999', '107 S 1470 E Ste 102', 'Saint George', 'Washington', 'UT', '84790', '4356524476', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-04-15', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007075', 0, 'N', 0, '2010-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12001280', 'W12001280', 'UT01', '', 'Daniel', 'B', 'Davenport', 'DC', 'Chiropractic', '', '', NULL, 'O', '10464 S Redwood', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012857053', '8012857056', '10464 S Redwood', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012857053', '8012857056', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-04-12', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073625869', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12001303', 'W12001303', 'UT01', 'Davis Comp Health Psych Services', 'David', 'W', 'Carrington', '', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-14', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942323654', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('830270913', 'W12001306', 'W12001306', 'WY01', 'Gillette Medical Imaging', '', '', 'Gillette Medical Imaging', '', 'Imaging Center', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881600', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881600', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407956246', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('870680455', 'W12001314', 'W12001314', 'UT01', 'Ogden Orthopedic Specialists', 'Donald', 'W', 'Bryan', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', 'WiseOGORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366434433', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870656518', 'W12001795', 'W12001795', 'ID02', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8007754372', NULL, 'Phone Number Only', '', '', '', '', '8007754372', '          ', 'WCSTDSC', '', '', '0.00', '35.00', '0.00', 3, '2010-05-02', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12001318', 'W12001318', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-09', '2010-08-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W12001319', 'W12001319', 'UTMH1', 'Alpine Center for Personal Growth', 'Jocelyn', 'E', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5796 S 900 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018790252', '8019635258', '5796 S 900 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018790252', '8019635258', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-02-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386547', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W12001320', 'W12001320', 'UTMH1', 'Alpine Center for Personal Growth', 'Jocelyn', 'E', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 57162', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012681715', '8019635258', 'PO Box 57162', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012681715', '8019635258', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-02-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386547', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W12001327', 'W12001327', 'UT01', 'St Marks Hospital Lone Peak Emergencey Center', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '74 E Kimballs Ln Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8012687111', NULL, '74 E Kimballs Ln Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8012687111', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2010-05-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'Y', 0, '2011-07-13', NULL, NULL, 40.537, -111.889, NULL, NULL),
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('870616107', 'W12001352', 'W12001352', 'UT01', 'University of Utah Hospitals and Clinics', 'Sarah', 'C', 'Petersen', '', 'Pediatrics', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073786711', 0, 'Y', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('860735726', 'W12001511', 'W12001511', 'Sinclair', 'Flagstaff Bone and Joint', 'John', 'H', 'Flint', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', NULL, '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2010-05-05', '2011-07-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1700094125', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('731714968', 'W12001382', 'W12001382', 'UT01', 'Rocky Mountain Anesthesiology', 'Shane', 'R', 'Syme', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Ogden', 'Weber', 'UT', '84110', '8008803566', NULL, NULL, NULL, 'Weber', NULL, NULL, '8008803566', '          ', '', '', '', '0.00', '19.00', '0.00', 3, '2010-05-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1508014556', 0, 'Y', 0, '2010-05-12', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12001383', 'W12001383', 'UT01', 'University of Utah', 'Stacey', 'N', 'Turner', '', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-03-19', NULL, 1, 0, NULL, '', '', '', '', 'HCFA|UB|', '1821312950', 0, 'N', 0, '2010-05-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
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('202630141', 'W12001387', 'W12001387', 'ID02', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83709', '2083784288', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83709', '2083784288', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-05-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'Y', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12001388', 'W12001388', 'UT01', 'Standard Optical', 'Tyler', 'J', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', NULL, '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', '', 'WUTALBERT5', '', '', '0.00', '35.00', '0.00', 6, '2010-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528268398', 0, 'N', 0, '2014-07-02', NULL, NULL, 40.3884, -111.828, NULL, NULL),
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('830270913', 'W12001307', 'W12001307', 'WY01', 'Gillette Medical Imaging', '', '', 'Gillette Medical Imaging', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 638', 'Gillette', 'Campbell', 'WY', '82717', '3076881600', NULL, 'PO Box 638', 'Gillette', 'Campbell', 'WY', '82717', '3076881600', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407956246', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12001302', 'W12001302', 'UT01', 'Davis Comp Health Psych Services', 'David', 'W', 'Carrington', '', 'Mental Health', 'Psychiatry', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077377', NULL, '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-14', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942323654', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'W12001247', 'W12001247', 'TX01', 'Institute for Womens Health', '', '', 'Institute for Womens Health', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006854', 0, 'Y', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W73000111', 'W73000111', 'UT01', 'Mountain Land Rehabilitation Home Health', 'Jerri', 'Lynn', 'Adams-Price', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1952 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84070', '8019423311', NULL, '1952 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84070', '8019423311', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '58.00', 3, '2006-05-01', '2008-09-30', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000004912', 0, 'N', 0, '2010-05-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001423', 'W12001423', 'UTPEHP', 'Neuro Psychology DRMC', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '1380 E Medical Ctr Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-09-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001428', 'W12001428', 'UTPEHP2', 'Safe and Healthy Families', 'Anne', 'F', 'Taverne', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2008-10-31', '2010-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780858662', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('270883702', 'W12001305', 'W12001305', 'UT01', 'Salt Lake MRI', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', 'Radiologist', '', NULL, 'B', 'PO Box 712559', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015630333', NULL, 'PO Box 712559', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015630333', '          ', 'WUSTDRAD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467459479', 0, 'Y', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12001161', 'W12001161', 'UTPEHP', 'Budge Clinic Radiology', '', '', 'Budge Clinic Radiology', '', 'Radiology', '', '', NULL, 'O', ' 1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357530401', NULL, ' 1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357530401', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982732186', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001429', 'W12001429', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001430', 'W12001430', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '8004465684', NULL, '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001431', 'W12001431', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001432', 'W12001432', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8004465684', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001433', 'W12001433', 'Sinclair', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', NULL, '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', '2012-12-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12001434', 'W12001434', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', NULL, 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001110', 'W12001110', 'WYBILLINGS', 'Billings Clinic Derm', 'Jared', 'J', 'Lund', '', 'Dermatology', NULL, NULL, NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382501', '4062382437', '', '', '', '0.00', '17.00', '0.00', 3, '2010-04-20', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1144424763', 0, 'N', 0, '2010-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('262668995', 'W12001135', 'W12001135', 'Sinclair', 'Wyoming Healthy Option & Alternatives', 'Medea', '', 'Woods', '', 'Mental Health', 'Psychology', '', NULL, 'O', ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', NULL, ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', '          ', 'RAWLINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881890291', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('262668995', 'W12001136', 'W12001136', 'Sinclair', 'Wyoming Healthy Option & Alternatives', 'Medea', '', 'Woods', '', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 248', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', NULL, 'PO Box 248', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', '          ', 'RAWLINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881890291', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('262668995', 'W12001133', 'W12001133', 'WY01', 'Wyoming Healthy Option & Alternatives', 'Medea', '', 'Woods', '', 'Mental Health', 'Psychology', '', NULL, 'O', ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', NULL, ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', '          ', 'RAWLINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881890291', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('262668995', 'W12001134', 'W12001134', 'WY01', 'Wyoming Healthy Option & Alternatives', 'Medea', '', 'Woods', '', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 248', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', NULL, 'PO Box 248', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', '          ', 'RAWLINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881890291', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001526', 'W12001526', 'TX01', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'B', ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', NULL, ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'Y', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001527', 'W12001527', 'TX01', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', NULL, '6243 IH10 West Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12001528', 'W12001528', 'TX01', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('271398525', 'W12001524', 'W12001524', 'UT01', 'Utah Valley Urgent Care', 'Orrin', 'B', 'Hansen', 'NP', 'Family Practice', '', '', NULL, 'O', ' 127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', NULL, ' 127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1104916543', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.3879, -111.847, NULL, NULL),
('271398525', 'W12001525', 'W12001525', 'UT01', 'Alpine Billing Concepts', 'Orrin', 'B', 'Hansen', 'NP', 'Family Practice', '', '', NULL, 'B', '425 S 1660 E', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017857257', '8017850927', '425 S 1660 E', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017857257', '8017850927', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1104916543', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'W12001529', 'W12001529', 'UT01', 'Utah Bone & Joint Center', 'Eric', 'B', 'Chatterley', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', NULL, '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679807572', 0, 'N', 0, '2010-06-09', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870518863', 'W12001530', 'W12001530', 'UT01', 'Jordan Meadows', 'Kurt', 'M', 'Bockoven', 'ARNP', 'Family Practice', '', '', NULL, 'O', ' 3354 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012822677', '8012822050', ' 3354 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012822677', '8012822050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|DEN|', '1154361459', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6095, -111.971, NULL, NULL),
