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
('201940980', 'W12015697', 'W12015697', 'UT01', 'Rocky Mountain Therapy Services', 'Steven', 'Bret', 'Bartlett', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-10-13', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1134334287', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('201940980', 'W12015698', 'W12015698', 'UT01', 'Rocky Mountain Therapy Services', 'Steven', 'Bret', 'Bartlett', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134334287', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('201940980', 'W12015699', 'W12015699', 'UT01', 'Rocky Mountain Therapy Services', 'Richard', 'D', 'Wortley', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-10-13', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1689667859', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('201940980', 'W12015700', 'W12015700', 'UT01', 'Rocky Mountain Therapy Services', 'Richard', 'D', 'Wortley', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '4358821263', '4358840930', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1689667859', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('270305622', 'W12015701', 'W12015701', 'UT01', 'Rocky Mountain Therapy Services', 'Travis', '', 'Booth', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8015667080', '8017481750', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8015667080', '8017481750', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-10-13', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1134160252', 0, 'Y', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('270305622', 'W12015702', 'W12015702', 'UT01', 'Rocky Mountain Therapy Services West Jordan LLC', 'Travis', '', 'Booth', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8015667080', '8017481750', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8015667080', '8017481750', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134160252', 0, 'Y', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12015703', 'W12015703', 'UT01', 'Wasatch Therapy Inc', 'Ashlee', '', 'Cresswell', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-09-26', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1811201817', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12015704', 'W12015704', 'UT01', 'Wasatch Therapy Inc', 'Ashlee', '', 'Cresswell', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2012-04-21', 0, 0, 0, '', '', '', '', 'HCFA|', '1811201817', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12015709', 'W12015709', 'UTIHCPHY', 'Zion Orthopaedics & Sports Medicine', 'Colton', 'J', 'Bennett', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831472679', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12015707', 'W12015707', 'UTIHCPHY', 'Sevier Valley FP SVMC', 'Brent', 'J', 'Allen', 'MD', 'General Surgery', '', '', NULL, 'O', '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358966496', '4358930214', '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358966496', '4358930214', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477660389', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12015712', 'W12015712', 'UTIHCPHY', 'Moroni Clinic', 'Gary', 'Monroe', 'Cole', 'DO', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598705139', 0, 'N', 0, '2012-03-26', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12015714', 'W12015714', 'UTIHCPHY', 'Utah HeartRiverton', 'Ritesh', '', 'Dhar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310939', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12015717', 'W12015717', 'UTIHCPHY', 'Utah HeartLDSH', 'Ritesh', '', 'Dhar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8th Ave and C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8014083909', '8th Ave and C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8014083909', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310939', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12015716', 'W12015716', 'UTIHCPHY', 'Utah HeartPark City', 'Ritesh', '', 'Dhar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310939', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12015718', 'W12015718', 'UTIHCPHY', 'Utah HeartAVH', 'Ritesh', '', 'Dhar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015013599', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015013599', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310939', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('942854057', 'W12015720', 'W12015720', 'UTIHCPHY', 'Intermountain Womens Health Specialists', 'Jennifer', 'H', 'Fisher', 'APRN', 'Family Practice', '', '', NULL, 'O', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '4356884601', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-17', '2013-05-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083925408', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12015723', 'W12015723', 'UTIHCPHY', 'Saratoga Springs InstaCare', 'Jeremy', 'R', 'Hadley', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '354 W State Rd 73', 'Lehi', 'Utah', 'UT', '84043', '8017664567', '8017669734', '354 W State Rd 73', 'Lehi', 'Utah', 'UT', '84043', '8017664567', '8017669734', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2014-04-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093943078', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.4071, -111.921, NULL, NULL),
('942854057', 'W12015724', 'W12015724', 'UTIHCPHY', 'Bountiful KidsCare', 'Richard', 'L', 'Jackson', 'MD', 'Pediatrics', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1295780559', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12015726', 'W12015726', 'UTIHCPHY', 'Bountiful KidsCare', 'John', 'J', 'Murdock', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1891786968', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('262786698', 'W12015729', 'W12015729', 'WY01', '', 'Chantel', '', 'Bowen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2014-05-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114949021', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.8347, -108.739, NULL, NULL),