('263981143', 'W12001533', 'W12001533', 'UT01', 'Peak ENT Associates', 'Scott', 'G', 'Shipley', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', ' 1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', NULL, ' 1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-11-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1477510329', 0, 'N', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('263981143', 'W12001534', 'W12001534', 'UT01', 'Peak ENT Associates', 'Scott', 'G', 'Shipley', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '220 N 1200 E Ste 101', 'Lehi', 'Utah', 'UT', '84043', '8017683500', NULL, '220 N 1200 E Ste 101', 'Lehi', 'Utah', 'UT', '84043', '8017683500', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-11-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1477510329', 0, 'N', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001272', 'W12001272', 'TX01', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'B', ' 590 N General Mcmullen Dr Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', NULL, ' 590 N General Mcmullen Dr Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'Y', 0, '2010-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001535', 'W12001535', 'TX01', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'M', ' 6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '          ', NULL, ' 6243 IH10 West Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '          ', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'N', 0, '2010-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001536', 'W12001536', 'TX01', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '          ', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '          ', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12001531', 'W12001531', 'UT01', 'Canyon View Medical Group', 'Matthew', 'S', 'Walton', 'DO', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2010-12-31', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1497905566', 0, 'N', 0, '2011-03-18', NULL, NULL, 0, 0, NULL, NULL),
('352290361', 'W12001539', 'W12001539', 'UT01', 'Davis Hosp and Medical Center ER Dept', 'Clayton', 'A', 'Bass', 'MD', 'Wound Care', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972598506', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('352290361', 'W12001537', 'W12001537', 'UT01', 'SanCuro Wound Care Systems Inc', 'Clayton', 'A', 'Bass', 'MD', 'Wound Care', '', '', NULL, 'O', '434 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8012634900', NULL, '434 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8012634900', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972598506', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('352290361', 'W12001541', 'W12001541', 'UT01', 'SanCuro Wound Care', 'Clayton', 'A', 'Bass', 'MD', 'Wound Care', '', '', NULL, 'M', '5097 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012634900', NULL, '5097 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012634900', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972598506', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('352290361', 'W12001538', 'W12001538', 'UT01', 'Ogden Regional Hosp ER Dept', 'Clayton', 'A', 'Bass', 'MD', 'Wound Care', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014757100', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972598506', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12001572', 'W12001572', 'TX01', 'The San Antonio Orthopaedic Group', 'Randall', 'C', 'Marx', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790980068', 0, 'N', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001598', 'W12001598', 'UTPEHP', 'Dixie Hospitalists', 'Jose', 'William', 'Convalecer', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, NULL, NULL, 'Washington', NULL, NULL, '4356886200', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-13', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1699794594', 0, 'N', 0, '2010-05-24', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001601', 'W12001601', 'UTPEHP', 'Dixie Hospitalists', 'Don', 'J', 'Neer', 'MD', 'Hospitalist', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-17', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104972819', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001603', 'W12001603', 'UTPEHP', 'Intermountain Womens Health Specialists', 'Richard', 'W', 'Ott', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', NULL, NULL, NULL, 'Washington', NULL, NULL, '4356884600', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, NULL, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003816927', 0, 'N', 0, '2008-11-03', NULL, NULL, 0, 0, NULL, NULL),
('264241796', 'W12001615', 'W12001615', 'WY01', 'Big Horn Family Medicine', 'Edward', 'D', 'Zimmerman', 'MD', 'Family Practice', '', '', NULL, 'O', ' 316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073478885', '3073472428', ' 316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073478885', '3073472428', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1386646669', 0, 'N', 0, '2014-05-22', NULL, NULL, 44.0191, -107.956, NULL, NULL),
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('621801973', 'W12001147', 'W12001147', 'UT01', 'Copper Canyon Womens Center', 'May', '', 'Chambers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', '8019649894', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', '8019649894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-14', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669512026', 0, 'N', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12001142', 'W12001142', 'UT01', 'Jordan Valley Medical Center', 'Paul', 'E', 'Pilgram', 'MD', 'Internal Medicine', 'Emergency Medicine', 'Sports Medicine', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8015618888', '8015623123', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8015618888', '8015623123', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2010-10-31', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1265490791', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12001290', 'W12001290', 'UT01', 'Ashley Regional Internal Medicine', 'Jon', 'W', 'Hughes', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4357899272', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4357899272', '', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-05', '2013-05-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851382493', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('870653551', 'W12001293', 'W12001293', 'UT01', 'Park City Health Care', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '          ', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('800255566', 'W12001822', 'W12001822', 'TX01', 'Alamo Mental Health Group', 'Vikram', '', 'Kashyap', 'MD', 'Pediatric Psychiatry', '', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', '', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', '', '78229', '2106148400', '          ', 'TXMHMD10', '', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255324083', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12001196', 'W12001196', '', 'After Hours Medical Company', 'Darron', 'T', 'Smith', 'PA', 'Urgent Care', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1982881181', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'W12001620', 'W12001620', 'UT01', 'Tanner Memorial Clinic', 'Nisha', '', 'Baur', 'DO', 'Pediatrics', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780838789', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('742763430', 'W12001625', 'W12001625', 'TX01', 'Allergy Asthma and Immunology Associates of South Texas', 'Erika', 'G', 'Gonzalez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', NULL, '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427022516', 0, 'N', 0, '2013-08-06', NULL, NULL, 29.6182, -98.4941, NULL, NULL),
('742763430', 'W12001623', 'W12001623', 'TX01', 'Allergy Asthma and Immunology Associates of South Texas', 'Erika', 'G', 'Gonzalez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2414 Babcock Rd Ste 109', 'San Antonio', 'Bexar', 'TX', '72229', '2106160882', NULL, '2414 Babcock Rd Ste 109', 'San Antonio', 'Bexar', 'TX', '72229', '2106160882', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427022516', 0, 'N', 0, '2013-08-06', NULL, NULL, 29.5057, -98.5856, NULL, NULL),
('742763430', 'W12001624', 'W12001624', 'TX01', 'Allergy Asthma and Immunology Associates of South Texas', 'Erika', 'G', 'Gonzalez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', NULL, '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427022516', 0, 'N', 0, '2013-08-06', NULL, NULL, 29.3528, -98.5466, NULL, NULL),
('753031794', 'W12001636', 'W12001636', 'WY01', 'Clear Image Vision Care', 'Kirby', 'T', 'Treat', 'OD', 'Optometry', '', '', NULL, 'O', '610 S 12 th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, '610 S 12 th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-05-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386836302', 0, 'N', 0, '2014-02-06', NULL, NULL, 44.0111, -107.954, NULL, NULL),
('621801973', 'W12001641', 'W12001641', 'UT01', 'Heritage Park Care Center', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '2700 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8018259731', '8011728422', '2700 W 5600 S', 'Roy', 'Davis', 'UT', '84067', '8018259731', '8011728422', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-09', '2014-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2009-06-15', NULL, NULL, 41.1617, -112.045, NULL, NULL),
('621801973', 'W12001640', 'W12001640', 'UT01', 'South Davis Community Hospital', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012945877', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012945877', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-15', '2014-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2009-06-15', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('621801973', 'W12001642', 'W12001642', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'B', 'Po Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'Po Box 281415', 'Atlanta', 'Davis', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-05-18', '2014-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2009-06-15', NULL, NULL, 0, 0, NULL, NULL),
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('741967809', 'W12001644', 'W12001644', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-07-15', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 29.5159, -98.5758, NULL, NULL),
('741967809', 'W12001645', 'W12001645', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'M', '8415 Datapoint Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8415 Datapoint Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-07-15', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W12001646', 'W12001646', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-07-15', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12001647', 'W12001647', 'UT01', 'Utah County Surgical Associates', 'Brian', '', 'Gill', 'MD', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164528717', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('263707046', 'W12001648', 'W12001648', 'UT01', 'Coral Desert Spine Surgery', 'Stephen', 'M', 'Hansen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-11-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1164491460', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'W12001649', 'W12001649', 'UT01', 'Health Clinics of Utah', 'Steven', 'A', 'Mickelson', 'NP', 'Family Practice', '', '', NULL, 'O', '150 E Ctr Ste 1100', 'Provo', 'Utah', 'UT', '84606', '8013747011', '8013747009', '150 E Ctr Ste 1100', 'Provo', 'Utah', 'UT', '84606', '8013747011', '8013747009', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982669982', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.2337, -111.656, NULL, NULL),
('870283830', 'W12001651', 'W12001651', 'UT01', 'Intermountain Allergy', 'Eric ', 'C', 'Chenworth', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '150 S 1000 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013634071', NULL, '150 S 1000 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013634071', '          ', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-12', '2013-03-25', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700859907', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12001652', 'W12001652', 'WY01', 'Sweetwater Medical Group', 'Augusto', 'G', 'Jamias', 'MD', 'General Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2010-10-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1700045358', 0, 'N', 0, '2014-03-04', NULL, NULL, 41.584, -109.232, NULL, NULL),
('549724555', 'W12001654', 'W12001654', 'ID03', 'Cody Accupuncture Clinic', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '12 Walnut E', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '          ', '12 Walnut E', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '          ', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('549724555', 'W12001653', 'W12001653', 'ID03', 'Sockeyes Square Bld', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '333 Main St Ste 104', 'Ketchum', 'Blaine', 'ID', '83340', '2087201787', NULL, '333 Main St Ste 104', 'Ketchum', 'Blaine', 'ID', '83340', '2087201787', '', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('549724555', 'W12001655', 'W12001655', 'ID03', 'Cody Accupuncture Clinic', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 652', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '          ', 'PO Box 652', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '          ', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('549724555', 'W12001656', 'W12001656', 'Sinclair', 'Cody Accupuncter Clinic (Sinclair Health Services Provider)', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '12 Walnut E', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', NULL, '12 Walnut E', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('549724555', 'W12001657', 'W12001657', 'Sinclair', 'Sockeyes Square Bld (Sinclair Health Services Provider)', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '333 Main St', 'Ketchum', 'Blaine', 'ID', '83340', '2087201787', NULL, '333 Main St', 'Ketchum', 'Blaine', 'ID', '83340', '2087201787', '', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('549724555', 'W12001658', 'W12001658', 'Sinclair', 'Cody Accupuncter Clinic (Sinclair Health Services Provider)', 'Roberta', 'M', 'Sawyer', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', 'Po Box 652', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', NULL, 'Po Box 652', 'Hailey', 'Blaine', 'ID', '83333', '2087884611', '', 'SINCLAIRMA1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386766236', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001661', 'W12001661', 'UT01', 'Community Health Centers Inc', 'Diane', 'E', 'Ellis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014126939', '          ', '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014126939', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-18', '2012-04-02', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447448865', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('800350980', 'W12001663', 'W12001663', 'UTMH1', 'Life Mosaics Family Counseling', 'Rodger', 'D', 'Bischoff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '218 N Center St Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017703030', '8017702839', '218 N Center St Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-12', '2011-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770594350', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001660', 'W12001660', 'UT01', 'Central City Clinic Medical', 'Diane', 'E', 'Ellis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-18', '2012-04-02', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447448865', 0, 'N', 0, '2014-04-25', NULL, NULL, 40.7593, -111.88, NULL, NULL),
('742412898', 'W12001666', 'W12001666', 'UT01', 'Community Health Centers', 'Christian', 'P', 'Hyer', 'PA', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', '1798 S W Temple', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2014-04-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164672549', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001665', 'W12001665', 'UT01', 'Central City', 'Christian', 'P', 'Hyer', 'PA', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2014-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164672549', 0, 'Y', 0, '2014-06-04', NULL, NULL, 40.7593, -111.88, NULL, NULL),
('870678993', 'W12001667', 'W12001667', 'UT01', 'Families First Pediatrics', 'Tiffany', 'A', 'Thomas', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790939866', 0, 'N', 0, '2012-08-20', NULL, NULL, 40.5622, -111.928, NULL, NULL),
('870678993', 'W12001668', 'W12001668', 'UT01', 'Families First Pediatrics', 'Tiffany', 'A', 'Thomas', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790939866', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001669', 'W12001669', 'UT01', 'Stephen D Ratcliffe Clinic', 'Amanda', 'C', 'Van Gils', 'PA', 'Family Practice', '', '', NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2012-12-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215186077', 0, 'N', 0, '2014-04-11', NULL, NULL, 40.791, -111.931, NULL, NULL),
('742412898', 'W12001670', 'W12001670', 'UT01', 'Community Health Centers', 'Amanda', 'C', 'Van Gils', 'PA', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2012-12-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215186077', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W12002417', 'W12002417', 'UTMH1', 'Clinical Consultants LLC', 'Christina', '', 'Jacketta', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7601 Redwood Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', NULL, '7601 Redwood Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-06-22', '2011-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669646626', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'W12001673', 'W12001673', 'UT01', 'Mountain West Cardiovascular Associates', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'B', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016763776', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016763776', '8012664174', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'W12001672', 'W12001672', 'UT01', 'Mountain West Cardiovascular Associates', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', NULL, '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('271647689', 'W12001674', 'W12001674', 'UT01', '', 'Jeffrey', 'J', 'Nelson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', NULL, '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1649433608', 0, 'N', 0, '2011-11-17', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('201207626', 'W12001675', 'W12001675', 'WY01', 'Fremont Family Practice', 'Wilson', '', 'Bernales', 'MD', 'Family Practice', '', '', NULL, 'O', '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', NULL, '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-03-12', '2010-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508824467', 0, 'N', 1, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12001676', 'W12001676', 'WY01', 'Lander Medical Clinic', 'Roger', '', 'Brecheen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-12-15', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720039357', 0, 'Y', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870354540', 'W12001678', 'W12001678', 'UT01', 'ENT Specialists', 'Wesley', 'R', 'Brown', 'MD', 'General Practice', '', '', NULL, 'O', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358826448', NULL, '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358826448', '', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932229416', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.5651, -112.298, NULL, NULL),
('870354540', 'W12001677', 'W12001677', 'UT01', 'ENT Specialists', 'Wesley', 'R', 'Brown', 'MD', 'General Practice', '', '', NULL, 'O', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', NULL, '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', '', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932229416', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('810587644', 'W12001679', 'W12001679', 'UT01', 'Cache Valley Community Health Ctr', 'F. Michael', '', 'Crane', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770724841', 0, 'N', 0, '2014-03-11', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('830236761', 'W12001680', 'W12001680', 'WY01', 'Fremont Orthopedics', 'Chris', '', 'Erschen', 'PA', 'Physician Assistant', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '          ', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811099450', 0, 'N', 0, '2012-06-08', NULL, NULL, 42.8241, -108.718, NULL, NULL),
('721545000', 'W12001681', 'W12001681', 'UT01', 'Dinosaurland Pediatrics', 'Tracy', 'B', 'Gelske', 'MD', 'Pediatrics', '', '', NULL, 'O', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-10-01', 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1134245442', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('262388378', 'W12001685', 'W12001685', 'UT01', 'Utah Endocrinology Associates PLLC', 'Bruce', 'R', 'Brady', 'MD', 'Endocrinology', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467474676', 0, 'N', 0, '2010-10-08', NULL, NULL, 40.6871, -111.878, NULL, NULL),
('262388378', 'W12001684', 'W12001684', 'UT01', 'Utah Endocrinology Associates PLLC', 'Bruce', 'R', 'Brady', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 571800', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012699939', NULL, 'PO Box 571800', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012699939', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467474676', 0, 'N', 0, '2010-10-08', NULL, NULL, 0, 0, NULL, NULL),
('830303520', 'W12001687', 'W12001687', 'WY01', 'Northwest Wyoming Family Planning', 'Sonja', 'M', 'Hein', 'PA', 'Family Practice', '', '', NULL, 'O', '1231 Rumsey Ave', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', '1231 Rumsey Ave', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902959265', 0, 'N', 0, '2014-06-04', NULL, NULL, 44.5271, -109.063, NULL, NULL),
('830303520', 'W12001688', 'W12001688', 'WY01', 'Northwest Wyoming Family Planning', 'Sonja', 'M', 'Hein', 'PA', 'Family Practice', '', '', NULL, 'O', '246 N Hamilton', 'Powell', 'Park', 'WY', '82435', '3077545023', '3075275286', '246 N Hamilton', 'Powell', 'Park', 'WY', '82435', '3077545023', '3075275286', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902959265', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830303520', 'W12001689', 'W12001689', 'WY01', 'Northwest Wyoming Family Planning', 'Sonja', 'M', 'Hein', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 941', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', 'PO Box 941', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902959265', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('260043031', 'W12001690', 'W12001690', 'UT01', 'Utah Hematology Oncology PC', 'Deanna', 'L', 'Bojanower', 'NP', 'Hematology and Oncology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1685', 'Ogden', 'Weber', 'UT', '84403', '8013877150', '8013877155', '4403 Harrison Blvd Ste 1685', 'Ogden', 'Weber', 'UT', '84403', '8013877150', '8013877155', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780886945', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870503286', 'W12001691', 'W12001691', 'UT01', 'Hearing Zone', 'Jennie', '', 'Mollerup', 'AUD', 'Audiology', '', '', NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376662791', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'W12001692', 'W12001692', 'UT01', 'Hearing Zone', 'Jennie', '', 'Mollerup', 'AUD', 'Audiology', '', '', NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376662791', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('263981143', 'W12001694', 'W12001694', 'UT01', 'Peak ENT Associates LLC', 'Steven', 'M', 'Sobol', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356157500', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356157500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-08-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598722712', 0, 'N', 0, '2011-11-30', NULL, NULL, 0, 0, NULL, NULL),
('261752159', 'W12001695', 'W12001695', 'UTMH1', 'Hope Haven Counseling', 'Lydia', '', 'Midgley', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', NULL, '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730382847', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001696', 'W12001696', 'WYBILLINGS', 'Billings Clinic - West End', 'Sally', '', 'Carey', '', 'Physical Therapy', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2010-05-25', '2014-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073832473', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001736', 'W12001736', 'UTIHC04', 'Sleep Medicine Department', 'Howard', 'M', 'Leaman', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043316102', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('942854057', 'W12001742', 'W12001742', 'UTIHC04', 'Bear River Valley Hospital', 'Layne', 'T', 'Summers', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'o', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '8012074515', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '8012074515', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528087848', 0, 'N', 0, '2010-06-01', NULL, NULL, 41.7162, -112.201, NULL, NULL),
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('820200896', 'W12001782', 'W12001782', 'ID01', 'Saint Alphonsus Medical Center-Nampa Family Birthing Center', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '1603-C 12th Avenue Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635940', '', '1603-C 12th Avenue Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635940', '', '', '', '', '0.00', '22.00', '0.00', 6, '2010-06-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('820200896', 'W12001785', 'W12001785', 'ID01', 'Mercy Medical Center Billing', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'B', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2084635038', '', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2084635038', '', '', '', '', '0.00', '22.00', '0.00', 6, '2010-06-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870656518', 'W12001794', 'W12001794', 'TX01', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8007754372', NULL, 'Phone Number Only', '', '', '', '', '8007754372', '          ', 'WCSTDSC', '', '', '0.00', '35.00', '0.00', 3, '2010-05-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
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('273780965', 'W12006270', 'W12006270', 'UT01', 'Alpine Spine Center LLC', 'David', 'M', 'Hammond', 'DC', 'Chiropractic', '', '', NULL, 'O', '5991 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015651155', '8012815583', '5991 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015651155', '8012815583', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457372005', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12003166', 'W12003166', 'WY01', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2010-05-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W12001809', 'W12001809', 'Sinclair', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'O', '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W12001812', 'W12001812', 'Sinclair', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('270980493', 'W12001813', 'W12001813', 'WY01', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('520193199', 'W12001814', 'W12001814', 'WY01', 'LS Educational and Psychoeducational Services', 'Liza', 'D', 'Sanderson', 'LPC', 'Mental Health', '', '', NULL, 'O', '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', NULL, '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2010-11-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1447584511', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001817', 'W12001817', 'UT01', 'Copperview Clinic', 'Brian', 'K', 'Connolly', 'PA-C', 'Family Practice', '', '', NULL, 'M', '1798 S W Temple', 'Midvale', 'Salt Lake', 'UT', '84115', '8015665494', '8015619647', '1798 S W Temple', 'Midvale', 'Salt Lake', 'UT', '84115', '8015665494', '8015619647', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922024926', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12001816', 'W12001816', 'UT01', 'Copperview Clinic', 'Brian', 'K', 'Connolly', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8446 S Harrison St', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', '8446 S Harrison St', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922024926', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('260043031', 'W12001633', 'W12001633', 'UT01', 'Utah Hematology Oncology PC', 'Jan', 'W', 'Davis', 'NP', 'General Surgery', 'Hematology and Oncology', '', NULL, 'B', '4403 Harrison Blvd Ste 1685', 'Ogden', 'Weber', 'UT', '84403', '8013877150', '8013877155', '4403 Harrison Blvd Ste 1685', 'Ogden', 'Weber', 'UT', '84403', '8013877150', '8013877155', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1821171786', 0, 'N', 0, '2011-12-21', NULL, NULL, 0, 0, NULL, NULL),
('260043031', 'W12001632', 'W12001632', 'UT01', 'Utah Hematology Oncology PC', 'Jan', 'W', 'Davis', 'NP', 'General Surgery', 'Hematology and Oncology', '', NULL, 'O', '5290 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014761777', NULL, '5290 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014761777', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1821171786', 0, 'N', 0, '2011-12-21', NULL, NULL, 41.1688, -111.971, NULL, NULL),