('752509430', 'ELFP00020', 'ELFP00020', 'TXDALSTD', 'Fort Worth Pediatrics', 'Ray', 'N', 'Rhodes', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1063470862', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('262786698', 'W12015730', 'W12015730', 'WYT1', 'High Mountain Fitness Physical Therapy and Pilates', 'Chantel', '', 'Bowen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2014-05-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114949021', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12015731', 'W12015731', 'WY01', 'College Hill Womens Center', 'Louanna', '', 'Bradley', 'NP', 'Family Practice', '', '', NULL, 'O', '3000 College Womens Ctr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Womens Ctr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-15', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1295830743', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12015732', 'W12015732', 'WYT2', 'College Hill Womens Center', 'Louanna', '', 'Bradley', 'NP', 'Family Practice', '', '', NULL, 'O', '3000 College Womens Ctr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Womens Ctr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1295830743', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12015733', 'W12015733', 'UTMH1', 'Heber Valley Counseling', 'Lesa', 'H', 'Carter', 'LPC', 'Mental Health', '', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-01-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356521702', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12015734', 'W12015734', 'UTMH1', 'Heber Valley Counseling', 'Kathy', 'T', 'Day', 'LSAC', 'Mental Health', '', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356573228', '4356540309', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356573228', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-01-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457578569', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('820497538', 'W12015735', 'W12015735', 'ID01', 'All Seasons Mental Health', 'Jason', 'D', 'Dinger', 'LMSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', NULL, '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811127988', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12015737', 'W12015737', 'WY01', 'North Platte Physical Therapy', 'Olivia', '', 'Donald', 'OTR', 'Occupational Therapy', '', '', NULL, 'B', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003029653', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12015736', 'W12015736', 'WY01', 'North Platte Physical Therapy', 'Olivia', '', 'Donald', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003029653', 0, 'N', 0, '2012-10-12', NULL, NULL, 44.2835, -105.51, NULL, NULL),
('742412898', 'W12015739', 'W12015739', 'UT01', 'Oquirrh View Clinic', 'Allison', 'R', 'Ellzey', 'MD', 'Pediatrics', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8019646214', '8019829232', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8019646214', '8019829232', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2012-10-31', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1710131297', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12015738', 'W12015738', 'UT01', 'Oquirrh View Clinic', 'Allison', 'R', 'Ellzey', 'MD', 'Pediatrics', '', '', NULL, 'O', '4745 S 3200 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', '4745 S 3200 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2012-10-31', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1710131297', 0, 'N', 0, '2014-04-11', NULL, NULL, 40.6664, -111.967, NULL, NULL),
('870532396', 'W12015740', 'W12015740', 'UT01', 'Pioneer Anesthesia Group Inc', 'Amy', '', 'Evans', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', '', '', '', '0.00', '20.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417143827', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12015743', 'W12015743', 'UT01', 'Silverton Group', 'Adam', 'M', 'Kraft', 'MD', 'Hospitalist', '', '', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154376481', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('270852226', 'W12015741', 'W12015741', 'UT01', 'Silverton Group', 'Adam', 'M', 'Kraft', 'MD', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154376481', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.7785, -111.881, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('452507722', 'W12015814', 'W12015814', 'UT01', '', 'Tyler', 'Scott', 'Wood', 'DC', 'Chiropractic', '', '', NULL, 'O', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019889772', '8013224054', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019889772', '8013224054', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073814919', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('680541263', 'W12015816', 'W12015816', 'IDREC', 'Idaho Pediatric Gastroenterology', 'Tyler ', '', 'Burpee ', ' MD (Recognized but Not Contracted)', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', NULL, '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700810454', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('870524176', 'W12015825', 'W12015825', 'Group', 'Comprehensive Psychological', '', '', 'Comprehensive Psychological', '', 'Mental Health', '', '', NULL, '', 'Change', 'Schenectady', 'Schenectady', 'NY', '12345', '          ', NULL, 'Change', 'Schenectady', 'Schenectady', 'NY', '12345', '          ', '', '', '', '', '0.00', '0.00', '0.00', 6, '2006-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009778', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('830281135', 'W12015909', 'W12015909', 'WYT1', 'Wyoming Interventional Pain Management', '', '', 'Northern Plains Anesthesia', '', 'Pain Management', '', '', NULL, 'O', '3100 W Laveway Rd Ste 3', 'Gillette', 'Campbell', 'WY', '82718', '3076827819', NULL, '3100 W Laveway Rd Ste 3', 'Gillette', 'Campbell', 'WY', '82718', '3076827819', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009791', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('830251081', 