('262388378', 'W12001635', 'W12001635', 'UT01', 'Utah Endocrinology Associates', 'James', 'R', 'Grua', 'MD', 'Endocrinology', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134159288', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('262388378', 'W12001634', 'W12001634', 'UT01', 'Utah Endocrinology Associates', 'James', 'R', 'Grua', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 571800', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017472800', NULL, 'PO Box 571800', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017472800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134159288', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('870649259', 'W12001819', 'W12001819', 'UT01', 'Alpine Orthopaedic Specialists', 'Jared', 'C', 'Shippee', 'DPM', 'Podiatry', '', '', NULL, 'O', '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357239700', '4357239710', '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357239700', '4357239710', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871637033', 0, 'N', 0, '2014-07-22', NULL, NULL, 41.4751, -112.025, NULL, NULL),
('870649259', 'W12001820', 'W12001820', 'UT01', 'Alpine Orthopaedic Specialists', 'Jared', 'C', 'Shippee', 'DPM', 'Podiatry', '', '', NULL, 'O', '2310 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', '2310 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871637033', 0, 'N', 0, '2014-07-22', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'W12001821', 'W12001821', 'UT01', 'Alpine Orthopaedic Specialists', 'Jared', 'C', 'Shippee', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 6250', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', 'PO Box 6250', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871637033', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('260231993', 'W12001823', 'W12001823', 'WY01', 'Central Wyoming Therapy', 'Cheryl', 'A', 'Keffeler', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', NULL, '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1649328873', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.8487, -106.324, NULL, NULL),
('870179340', 'W12001829', 'W12001829', 'UT01', 'Standard Optical', 'Mitchell', 'E', 'Pebley', 'OD', 'Optometry', '', '', NULL, 'M', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '841119', '8015061111', '8015062021', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '841119', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-01', '2010-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1710115332', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W12001824', 'W12001824', 'UT01', 'Utah State University- Language Hearing Center', 'Lila', 'J', 'Littledike', 'AUD', 'Speech Therapy', '', '', NULL, 'O', ' 1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '4357970221', ' 1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1912149600', 0, 'Y', 0, '2013-11-20', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('260231993', 'W12001825', 'W12001825', 'Sinclair', 'Central Wyoming Therapy', 'Cheryl', 'A', 'Keffeler', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', NULL, '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1649328873', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12001826', 'W12001826', 'UTMH1', 'LDS Family Services', 'Keith', '', 'Louw', 'LMFT', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2010-07-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1063545648', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('262053980', 'W12001827', 'W12001827', 'WY01', 'Coal Country Clinic', 'Lori', 'E', 'McKinsey', 'FNP', 'Family Practice', '', '', NULL, 'O', '1206 W 4th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076823004', '3076823004', '1206 W 4th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076823004', '3076823004', 'WISEWYSTD', 'WISESTD', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2010-09-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730186255', 0, 'N', 0, '2012-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12001828', 'W12001828', 'UT01', 'Standard Optical', 'Mitchell', 'E', 'Pebley', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-01', '2010-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1710115332', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('201207626', 'W12001830', 'W12001830', 'WY01', 'Fremont Family Practice', 'Gerald', '', 'Stopczynski', 'DO', 'Family Practice', '', '', NULL, 'O', '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', '3078577071', '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', '3078577071', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1528025780', 0, 'N', 1, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12001831', 'W12001831', 'UT01', 'Central Utah Clinic', 'Aaron ', 'N', 'Weaver', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W 101 bldg C', 'Provo', 'Utah', 'UT', '84604', '8013734366', NULL, '1055 N 500 W 101 bldg C', 'Provo', 'Utah', 'UT', '84604', '8013734366', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1750594222', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12001832', 'W12001832', 'UT01', 'Central Utah Clinic', 'Aaron ', 'N', 'Weaver', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'Po Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013734366', NULL, 'Po Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013734366', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1750594222', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12001836', 'W12001836', 'UT01', 'South Ogden Center for Family Medicine', 'James', 'A', 'Bledsoe', 'DO', 'Family Practice', '', '', NULL, 'O', '5740 Ogden Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Ogden Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1669467544', 0, 'Y', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870570172', 'W12001838', 'W12001838', 'UT01', 'Bear River Medical Arts', 'Jennifer', '', 'Sorensen', '', 'Family Practice', '', '', NULL, 'O', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', NULL, '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1871743369', 0, 'N', 1, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('270624464', 'W12001839', 'W12001839', 'WY01', 'Unitah General Surgery', 'Jared', 'B', 'Barton', 'MD', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WISEWYSTD', 'WYSTD', '', '0.00', '35.00', '0.00', 3, '2010-06-02', '2012-08-19', 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1144328949', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001840', 'W12001840', 'WYBILLINGS', 'Billings Clinic - Occupational Health and Wellness', 'Stephanie', 'W', 'Stoke', 'md', 'Occupational Medicine', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062476240', '1020 N 27th St  ', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062476240', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1285894998', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001841', 'W12001841', 'WYBILLINGS', 'Billings Clinic - Occupational Health and Wellness', 'Stephanie', 'W', 'Stoke', 'md', 'Occupational Medicine', '', '', NULL, 'M', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062476240', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062476240', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1285894998', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001842', 'W12001842', 'WYBILLINGS', 'Behavioral Health Clinic', 'Elizabeth', 'A', 'Walter', 'MD', 'Mental Health', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062525430', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062525430', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1144239385', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001843', 'W12001843', 'WYBILLINGS', 'Behavioral Health Clinic', 'Elizabeth', 'A', 'Walter', 'MD', 'Mental Health', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062525430', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062525430', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1144239385', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('352163112', 'W12001844', 'W12001844', 'UT01', 'Southeast Utah Community Health Center', 'Karen', 'W', 'Whittemore', 'NP', 'Family Practice', '', '', NULL, 'O', '168 N 100 E Ste 101', 'St George', 'Washington', 'UT', '84770', '4359862565', '4359862577', '168 N 100 E Ste 101', 'St George', 'Washington', 'UT', '84770', '4359862565', '4359862577', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|DEN|', '1033153341', 0, 'N', 0, '2014-06-17', NULL, NULL, 37.1111, -113.581, NULL, NULL),
('352163112', 'W12001845', 'W12001845', 'UT01', 'Cedar City Community Clinic', 'Karen', 'W', 'Whittemore', 'NP', 'Family Practice', '', '', NULL, 'O', '74 W Harding Ave', 'Cedar City', 'Iron', 'UT', '84720', '4358651387', '4358656357', '74 W Harding Ave', 'Cedar City', 'Iron', 'UT', '84720', '4358651387', '4358656357', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|DEN|', '1033153341', 0, 'N', 0, '2014-06-17', NULL, NULL, 37.6785, -113.063, NULL, NULL),
('810231784', 'W12001846', 'W12001846', 'WYBILLINGS', 'Billings Clinic ', 'Michael', 'S', 'Englehart', '', 'General Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1932355054', 0, 'N', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001848', 'W12001848', 'WYBILLINGS', 'Billings Clinic ', 'Michael', 'S', 'Englehart', '', 'General Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '4062382648', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '4062382648', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1932355054', 0, 'N', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001847', 'W12001847', 'WYBILLINGS', 'Billings Clinic ', 'Michael', 'S', 'Englehart', '', 'General Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382501', '4062382648', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382501', '4062382648', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1932355054', 0, 'N', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12001849', 'W12001849', 'TX01', 'Health Texas Medical Group of San Antonio', 'Iveth', '', 'Soza', 'DO', 'Family Practice', '', '', NULL, 'O', '2911 S New Braunfels', 'San Antonio', 'Bexar', 'TX', '78210', '2105320891', '2105320717', '2911 S New Braunfels', 'San Antonio', 'Bexar', 'TX', '78210', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467421875', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.3905, -98.4615, NULL, NULL),
('202148889', 'W12001850', 'W12001850', 'TX01', 'Health Texas Medical Group of San Antonio', 'Iveth', '', 'Soza', 'DO', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 780', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', '6243 IH 10 W Ste 780', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1467421875', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12001851', 'W12001851', 'TX01', 'Health Texas Medical Group of San Antonio', 'Iveth', '', 'Soza', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1467421875', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12001853', 'W12001853', 'UT01', 'UUHC - Westridge Center', 'Scott', 'D', 'Miller', 'OD', 'Optometry', '', '', NULL, 'O', '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139200', '8012139205', '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139200', '8012139205', 'WUNIVOP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-20', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982831632', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12001852', 'W12001852', 'UT01', 'UUHC - Westridge Center', 'Scott', 'D', 'Miller', 'OD', 'Optometry', '', '', NULL, 'O', '3730 W 4700 S', 'West Valley City', 'Salt Lake', 'UT', '84118', '8012139200', '8012139205', '3730 W 4700 S', 'West Valley City', 'Salt Lake', 'UT', '84118', '8012139200', '8012139205', 'WUNIVOP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-20', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982831632', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12001854', 'W12001854', 'UT01', 'U of U Hopital Therapy Services', 'Collin', 'K', 'Shepherd', '', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015872121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015872121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-05-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1205169091', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12001856', 'W12001856', 'UT01', 'U of U Hopital Therapy Services', 'Collin', 'K', 'Shepherd', '', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015872121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015872121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-05-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1205169091', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12001857', 'W12001857', 'UT01', 'U of U Hospital Therapy Services ', 'Rachel', 'L', 'Tharpe', '', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015872121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015872121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-05-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1407099377', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12001858', 'W12001858', 'UT01', 'U of U Hospital Therapy Services ', 'Rachel', 'L', 'Tharpe', '', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015872121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015872121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-05-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1407099377', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12001859', 'W12001859', 'UT01', 'U of U Hospital Therapy Services', 'Spencer', '', 'Thompson', '', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1962727727', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12001860', 'W12001860', 'UT01', 'U of U Hospital Therapy Services', 'Spencer', '', 'Thompson', '', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2010-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1962727727', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870636424', 'W12001863', 'W12001863', 'UT01', 'Grantsville Medical Clinic', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 1060', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, 'PO Box 1060', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|DEN|', '1639221526', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12001866', 'W12001866', 'UT01', 'Mountain West Gastroenterology', 'D Rayburn ', '', 'Moore', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1215969837', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12001865', 'W12001865', 'UT01', 'Mountain West Gastroenterology', 'D Rayburn ', '', 'Moore', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', NULL, '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1215969837', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12001867', 'W12001867', 'UT01', 'Mountain West Gastroenterology', 'D Rayburn ', '', 'Moore', 'MD', 'Gastroenterology', '', '', NULL, 'M', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012854850', NULL, '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012854850', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1215969837', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12001558', 'W12001558', 'UTMH1', 'LDS Family Services', 'Mike', '', 'Fitch', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2010-07-15', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225204159', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12001868', 'W12001868', 'UTMH1', 'Davis Comprehensive Health Psych', 'Julie', 'K', 'Krause', '', 'Mental Health', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1679777148', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12001869', 'W12001869', 'UTMH1', 'Davis Comprehensive Health Psych', 'Julie', 'K', 'Krause', '', 'Mental Health', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'Atlanta', 'Fulton', 'GA', '84095', '8018077377', NULL, '406 W South Jordan Pkwy Ste 450', 'Atlanta', 'Fulton', 'GA', '84095', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1679777148', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('544662808', 'W12001871', 'W12001871', 'Sinclair', '(Sinclair Health Services Provider)', 'Janice', 'W', 'Payne', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '416 S Main Ste B-3', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', NULL, '416 S Main Ste B-3', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1003006883', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('544662808', 'W12001873', 'W12001873', 'Sinclair', '', 'Janice', 'W', 'Payne', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 3856 ', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', NULL, 'PO Box 3856 ', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1003006883', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('544662808', 'W12001870', 'W12001870', 'WY01', '', 'Janice', 'W', 'Payne', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '416 S Main Ste B-3', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', NULL, '416 S Main Ste B-3', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1003006883', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('544662808', 'W12001874', 'W12001874', 'WY01', '', 'Janice', 'W', 'Payne', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 3856 ', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', NULL, 'PO Box 3856 ', 'Hailey', 'Blaine', 'ID', '83333', '2087883130', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2010-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1003006883', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('352332742', 'W12001875', 'W12001875', 'ID02', 'Healthy Habits Wellness Clinic', 'Paul', 'A', 'Stadler', 'DC', 'Chiropractic', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088550289', '2088876331', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088550289', '2088876331', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1114246238', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001876', 'W12001876', 'WYBILLINGS', 'Billings Clinic ', 'Jeffrey ', 'M', 'Williams', 'MD', 'Dermatology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', '', '', '', '0.00', '17.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1538371133', 0, 'N', 0, '2010-11-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12001877', 'W12001877', 'WYBILLINGS', 'Billings Clinic ', 'Jeffrey ', 'M', 'Williams', 'MD', 'Dermatology', '', '', NULL, 'M', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', '', '', '', '0.00', '17.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1538371133', 0, 'N', 0, '2010-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W12001878', 'W12001878', 'UTMH1', 'Axis One Inc.', 'Michael', 'J', 'Beaudoin', 'LCSW', 'Mental Health', '', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1306928080', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W12001879', 'W12001879', 'UTMH1', 'Axis One Inc.', 'Michael', 'J', 'Beaudoin', 'LCSW', 'Mental Health', '', '', NULL, 'O', '60 S Main Ste 109', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230210', NULL, '60 S Main Ste 109', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230210', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1306928080', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12001269', 'W12001269', 'ID02', 'Primary Health Medical Group', 'Jon', 'E', 'Perry', 'PA', 'Family Practice', '', '', NULL, 'O', '1825 Kimball Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', NULL, '1825 Kimball Ave  ', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '          ', 'IDSTDPPO', '', '', '0.00', '30.00', '0.00', 3, '2010-04-20', '2011-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740376102', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6537, -116.698, NULL, NULL),
('202630141', 'W12001271', 'W12001271', 'ID02', 'Primary Health Medical Group', 'Jon', 'E', 'Perry', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', NULL, 'PO Box 191050   ', 'Boise', 'Ada', 'ID', '83719', '2084553545', '          ', 'IDSTDPPO', '', '', '0.00', '30.00', '0.00', 3, '2010-04-20', '2011-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740376102', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W12001880', 'W12001880', 'UT01', 'Lifetree Pain Clinic', 'Steven ', 'C', 'Pulley', 'MD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', 'WUSTDPAIN5', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2010-12-31', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1104037878', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W12001881', 'W12001881', 'UT01', 'Lifetree Pain Clinic', 'Steven ', 'C', 'Pulley', 'MD', 'Pain Management', '', '', NULL, 'M', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699427', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699427', 'WUSTDPAIN5', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2010-12-31', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1104037878', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('271920709', 'W12001882', 'W12001882', 'UT01', 'MTD Medical Services ', 'Jonathan', 'F', 'Koehler', 'MD', 'Family Practice', 'Pathology', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357165489', '4357165442', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357165489', '4357165442', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144250705', 0, 'N', 0, '2010-11-05', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('953134847', 'W12001884', 'W12001884', 'ID02', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'O', ' 868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '2089396442', ' 868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-06-01', '2010-12-08', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W12001885', 'W12001885', 'ID02', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'M', '101 E Redlands Blvd Ste 212', 'Redlands', '', 'CA', '92373', '2089396227', '2089396442', '101 E Redlands Blvd Ste 212', 'Redlands', '', 'CA', '92373', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-06-01', '2010-12-08', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W12001886', 'W12001886', 'ID02', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'B', 'Po Box 2150', 'Redlands', '', 'CA', '92373', '2089396227', '2089396442', 'Po Box 2150', 'Redlands', '', 'CA', '92373', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-06-01', '2010-12-08', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('820498010', 'W12001892', 'W12001892', 'ID02', 'Meridian Pain Center', 'Thomas', '', 'Rambow', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3875 E Overland Rd, Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2089557246', '2089557246', '3875 E Overland Rd, Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2089557246', '2089557246', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-04-26', '2012-03-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679534184', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12001893', 'W12001893', 'ID01', 'Saint Alphonsus Medical Group Heart Care Fruitland ', 'Mark', 'G', 'Parent', 'MD', 'Cardiology', '', '', NULL, 'O', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2087278240', '2084522140', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2087278240', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-03-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558301515', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12001894', 'W12001894', 'ID01', 'Saint Alphonsus Medical Group Heart Care Fruitland ', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12001895', 'W12001895', 'ID01', 'Dominican Health Services', 'James', 'W', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-04-08', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1730275876', 0, 'N', 0, '2014-03-24', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12001896', 'W12001896', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-04-26', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12001898', 'W12001898', 'ID01', 'Northwest Pulmonary Saint Alphonsus ', 'Suzanne', 'C', 'Spurgeon', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-04-26', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|', '1407898596', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('260553931', 'W12001899', 'W12001899', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Iowa', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '211 W Iowa Ave', 'Ketchum', 'Blaine', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Ketchum', 'Blaine', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-11-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.4891, -116.589, NULL, NULL),
('260553931', 'W12001900', 'W12001900', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Iowa', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-11-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'Y', 0, '2013-09-17', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('260553931', 'W12001901', 'W12001901', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Iowa', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '211 W Iowa Ave', 'Boise', 'Ada', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Boise', 'Ada', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-11-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001903', 'W12001903', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Jacquie', '', 'Elcox', 'HA', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316118466', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001904', 'W12001904', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Jacquie', '', 'Elcox', 'HA', 'Audiology', '', '', NULL, 'O', '1463 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084634900', '2084656322', '1463 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084634900', '2084656322', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316118466', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001905', 'W12001905', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Jacquie', '', 'Elcox', 'HA', 'Audiology', '', '', NULL, 'O', '52 N Palmetto Rd Ste 106', 'Eagle', 'Ada', 'ID', '83616', '2089383777', '2089384093', '52 N Palmetto Rd Ste 106', 'Eagle', 'Ada', 'ID', '83616', '2089383777', '2089384093', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-07-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316118466', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001907', 'W12001907', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Angela', '', 'Gillentine', 'AUD', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518024918', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001908', 'W12001908', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Angela', '', 'Gillentine', 'AUD', 'Audiology', '', '', NULL, 'O', '1463 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084634900', '2084656322', '1463 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084634900', '2084656322', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518024918', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001909', 'W12001909', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Angela', '', 'Gillentine', 'AUD', 'Audiology', '', '', NULL, 'O', '52 N Palmetto Rd', 'Eagle', 'Ada', 'ID', '83616', '2089383777', '2089384093', '52 N Palmetto Rd', 'Eagle', 'Ada', 'ID', '83616', '2089383777', '2089384093', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518024918', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001911', 'W12001911', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Melvin', '', 'Miller', 'AUD', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164655262', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12001913', 'W12001913', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Curtis', '', 'Whitcomb', 'AUD', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', '2011-09-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1841290640', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12001915', 'W12001915', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'David', '', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2011-03-16', 0, 0, 1, 'West Valley Medical Center', 'Castleview Hospital', '', '', 'HCFA|UB|', '1821066788', 0, 'N', 0, '2011-12-07', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12001916', 'W12001916', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'David', '', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2011-03-16', 0, 0, 1, 'West Valley Medical Center', 'Castleview Hospital', '', '', 'HCFA|UB|', '1821066788', 0, 'Y', 0, '2011-12-07', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12001919', 'W12001919', 'UT01', 'Ashley Valley Physician Practice', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '4357891524', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '4357891524', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('272288227', 'W12002324', 'W12002324', 'UTMH1', '', 'Kyle', 'M', 'Hancock', 'PHD', 'Mental Health', 'Pediatric Psychology', '', NULL, 'O', '246 E 1260 N', 'Logan', 'Cache', 'UT', '84341', '4357506300', '4357538995', '246 E 1260 N', 'Logan', 'Cache', 'UT', '84341', '4357506300', '4357538995', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164748729', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12001922', 'W12001922', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Hillary', '', 'Robinowitz-Elins', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2010-06-30', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1376511394', 0, 'N', 0, '2010-06-17', NULL, NULL, 43.6539, -116.695, 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