'W12015924', 'W12015924', 'WY01', 'Powder River Orthopedics and Spine', 'Gary', 'I', 'Molk', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '508 Stocktrail Ste Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', '2012-06-08', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1629233895', 0, 'N', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('830251081', 'W12015929', 'W12015929', 'WYT1', 'Powder River Orthopedics & Spine PC', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', '2012-06-29', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('274409223', 'W12015930', 'W12015930', 'WY01', 'Davis ENT Specialists', 'Thomas', '', 'Davis', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', 'Sleep Medicine', NULL, 'O', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '', '', '', '0.00', '19.50', '0.00', 6, '2011-11-07', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336139120', 0, 'N', 0, '2013-11-08', NULL, NULL, 44.29, -105.521, 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
('274409223', 'W12015931', 'W12015931', 'WYT1', 'Davis ENT Specialists', 'Thomas', '', 'Davis', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', 'Sleep Medicine', NULL, 'O', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '', '', '', '0.00', '19.50', '0.00', 6, '2011-11-07', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336139120', 0, 'N', 0, '2013-11-08', NULL, NULL, 0, 0, NULL, NULL),
('271610209', 'W12015933', 'W12015933', 'WY01', 'Cloud Peak Physical Therapy', 'James', 'E', 'Klaassen', '', 'Physical Therapy', '', '', NULL, 'O', '300 Reno Dr', 'Wright', 'Campbell', 'WY', '82732', '3074645725', NULL, '300 Reno Dr', 'Wright', 'Campbell', 'WY', '82732', '3074645725', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346571882', 0, 'N', 0, '2011-11-07', NULL, NULL, 43.7011, -105.545, NULL, NULL),
('271610209', 'W12015934', 'W12015934', 'WYT1', 'Cloud Peak Physical Therapy', 'James', 'E', 'Klaassen', '', 'Physical Therapy', '', '', NULL, 'O', '300 Reno Dr', 'Wright', 'Campbell', 'WY', '82732', '3074645725', NULL, '300 Reno Dr', 'Wright', 'Campbell', 'WY', '82732', '3074645725', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346571882', 0, 'N', 0, '2011-11-07', NULL, NULL, 0, 0, NULL, NULL),
('202444337', 'W12015936', 'W12015936', 'WY01', 'Gillette Physical Therapy', 'Kenneth', '', 'Clouston', '', 'Physical Therapy', '', '', NULL, 'O', '201 W Lakeway Ste 700', 'Gillette', 'Campbell', 'WY', '82718', '3076824900', NULL, '201 W Lakeway Ste 700', 'Gillette', 'Campbell', 'WY', '82718', '3076824900', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1841390721', 0, 'N', 0, '2011-11-07', NULL, NULL, 44.269, -105.505, NULL, NULL),
('202444337', 'W12015937', 'W12015937', 'WYT1', 'Gillette Physical Therapy', 'Kenneth', '', 'Clouston', '', 'Physical Therapy', '', '', NULL, 'O', '201 W Lakeway Ste 700', 'Gillette', 'Campbell', 'WY', '82718', '3076824900', NULL, '201 W Lakeway Ste 700', 'Gillette', 'Campbell', 'WY', '82718', '3076824900', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1841390721', 0, 'N', 0, '2011-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870653164', 'W12015938', 'W12015938', 'UT01', 'Utah Digestive Health Institute', 'Brian', 'W', 'Pugh', 'DO', 'Gastroenterology', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', '2132 N 1700 W Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-08', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1023005808', 0, 'N', 0, '2012-06-13', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('743102924', 'W12015939', 'W12015939', 'UT01', 'Ogden Internal Medicine', 'Elena', 'L', 'Goncharova', 'MD', 'Internal Medicine', 'Pain Management', '', NULL, 'O', '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014755100', '8014758580', '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014755100', '8014758580', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-08', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1619085339', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870687579', 'W12015940', 'W12015940', 'UT01', 'Ogden Internal Medicine', 'Seth', 'R', 'Lewis', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'O', '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014755100', NULL, '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014755100', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-08', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851409544', 0, 'N', 0, '2011-11-10', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870653164', 'W12015941', 'W12015941', 'UT01', 'Utah Digestive Health Institute', 'Jeffrey', 'S', 'Poole', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', '2132 N 1700 W Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-08', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1649266776', 0, 'N', 0, '2013-10-21', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870286381', 'W12015942', 'W12015942', 'UT01', 'Ogden Clinic', 'James', 'W', 'Adams', 'MD', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'O', '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014799860', NULL, '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014799860', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-08', '2012-06-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1598757080', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12015943', 'W12015943', 'UT01', 'Ogden Clinic', 'Allisyn', '', 'Okawa', 'MD', 'Plastic Surgery', 'Hand Surgery', '', NULL, 'O', '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538151063', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('870286381', 'W12015944', 'W12015944', 'UT01', 'Ogden Clinic', 'Kevin', 'L', 'Stucki', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014799860', NULL, '4700 S Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014799860', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-08', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306975701', 0, 'N', 0, '2012-01-17', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('942854057', 'W12015946', 'W12015946', 'UTIHC01', 'Occupational Therapy', 'Kristen', '', 'Gallup', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891927836', 0, 'N', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12015948', 'W12015948', 'UTIHC03', 'Occupational Therapy', 'Kristen', '', 'Gallup', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891927836', 0, 'N', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12015951', 'W12015951', 'UTIHC01', 'Rehab', 'Laura', 'Newman', 'Varier', 'AUD', 'Audiology', '', '', NULL, 'O', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8016624949', NULL, '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-10-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821244245', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