('820309671', 'W12001923', 'W12001923', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Hillary', '', 'Robinowitz-Elins', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2010-06-30', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1376511394', 0, 'N', 0, '2010-06-17', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820309671', 'W12001927', 'W12001927', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Michael', '', 'Robinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2014-07-14', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1275533184', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12001926', 'W12001926', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Michael', '', 'Robinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2011-01-01', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1275533184', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('260553931', 'W12001928', 'W12001928', 'ID01', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'W12001931', 'W12001931', 'ID01', 'Saint Alponsus Medical Group Heart Care Caldwell', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'W12001930', 'W12001930', 'ID01', 'Saint Alphonsus Medical group Heart Care Calwell', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820200895', 'W12001932', 'W12001932', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Sheila', 'M', 'Giffen', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-03-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1013957802', 0, 'N', 0, '2013-07-31', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12001933', 'W12001933', 'ID01', 'Dominican Health Services', 'Sheri', 'W', 'Malakhova', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-03-06', '2010-10-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1164464517', 0, 'N', 0, '2009-10-22', NULL, NULL, 44.025, -116.928, NULL, NULL),
('260553931', 'W12001934', 'W12001934', 'ID01', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Beth', '', 'Malasky', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730285719', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820200895', 'W12001935', 'W12001935', 'ID01', 'Idaho Neurology Saint Alphonsus', 'Karin', 'M', 'Lindholm', 'DO', 'Neurology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-01-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1083660583', 0, 'N', 0, '2012-12-28', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820200895', 'W12001937', 'W12001937', 'ID01', 'Idaho Neurology Saint Alphonsus', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205882743', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'W12001938', 'W12001938', 'ID01', 'INI Saint Alphonsus Neurosurgery', 'Phillip', NULL, 'Berryhill', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083674000', '2083678983', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083674000', '2083678983', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2010-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225122690', 0, 'N', 0, '2009-12-29', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'W12001939', 'W12001939', 'ID01', 'Saint Alphonsus Medical Group Neurosurgery Caldwell', 'Ann Marie', '', 'Yost', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083674000', '2083678983', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083674000', '2083678983', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730217704', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820527771', 'W12001941', 'W12001941', 'ID02', 'Pediatric Cardiology', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '111 Broadway Ave Ste 101-165', 'Boise', 'Ada', 'ID', '83702', '2084539962', '2084539963', '111 Broadway Ave Ste 101-165', 'Boise', 'Ada', 'ID', '83702', '2084539962', '2084539963', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-01', '2012-01-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1912950338', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12001946', 'W12001946', 'ID02', 'St Lukes Idaho Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-06-01', '2012-06-11', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001986', 'W12001986', 'UTIHCPHY', 'Logan InstaCare', 'Jeremy', 'W', 'Broadhurst', 'DO', 'Family Practice', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357553300', NULL, '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357553300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-13', '2011-01-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114115664', 0, 'Y', 0, '2010-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12001989', 'W12001989', 'UTIHCPHY', 'Utah Heart', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001990', 'W12001990', 'UTIHCPHY', 'Utah Heart', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12001992', 'W12001992', 'UT01', 'University Health Care', 'Cammon', 'Bart', 'Arrington', 'MD', 'Pediatric Cardiology', 'Pediatrics', NULL, NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-11-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700910114', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
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('320186101', 'W12001995', 'W12001995', 'UT01', 'University Health Care', 'Susan', 'P', 'Etheridge', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-11-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952480527', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12001996', 'W12001996', 'UT01', 'University Health Care', 'Melanie', 'D', 'Everitt', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952480428', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12001997', 'W12001997', 'UT01', 'University Health Care', 'Robert', 'G', 'Gray', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-12-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538283932', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12001998', 'W12001998', 'UT01', 'University Health Care', 'Victoria', 'E', 'Judd', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790864361', 0, 'N', 0, '2012-07-06', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12001999', 'W12001999', 'UT01', 'University Health Care', 'Gordon', 'K', 'Mack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982937058', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12002000', 'W12002000', 'UT01', 'University Health Care', 'Christopher', 'R', 'Mart', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-12-01', '2012-05-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346329810', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12002001', 'W12002001', 'UT01', 'University Health Care', 'Shaji', 'C', 'Menon', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', NULL, '3773  S 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012851440', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-05-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1841278066', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('711048468', 'W12002015', 'W12002015', 'UT01', 'Cheryl Farnsworth Physical Therapy', 'Timothy', '', 'Whitaker', 'DPT', 'Physical Therapy', '', '', NULL, '', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-06-01', '2010-12-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568796084', 0, 'N', 0, '2010-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('870502207', 'W12002032', 'W12002032', 'UT01', 'Wasatch Therapy Inc', 'Robert', 'G', 'Black', '', 'Physical Therapy', '', '', NULL, 'O', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014799865', '8014795846', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014799865', '8014795846', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-06-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1457499428', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12001723', 'W12001723', 'ID01', 'Boise Orthopedic Clinic', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
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('820161600', 'W12002035', 'W12002035', 'ID01', 'Boise Orthopedic Clinic', 'James', 'M', 'Johnston', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114940699', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002036', 'W12002036', 'ID01', 'Boise Orthopedic Clinic', 'James', 'M', 'Johnston', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114940699', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002037', 'W12002037', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002038', 'W12002038', 'ID01', 'Cascade Medical Center', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'B', '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', NULL, '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12002039', 'W12002039', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002040', 'W12002040', 'ID01', 'Boise Orthopedic Clinic', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002041', 'W12002041', 'ID01', 'Cascade Medical Center', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'B', '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', NULL, '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12002042', 'W12002042', 'ID01', 'Boise Orthopedic Clinic', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002043', 'W12002043', 'ID01', 'Boise Orthopedic Clinic', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002044', 'W12002044', 'ID01', 'Boise Orthopedic Clinic', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002045', 'W12002045', 'ID01', 'Boise Orthopedic Clinic', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002046', 'W12002046', 'ID01', 'Boise Orthopedic Clinic', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002047', 'W12002047', 'ID01', 'Boise Orthopedic Clinic', 'Jeffry', 'P', 'Menzner', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Hematology and Oncology', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1487607198', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002048', 'W12002048', 'ID01', 'Boise Orthopedic Clinic', 'Jeffry', 'P', 'Menzner', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Hematology and Oncology', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1487607198', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, 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
('820161600', 'W12002049', 'W12002049', 'ID01', 'Boise Orthopedic Clinic', 'Robert', 'N', 'Walker', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306856471', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002050', 'W12002050', 'ID01', 'Boise Orthopedic Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12002051', 'W12002051', 'ID01', 'Payette Lakes Medical Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', NULL, '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12002052', 'W12002052', 'ID01', 'Boise Orthopedic Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12002053', 'W12002053', 'ID01', 'Elmore Medical Center', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'o', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', NULL, '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.1388, -115.693, NULL, NULL),
('810231784', 'W12002054', 'W12002054', 'WYBILLINGS', 'Billings Clinic - West End', 'Krista', 'R', 'Bakkedahl', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062385218', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062385218', '', '', '', '0.00', '17.00', '0.00', 3, '2010-05-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255583753', 0, 'N', 0, '2010-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870549520', 'W12002057', 'W12002057', 'UTDT01', 'Willow Creek Dental', 'Darin', '', 'Knudson', 'DDS', 'Dentist', 'Pedodontist', '', NULL, 'O', '8757 Highland Dr', 'Sandy', 'Salt Lake', 'UT', '84093', '8019470505', NULL, '8757 Highland Dr', 'Sandy', 'Salt Lake', 'UT', '84093', '8019470505', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007122', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('271840081', 'W12002059', 'W12002059', 'UTDT01', 'Cyprus Family Dental', 'Nicholas', '', 'Cantwell', 'DDS', 'Dentist', '', '', NULL, 'O', '8370 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012500203', NULL, '8370 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012500203', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000002', 0, 'N', 0, '2010-06-21', NULL, NULL, 0, 0, NULL, NULL),
('510509395', 'W12002061', 'W12002061', 'UTDT01', '', 'Rick', '', 'Larson', 'DDS', 'Dentist', '', '', NULL, 'O', '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', NULL, '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'DEN|', '0001000003', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870490873', 'W12002063', 'W12002063', 'UTDT01', '', 'Scot', '', 'Drury', 'DDS', 'Dentist', '', '', NULL, 'O', '1400 Foothill Dr Ste B36', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015829351', NULL, '1400 Foothill Dr Ste B36', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015829351', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000004', 0, 'N', 0, '2010-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870365095', 'W12001630', 'W12001630', 'UT01', 'Kanosh Paiute Medical Clinic', 'Jarid', 'D', 'Gray', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '157 N Reservation Dr', 'Kanosh', 'Millard', 'UT', '84637', '4357592610', '4357592608', '157 N Reservation Dr', 'Kanosh', 'Millard', 'UT', '84637', '4357592610', '4357592608', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1861409120', 0, 'N', 0, '2014-06-16', NULL, NULL, 38.8012, -112.438, NULL, NULL),
('870365095', 'W12001627', 'W12001627', 'UT01', 'Cedar City Paiute Medical Clinic', 'Jarid', 'D', 'Gray', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '440 N Paiute Dr', 'Cedar City', 'Iron', 'UT', '84721', '4358671520', '4358672658', '440 N Paiute Dr', 'Cedar City', 'Iron', 'UT', '84721', '4358671520', '4358672658', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1861409120', 0, 'N', 0, '2014-06-16', NULL, NULL, 37.683, -113.059, NULL, NULL),
('870365095', 'W12001629', 'W12001629', 'UT01', 'Shivwits Paiute Medical Clinic', 'Jarid', 'D', 'Gray', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', '4356888199', '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', '4356888199', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', '2011-10-27', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1861409120', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870365095', 'W12001628', 'W12001628', 'UT01', 'Koosharem Paiute Medical Clinic', 'Jarid', 'D', 'Gray', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '826 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358930977', '4358930981', '826 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358930977', '4358930981', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', '2011-10-13', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1861409120', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12001864', 'W12001864', 'UTMH1', 'Jordan West Family Counseling', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2010-06-01', '2010-10-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12001156', 'W12001156', 'UTMH1', 'Alpine Center for Behavioral Health', 'Richard', 'E', 'Hallam', '', 'Mental Health', 'Counseling', '', NULL, 'O', ' 475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, ' 475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-04-18', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972746006', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12001171', 'W12001171', 'TX01', 'Alamo Mental Health Group', 'Michael', '', 'Castillo', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', '2011-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992734479', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('820445140', 'W12001154', 'W12001154', 'ID01', 'The Eye Associates', 'Adam', '', 'Heiner', '', 'Optometry', '', '', NULL, 'O', ' 1602 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084590717', NULL, ' 1602 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084590717', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-04-19', '2010-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992792469', 0, 'N', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('820445140', 'W12001153', 'W12001153', 'ID01', 'The Eye Associates', 'Adam', '', 'Heiner', '', 'Optometry', '', '', NULL, 'O', '901 N Curtis Rd Ste 302', 'Boise', 'Ada', 'ID', '83706', '2083425151', NULL, '901 N Curtis Rd Ste 302', 'Boise', 'Ada', 'ID', '83706', '2083425151', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-04-19', '2010-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992792469', 0, 'N', 0, '2012-06-08', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('870634173', 'W12002065', 'W12002065', 'UTDT01', 'VIP Tooth Care', 'Clive', '', 'Ingram', '', 'Dentist', '', '', NULL, 'O', '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', NULL, '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'DEN|', '0001000005', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('870364897', 'W12002067', 'W12002067', 'UTDT01', '', 'Don', '', 'Kimball', 'DDS', 'Dentist', '', '', NULL, 'O', '2860 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019681142', NULL, '2860 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019681142', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000006', 0, 'N', 0, '2010-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870634173', 'W12002073', 'W12002073', 'UTDT01', 'VIP Tooth Care', 'Richard', '', 'Ingram', 'DMD', 'Dentist', '', '', NULL, 'O', '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', NULL, '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000009', 0, 'N', 0, '2011-01-06', NULL, NULL, 0, 0, NULL, NULL),
('200887963', 'W12002075', 'W12002075', 'UTDT01', 'Warm Family Dental', 'Scott', '', 'Cold', 'DDS', 'Dentist', '', '', NULL, 'O', '4143 S 1785 W', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019659898', NULL, '4143 S 1785 W', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019659898', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000010', 0, 'N', 0, '2011-12-05', NULL, NULL, 0, 0, NULL, NULL),
('870634173', 'W12002077', 'W12002077', 'UTDT01', 'VIP Tooth Care', 'Shad', '', 'Ingram', '', 'Dentist', '', '', NULL, 'O', '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', NULL, '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000011', 0, 'N', 0, '2011-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870623230', 'W12002079', 'W12002079', 'UTDT01', 'Jordan Landing Dental Care', 'Andrew', '', 'Erickson', 'DMD', 'Dentist', '', '', NULL, 'O', '7611 S Jordan Landing Blvd Ste 201', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012807001', NULL, '7611 S Jordan Landing Blvd Ste 201', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012807001', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000012', 0, 'N', 0, '2011-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('510509395', 'W12002131', 'W12002131', 'UTDT01', 'Canyon River Dental', 'Robert', '', 'Guenter', 'DDS', 'Dentist', '', '', NULL, 'O', '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', NULL, '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-06-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000006503', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('202161972', 'W12002142', 'W12002142', 'UTDT01', 'Alpine Family Dentistry', 'Ralph', '', 'Ogilvie', 'DMD', 'Dentist', '', '', NULL, 'O', '425 E 1200 S', 'Heber City', 'Wasatch', 'UT', '84032', '8016544004', NULL, '425 E 1200 S', 'Heber City', 'Wasatch', 'UT', '84032', '8016544004', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000036', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12002182', 'W12002182', 'UTIHCPHY', 'Snow College Clinic', 'Tristy', 'L', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'o', '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', NULL, '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2010-11-01', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093753469', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12002192', 'W12002192', 'UTIHCPHY', 'Sunset InstaCare', 'Daniel', '', 'Davie', 'MD', 'Urgent Care', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', NULL, '1739 W Sunset Blvd', 'Saint George', 'Washington', 'UT', '84770', '4356346050', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356376677', 0, 'Y', 0, '2010-06-24', NULL, NULL, 37.1227, -113.62, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12002194', 'W12002194', 'UTIHCPHY', 'Bountiful KidsCare', 'Daniel', 'W', 'Davis', '', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083652242', 0, 'Y', 0, '2010-06-24', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002196', 'W12002196', 'UTIHCPHY', 'Valley View Radiation Oncology', 'Craig', 'W', 'Donaldson', 'MD', 'Radiation Oncology', '', '', NULL, 'o', '1303 N Main', 'St George', 'Washington', 'UT', '84720', '4356884175', NULL, '1303 N Main', 'St George', 'Washington', 'UT', '84720', '4356884175', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295753325', 0, 'N', 0, '2008-05-14', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12002198', 'W12002198', 'UTIHC04', 'River Road InstaCare', 'Steven', 'L', 'Embley', 'DO', 'Family Practice', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2009-07-01', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1760672000', 0, 'Y', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002199', 'W12002199', 'UTIHCPHY', 'Heber Valley Clinic', 'Jill', 'B', 'Faatz', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417981002', 0, 'Y', 0, '2010-09-23', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12002200', 'W12002200', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'A Jennifer', '', 'Fischbach', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5121 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', '5121 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', '2008-04-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1528017456', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002201', 'W12002201', 'UTIHCPHY', 'Dixie Hospitalists', 'Karen', 'M', 'Frieden', 'MD', '', 'Hospitalist', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-01', '2010-07-09', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043289820', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002202', 'W12002202', 'UTIHCPHY', 'River Road InstaCare', 'Jed', 'R', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861452542', 0, 'Y', 0, '2012-02-29', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12002203', 'W12002203', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'Dixie', 'Lee', 'Harris', 'MD', 'Pulmonary', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740296730', 0, 'N', 0, '2008-07-29', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12002204', 'W12002204', 'UTIHCPHY', 'Bountiful KidsCare', 'James', 'H', 'Hart', 'MD', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730168329', 0, 'Y', 0, '2007-11-05', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002205', 'W12002205', 'UTIHCPHY', 'Heber Valley Clinic', 'Vanessa', 'M', 'Hart', 'MD', 'General Surgery', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-09-15', '2014-06-16', 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1366439127', 0, 'N', 0, '2014-07-09', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12002206', 'W12002206', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Anne', 'M', 'Hawkins', 'MD', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801845755', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002207', 'W12002207', 'UTIHCPHY', 'Mt. Pleasant Clinic', 'Barbara', 'L', 'Hennagir', 'PA-C', 'Family Practice', '', '', NULL, 'o', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538215181', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002208', 'W12002208', 'UTIHCPHY', 'Manti Family Clinic', 'Barbara', 'L', 'Hennagir', 'PA-C', 'Family Practice', '', '', NULL, 'o', '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', NULL, '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538215181', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002209', 'W12002209', 'UTIHCPHY', 'Moroni Clinic', 'Barbara', 'L', 'Hennagir', 'PA-C', 'Family Practice', '', '', NULL, 'o', '51 E Main St-po Box 810', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', NULL, '51 E Main St-po Box 810', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538215181', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002210', 'W12002210', 'UTIHCPHY', 'South Cache Valley Clinic', 'Thomas', 'O', 'Higginbotham', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588673800', 0, 'N', 0, '2008-05-14', NULL, NULL, 41.7032, -111.828, NULL, NULL),
('942854057', 'W12002211', 'W12002211', 'UTIHCPHY', 'Utah Heart-AVH', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', NULL, '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W12002212', 'W12002212', 'UTIHCPHY', 'Utah Heart-LDSH', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002214', 'W12002214', 'UTIHCPHY', 'Valley View Radiation Oncology', 'Christian', 'Cooper', 'Hyde', 'MD', 'Radiation Oncology', '', '', NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4356884175', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4356884175', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2012-07-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316972086', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002215', 'W12002215', 'UTIHCPHY', 'Utah Heart-LDSH', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002216', 'W12002216', 'UTIHCPHY', 'Utah Heart-Riverton', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', NULL, '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12002217', 'W12002217', 'UTIHCPHY', 'Utah Heart-Sanpete', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8015073500', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002218', 'W12002218', 'UTIHCPHY', 'Utah Heart-Richfield', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8015073500', NULL, '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2009-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002220', 'W12002220', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'Robert', 'J', 'Lee', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5121 S Cottonwood St', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8015073888', '8012662074', '5121 S Cottonwood St', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8015073888', '8012662074', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2008-07-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548219991', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002221', 'W12002221', 'UTIHCPHY', 'Dixie Orthopaedics-Hurricane', 'Zachary', 'R', 'Leitze', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053341115', 0, 'N', 0, '2010-06-25', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12002222', 'W12002222', 'UTIHCPHY', 'Southwest Regional Cancer-Cedar City', 'Robert', 'H', 'Lemon', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4356884900', NULL, '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4356884900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992867147', 0, 'N', 0, '2013-04-25', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12002223', 'W12002223', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Michael', 'R', 'Major', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', NULL, '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831193879', 0, 'N', 0, '2010-06-25', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12002224', 'W12002224', 'UTIHCPHY', 'Utah Heart-Sanpete', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', NULL, '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W12002225', 'W12002225', 'UTIHCPHY', 'Utah Heart', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002226', 'W12002226', 'UTIHCPHY', 'Utah Heart', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', NULL, '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('820200895', 'W12003462', 'W12003462', 'ID01', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6481, -116.335, NULL, NULL),
('942854057', 'W12002228', 'W12002228', 'UTIHCPHY', 'Canyon View Orthopedics & Podiatry Associates', 'Wade', 'O', 'Milne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-15', '2010-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508843467', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002229', 'W12002229', 'UTIHCPHY', 'Utah Heart', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', NULL, '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W12002230', 'W12002230', 'UTIHCPHY', 'Utah Heart', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
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('942854057', 'W12002233', 'W12002233', 'UTIHCPHY', 'Utah Valley Heart & Lung Surgical Associates', 'John', 'H', 'Mitchell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781674', 0, 'N', 0, '2014-07-09', NULL, NULL, 40.2484, -111.667, NULL, NULL),