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('870540039', 'W12016123', 'W12016123', 'UT01', 'Midtown Community Health Center', 'Richard', 'J', 'Gregoire', 'MD PHD', 'Family Practice', '', '', NULL, 'O', '22 S State Ste 1007', 'Clearfield', 'Davis', 'UT', '84015', '8013935355', NULL, '22 S State Ste 1007', 'Clearfield', 'Davis', 'UT', '84015', '8013935355', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1528066149', 0, 'N', 0, '2011-11-17', NULL, NULL, 41.1135, -112.026, NULL, NULL),
('820161600', 'W12014106', 'W12014106', 'IDREC', 'St Lukes Developmental Pediatrics', 'Michael', '', 'Sexton', 'MD (Recognized but not Contracted)', 'Pediatrics', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817312', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817312', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265486021', 0, 'N', 0, '2011-11-15', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('223510467', 'W12016124', 'W12016124', 'NA01', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12016143', 'W12016143', 'UT01', 'Cardiovascular Consultants of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'O', '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', NULL, '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-21', '2011-12-31', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12016148', 'W12016148', 'WYT1', 'Campbell County Memorial Hospital', '', '', 'Campbell County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005551', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('271147372', 'W12016150', 'W12016150', 'UT01', 'Utah Spine Care', 'Kurt', 'D', 'Bangerter', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1660 W Antelope Dr Ste 225', 'Layton', 'Davis', 'UT', '84041', '8013876520', '8013876525', '1660 W Antelope Dr Ste 225', 'Layton', 'Davis', 'UT', '84041', '8013876520', '8013876525', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-21', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1215948799', 0, 'N', 0, '2011-11-28', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('271147372', 'W12016149', 'W12016149', 'UT01', 'Utah Spine Care', 'Kurt', 'D', 'Bangerter', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-21', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1215948799', 0, 'N', 0, '2011-11-28', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('850381680', 'W12016157', 'W12016157', 'NM01', 'Albuquerque Urology Associates', '', '', 'Albuquerque Urology Associates', '', 'Urology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87102', '          ', NULL, 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87102', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009793', 0, 'Y', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
('450618187', 'W12016159', 'W12016159', 'UTMH1', 'Redwood Therapy Group', 'Brian', 'B', 'Murdock', 'LPC', 'Mental Health', '', '', NULL, 'O', '8541 S Redwood Rd Ste C', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018784220', '8018789846', '8541 S Redwood Rd Ste C', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932423522', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('450618187', 'W12016160', 'W12016160', 'UTMH1', 'Redwood Therapy Group', 'Brian', 'B', 'Murdock', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932423522', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('850460777', 'W12016158', 'W12016158', 'NM01', 'Hematology Oncology Associates', '', '', 'Hematology Oncology Associates', '', 'Hematology and Oncology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87106', '          ', NULL, 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87106', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009794', 0, 'Y', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12016162', 'W12016162', 'UT01', 'Cache Valley Specialty Hospital', 'Megan', 'E', 'Bressel', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 8, '2011-11-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366628356', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12016163', 'W12016163', 'UT01', 'Cache Valley Specialty Hospital', 'Megan', 'E', 'Bressel', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2012-04-01', '2012-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366628356', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016180', 'W12016180', 'UT01', 'Mountain Land Holladay ', 'Mark', 'D', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-11-19', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1790889889', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016181', 'W12016181', 'UT01', 'Mountain Land Holladay ', 'Mark', 'D', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1790889889', 0, 'N', 0, '2012-01-10', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870574059', 'W12016182', 'W12016182', 'UT01', 'Mountain Land Layton', 'Kurt', 'Aaron', 'Leschke', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-11-15', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1235321647', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016183', 'W12016183', 'UT01', 'Mountain Land Layton', 'Kurt', 'Aaron', 'Leschke', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235321647', 0, 'N', 0, '2012-01-10', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('870574059', 'W12016184', 'W12016184', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-11-15', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1932438249', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016185', 'W12016185', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', '2950 N Church St Ste 102', 'Layton', 'Davis', 'UT', '84040', '8015479462', '8015479116', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932438249', 0, 'N', 0, '2012-01-10', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('870574059', 'W12016186', 'W12016186', 'UT01', 'Mountain Land Movement Specialists Murray', 'Michael', 'Adam', 'King', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5250 Commerce Dr Ste 320', 'Murray', 'Salt Lake', 'UT', '84107', '8017473889', '8017475218', '5250 Commerce Dr Ste 320', 'Murray', 'Salt Lake', 'UT', '84107', '8017473889', '8017475218', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-11-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1063675304', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016187', 'W12016187', 'UT01', 'Mountain Land Movement Specialists Murray', 'Michael', 'Adam', 'King', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5250 Commerce Dr Ste 320', 'Murray', 'Salt Lake', 'UT', '84107', '8017473889', '8017475218', '5250 Commerce Dr Ste 320', 'Murray', 'Salt Lake', 'UT', '84107', '8017473889', '8017475218', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1063675304', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016189', 'W12016189', 'UT01', 'Mountain Land Rehabilitation Home', 'Paul', 'Skidmore', 'Macfarlane', 'SLP', 'Physical Therapy', '', '', NULL, 'O', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019433989', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019433989', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-12-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1013074764', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016190', 'W12016190', 'UT01', 'Mountain Land Rehabilitation Home', 'Paul', 'Skidmore', 'Macfarlane', 'SLP', 'Physical Therapy', '', '', NULL, 'O', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019433989', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019433989', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013074764', 0, 'N', 0, '2011-12-19', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870574059', 'W12016191', 'W12016191', 'UT01', 'Mountain Land Rehabilitation Home', 'Paul', 'Skidmore', 'Macfarlane', 'SLP', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019423311', '8019433989', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019423311', '8019433989', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-12-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1013074764', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12016192', 'W12016192', 'UT01', 'Mountain Land Rehabilitation Home', 'Paul', 'Skidmore', 'Macfarlane', 'SLP', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019423311', '8019433989', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019423311', '8019433989', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013074764', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12016193', 'W12016193', 'UT01', 'Physical & Sports Therapy Services LLC', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'O', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-11-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12016194', 'W12016194', 'UT01', 'Physical & Sports Therapy Services ', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'O', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'N', 0, '2011-12-19', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('452716222', 'W12016195', 'W12016195', 'ID02', 'St Lukes Clinic Family Medicine', 'Wajeeh', 'E', 'Nasser', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083694053', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016196', 'W12016196', 'ID02', 'St Lukes Physician Services', 'Wajeeh', 'E', 'Nasser', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083694053', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016197', 'W12016197', 'ID02', 'St Lukes Clinic Family Medicine', 'Idalyn', 'G', 'Cyprus', 'MD', 'Family Practice', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1245210228', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016198', 'W12016198', 'ID02', 'St Lukes Physician Services', 'Idalyn', 'G', 'Cyprus', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1245210228', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12016200', 'W12016200', 'ID02', 'Saint Alphonsus Medical Center Nampa', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'B', 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', NULL, 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', '', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-09-15', '2012-09-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134296106', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016201', 'W12016201', 'ID02', 'St Lukes Clinic Family Medicine', 'Laurie', 'J', 'Ashby', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1730169178', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016202', 'W12016202', 'ID02', 'St Lukes Physician Services', 'Laurie', 'J', 'Ashby', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1730169178', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12016204', 'W12016204', 'ID02', 'Saint Alphonsus Medical Center - Nampa', 'John', 'A', 'Staniewski', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', NULL, 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-09-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1801822101', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016205', 'W12016205', 'ID02', 'Saltzer Medical Group', 'Michael', 'R', 'Djernes', 'MD', 'Neurology', '', '', NULL, 