('942854057', 'W12002235', 'W12002235', 'UTIHCPHY', 'River Road InstaCare', 'Dennis', 'J', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'Saint George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306864624', 0, 'Y', 0, '2008-05-14', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12002236', 'W12002236', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Dennis', 'J', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306864624', 0, 'Y', 0, '2008-05-14', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12002237', 'W12002237', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Susan', 'M', 'Myers', 'MD', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326063140', 0, 'Y', 0, '2008-05-14', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12002238', 'W12002238', 'UTIHCPHY', 'Cedar City WorkMed', 'Steven', 'Richard', 'Newman', 'MD', 'Family Practice', 'Sports Medicine', 'Occupational Therapy', NULL, 'o', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134157613', 0, 'N', 0, '2013-04-15', NULL, NULL, 37.6608, -113.081, NULL, NULL),
('942854057', 'W12002239', 'W12002239', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Jon', 'B', 'Obray', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', NULL, '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-21', '2011-09-10', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1205814803', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002240', 'W12002240', 'UTIHCPHY', 'Utah Heart', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', NULL, '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W12002241', 'W12002241', 'UTIHCPHY', 'Utah Heart', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002242', 'W12002242', 'UTIHCPHY', 'Utah Heart', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12002243', 'W12002243', 'UTIHCPHY', 'River Road InstaCare', 'Broc', 'B', 'Parson', 'DO', 'Family Practice', 'Occupational Medicine', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285857268', 0, 'Y', 0, '2013-07-12', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12002244', 'W12002244', 'UTIHCPHY', 'Cedar City Clinic', 'Broc', 'B', 'Parson', 'DO', 'Family Practice', 'Occupational Medicine', '', NULL, 'O', '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-14', '2012-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285857268', 0, 'Y', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12002246', 'W12002246', 'UTIHCPHY', 'South Cache Valley Clinic', 'Curtis', 'Charles', 'Pedersen', 'DPM', 'Podiatry', '', '', NULL, 'o', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2012-01-13', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366452757', 0, 'N', 0, '2012-11-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002247', 'W12002247', 'UTIHCPHY', 'Bountiful KidsCare', 'Jennifer', '', 'Plumb', 'MD', 'Pediatric Emergency Medicine', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992819296', 0, 'N', 0, '2010-06-25', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002250', 'W12002250', 'UTIHCPHY', 'Utah Heart-LDSH', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '8014083909', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '8014083909', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002251', 'W12002251', 'UTIHCPHY', 'Utah Heart-Riverton', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8014083909', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8014083909', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12002252', 'W12002252', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'William', 'T', 'Sause', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5121 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', NULL, '5121 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881612927', 0, 'N', 0, '2010-06-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002253', 'W12002253', 'UTIHCPHY', 'Ephraim Clinic', 'Jeffrey', 'R', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972519239', 0, 'N', 0, '2008-07-29', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12002255', 'W12002255', 'UTIHCPHY', 'Dixie Orthopaedics-Hurricane', 'Scott', 'M', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588698997', 0, 'N', 0, '2010-08-25', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12002256', 'W12002256', 'UTIHCPHY', 'Sunset Family Practice', 'Seth', 'A', 'Spanos', 'MD', 'Family Practice', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', NULL, '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-10-15', '2011-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780629568', 0, 'N', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002257', 'W12002257', 'UTIHCPHY', 'Bountiful KidsCare', 'David', 'A', 'Stevenson', 'MD', 'Pediatrics', 'Pediatric Genetics', '', NULL, 'o', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1073617460', 0, 'N', 0, '2010-06-25', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002258', 'W12002258', 'UTIHCPHY', 'Logan Hospitalists', 'Jeffrey', 'S', 'Strong', 'MD', 'Hospitalist', '', '', NULL, 'o', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-01-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023028438', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002259', 'W12002259', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'Michael', 'G', 'Stults', 'MD', 'General Surgery', '', '', NULL, 'o', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528087236', 0, 'N', 0, '2012-05-01', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12002260', 'W12002260', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'Michael', 'G', 'Stults', 'MD', 'General Surgery', '', '', NULL, 'o', '700 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', NULL, '700 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528087236', 0, 'N', 0, '2012-05-01', NULL, NULL, 38.953, -112.341, NULL, NULL),
('942854057', 'W12002261', 'W12002261', 'UTIHCPHY', 'Hillcrest Pediatrics', 'Jed', 'B', 'VanDenBerghe', 'MD', 'Pediatrics', '', '', NULL, 'o', '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', NULL, '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2010-07-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922011576', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002262', 'W12002262', 'UTIHCPHY', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12002263', 'W12002263', 'UTIHCPHY', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8015073500', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002264', 'W12002264', 'UTIHCPHY', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8015073500', NULL, '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2009-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002265', 'W12002265', 'UTIHCPHY', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '719 W 4th N', 'Moab', 'Grand', 'UT', '84532', '8015073500', NULL, '719 W 4th N', 'Moab', 'Grand', 'UT', '84532', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002267', 'W12002267', 'UTIHCPHY', 'Cedar City InstaCare', 'Thomas', 'H', 'Welsh', 'MD', 'Urgent Care', '', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487604740', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002268', 'W12002268', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Thomas', 'H', 'Welsh', 'MD', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487604740', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002269', 'W12002269', 'UTIHCPHY', 'Sunset InstaCare', 'Thomas', 'H', 'Welsh', 'MD', 'Urgent Care', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', NULL, '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487604740', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002270', 'W12002270', 'UTIHCPHY', 'Utah Heart', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002271', 'W12002271', 'UTIHCPHY', 'Canyon View Orthopedics & Podiatry Associates', 'Bradley', 'D', 'Workman', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-14', '2010-12-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881764835', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002272', 'W12002272', 'UTIHCPHY', 'Utah Heart', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002273', 'W12002273', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Joanne', 'H', 'Abegglen', 'APRN', 'Pain Management', 'Family Practice', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', NULL, '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-04-06', '2011-02-04', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1104909878', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002274', 'W12002274', 'UTIHCPHY', 'Southwest Cardiology - St. George', 'Meredith', 'L', 'Moyes', 'APRN', 'Vascular Surgery', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr Ste 1500', 'Saint George', 'Washington', 'UT', '84790', '4352512500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-23', '2010-04-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760418529', 0, 'N', 0, '2010-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002275', 'W12002275', 'UTIHCPHY', 'Cache Valley Heart Clinic', 'Rudolf', '', 'Otrusinik', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', NULL, '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1003922394', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12002277', 'W12002277', 'UTIHCPHY', 'Heber Valley Clinic', 'Barbara', 'J', 'Rowley', 'PA', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245244557', 0, 'N', 0, '2010-06-28', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12002278', 'W12002278', 'UTIHCPHY', 'Cache Valley Heart Clinic', 'William', 'L', 'Saul', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', NULL, '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1255447538', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12002279', 'W12002279', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Sheryl', 'Yeates', 'Spriet', 'AUD', 'Audiology', '', '', NULL, 'O', '1350 N 500 E Ste ', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E Ste ', 'Logan', 'Cache', 'UT', '84341', '4357921950', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-10-01', '2011-05-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982887428', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002284', 'W12002284', 'UTIHCPHY', 'Bountiful Clinic', 'Kerry', 'S', 'Fisher', 'MD', 'General Surgery', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932156346', 0, 'N', 0, '2011-07-12', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002286', 'W12002286', 'UTIHCPHY', 'Bountiful KidsCare', 'John', 'N', 'Galian', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952414880', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002288', 'W12002288', 'UTIHCPHY', 'River Road InstaCare', 'Allison', '', 'Hanna', 'DO', 'Urgent Care', '', '', NULL, 'O', 'River Rd Instacare', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, 'River Rd Instacare', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-10-30', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003080409', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002290', 'W12002290', 'UTIHCPHY', 'Bountiful KidsCare', 'Grace', 'K', 'Harris', 'DO', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093725277', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002292', 'W12002292', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Kim', 'T', 'Heaton', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225051089', 0, 'Y', 0, '2012-02-29', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12002293', 'W12002293', 'UTIHCPHY', 'Sunset InstaCare', 'Kim', 'T', 'Heaton', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1739 W Sunset Blvd', 'Hurricane', 'Washington', 'UT', '84770', '4356346050', NULL, '1739 W Sunset Blvd', 'Hurricane', 'Washington', 'UT', '84770', '4356346050', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225051089', 0, 'Y', 0, '2012-02-29', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12002295', 'W12002295', 'UTIHCPHY', 'River Road InstaCare', 'Stephen', 'T', 'Kirk', 'MD', 'Sports Medicine', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578737979', 0, 'Y', 0, '2013-06-13', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12002297', 'W12002297', 'UTIHCPHY', 'Bountiful KidsCare', 'Bernard', 'J', 'Liang', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154341634', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002299', 'W12002299', 'UTIHCPHY', 'Park City Specialty Clinic', 'Steven', 'C', 'Lynch', 'MD', 'Urology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578677803', 0, 'N', 0, '2010-06-28', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12002301', 'W12002301', 'UTIHCPHY', 'Park City Specialty Clinic', 'Richard', 'V', 'Matern', 'MD', 'Urology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-08-11', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851571590', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002305', 'W12002305', 'UTIHCPHY', 'Bountiful KidsCare', 'Clare', 'P', 'Meysenburg', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010170', 0, 'Y', 0, '2014-05-19', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002307', 'W12002307', 'UTIHCPHY', 'Bountiful KidsCare', 'Jon', 'A', 'Middleton', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578586061', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002309', 'W12002309', 'UTIHCPHY', 'River Road InstaCare', 'Erika', 'M', 'Noonan', 'MD', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-10-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689848178', 0, 'Y', 0, '2011-11-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002311', 'W12002311', 'UTIHCPHY', 'Bountiful KidsCare', 'Daniel', 'J', 'Ricks', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467469239', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002313', 'W12002313', 'UTIHCPHY', 'Bountiful KidsCare', 'Laurel', 'A', 'Shepherd', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326151234', 0, 'Y', 0, '2010-06-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12002315', 'W12002315', 'UTIHCPHY', 'Park City Specialty Clinic', 'Testa', '', 'Massimo', 'MD', 'Sports Medicine', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '          ', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699751008', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12002317', 'W12002317', 'UTIHCPHY', 'Primary Childrens Radiation Oncology', 'John', 'W', 'Thomson', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014081146', NULL, '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014081146', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-10-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447293972', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002318', 'W12002318', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'John', 'W', 'Thomson', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5121 S Cottonwood St', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8015073888', NULL, '5121 S Cottonwood St', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8015073888', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447293972', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL);