'O', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2084633044', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-09-15', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346230356', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820536340', 'W12016207', 'W12016207', 'ID02', 'The Clinic at Eagle', 'Alessa', '', 'LopezCastor', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728112', '2084728112', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728112', '2084728112', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-04-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285661744', 0, 'N', 0, '2012-05-17', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12016210', 'W12016210', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Jennifer', 'L', 'Newman', 'NPC', 'Nurse Practitioner', '', '', 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, '2009-07-28', '2012-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710132931', 0, 'N', 0, '2012-05-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12016209', 'W12016209', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Jennifer', 'L', 'Newman', 'NPC', 'Nurse Practitioner', '', '', 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, '2009-07-28', '2012-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710132931', 0, 'N', 0, '2012-05-09', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12016213', 'W12016213', 'ID02', 'Idaho Nephrology Associates', 'Tory', 'M', 'Thornton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-01', '2012-04-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063719292', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12016212', 'W12016212', 'ID02', 'Idaho Nephrology Associates', 'Tory', 'M', 'Thornton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-01', '2012-03-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063719292', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016216', 'W12016216', 'ID02', 'Saltzer Medical Group- Caldwell', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12016219', 'W12016219', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12016222', 'W12016222', 'ID02', 'Saltzer Medical Group', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016215', 'W12016215', 'ID02', 'Saltzer Medical Group', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016220', 'W12016220', 'ID02', 'Saltzer Medical Group Rehab', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016217', 'W12016217', 'ID02', 'Saltzer Medical Group Portico ', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016221', 'W12016221', 'ID02', 'Saltzer Medical Group North', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12016218', 'W12016218', 'ID02', 'Saltzer Medical Group-Sleep', 'Cynthia', 'M', 'Boulton', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750397238', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12016223', 'W12016223', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Michael', '', 'Robinson', '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, '2011-01-01', '2013-09-04', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1275533184', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12016224', 'W12016224', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Theodore', '', 'Colwell', '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, '2011-01-01', '2013-09-04', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1598735391', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12016225', 'W12016225', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Jessica', '', 'Fu', '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, '2011-08-29', '2013-09-04', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1710185111', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('453617566', 'W12016226', 'W12016226', 'UT01', 'Davis Endocrinology and Diabeties ', 'Khaldoun', 'M', 'Al-Rayess', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '1492 W Antelope Dr Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '8017762888', '1492 W Antelope Dr Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '8017762888', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1003808122', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('453617566', 'W12016227', 'W12016227', 'UT01', 'Davis Endocrinology and Diabeties ', 'Khaldoun', 'M', 'Al-Rayess', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1003808122', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016233', 'W12016233', 'ID02', 'Saltzer Medical Group- Caldwell', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2014-02-26', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12016237', 'W12016237', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12016231', 'W12016231', 'ID02', 'Saltzer Medical Group', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016229', 'W12016229', 'ID02', 'Saltzer Medical Group', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016232', 'W12016232', 'ID02', 'Saltzer Medical Group Rehab', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016235', 'W12016235', 'ID02', 'Saltzer Medical Group Portico ', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016234', 'W12016234', 'ID02', 'Saltzer Medical Group North', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12016236', 'W12016236', 'ID02', 'Saltzer Medical Group-Sleep', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016230', 'W12016230', 'ID02', 'Saltzer Medical Group', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2084633044', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', '2012-05-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016238', 'W12016238', 'ID02', 'St Lukes Clinic Family Medicine', 'William', 'L', 'Jonakin', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114907524', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016239', 'W12016239', 'ID02', 'St Lukes Physician Services', 'William', 'L', 'Jonakin', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114907524', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016240', 'W12016240', 'ID02', 'St Lukes Clinic Family Medicine', 'Jessica', 'A', 'Briggs', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053311084', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016241', 'W12016241', 'ID02', 'St Lukes Physician Services', 'Jessica', 'A', 'Briggs', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053311084', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016242', 'W12016242', 'ID02', 'St Lukes Clinic Family Medicine', 'Kathleen', '', 'Duffy', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154301141', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016243', 'W12016243', 'ID02', 'St Lukes Physician Services', 'Kathleen', '', 'Duffy', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154301141', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016244', 'W12016244', 'ID02', 'St Lukes Clinic Family Medicine', 'Kevin', '', 'Hudson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922088905', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12016245', 'W12016245', 'ID02', 'St Lukes Physician Services', 'Kevin', '', 'Hudson', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922088905', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12016248', 'W12016248', 'ID02', 'Idaho Nephrology Associates', 'Heather', 'J', 'Spero', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972545473', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12016247', 'W12016247', 'ID02', 'Idaho Nephrology Associates', 'Heather', 'J', 'Spero', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-11-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972545473', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12016249', 'W12016249', 'ID01', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Graham', 'K', 'Wetherley', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-10-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821030586', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
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('820200895', 'W12016280', 'W12016280', 'ID01', 'Saint Alphonsus Medical Group Neurology Boise', 'David', 'W', 'Tesar', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-11-03', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205913746', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12016282', 'W12016282', 'ID01', 'Saint Alphonsus Medical Group Maternal Fetal Medicine Boise', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '900 N Liberty Ste 206', 'Boise', 'Ada', 'ID', '83704', '2083675544', '2083675543', '900 N Liberty Ste 206', 'Boise', 'Ada', 'ID', '83704', '2083675544', '2083675543', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-11-03', '2012-08-19', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6133, -116.259, NULL, NULL);
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('820200895', 'W12016284', 'W12016284', 'ID01', 'Saint Alphonsus Medical Group Neurology ALS  Clinic Idaho Elks Rehab', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '600 W Robbins Rd', 'Boise', 'Ada', 'ID', '83702', '2083677272', '2083677111', '600 W Robbins Rd', 'Boise', 'Ada', 'ID', '83702', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6157, -116.192, NULL, NULL),
('820200895', 'W12016285', 'W12016285', 'ID01', 'Saint Alphonsus Medical Group Neurology MDA Clinic', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '3551 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2083677272', '2083677111', '3551 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029177', 'W12029177', 'UT01', 'Central Utah Clinic PC', 'Scott', 'A', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', NULL, '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548292485', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12016286', 'W12016286', 'ID01', 'Saint Alphonsus Medical Group Neurosurgery Boise 503', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-10-28', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('320340482', 'W12016287', 'W12016287', 'UT01', 'Perry Family Medicine', 'Cynthia', 'L', 'Duncan', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8014516060', '8012960218', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8014516060', '8012960218', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922242262', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('202403308', 'W12016339', 'W12016339', 'NM01', '', 'Robert', 'E', 'Byrd', 'DC', 'Chiropractic', '', '', NULL, 'O', '1110 Pennsylvania St NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87116', '5052680808', '5052682458', '1110 Pennsylvania St NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87116', '5052680808', '5052682458', 'WUSTDHCPC5', '', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093890220', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.09, -106.559, NULL, NULL),
('680548602', 'W12016346', 'W12016346', 'Sinclair', 'Verst Spine and Orthopedic Care', 'Gretchen', 'G', 'Basen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '15 W Galena St', 'Hailey', 'Blaine', 'ID', '83333', '2087887779', NULL, '15 W Galena St', 'Hailey', 'Blaine', 'ID', '83333', '2087887779', '          ', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549396', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('721311350', 'W12016347', 'W12016347', 'Sinclair', '(Sinclair Health Services\rProvider) Gooding Specialty Clinic', 'Thomas ', 'F', 'Crais', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '267 N Canyon Dr', 'Gooding', 'Gooding', 'ID', '83330', '2089348829', NULL, '267 N Canyon Dr', 'Gooding', 'Gooding', 'ID', '83330', '2089348829', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073668042', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('850459199', 'W12016355', 'W12016355', 'NM01', 'Bear Canyon Therapy Associates', 'Chris', '', 'Boling', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033357504', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.1449, -106.583, NULL, NULL),
('453836973', 'W12016356', 'W12016356', 'UT01', 'Creekside Oral and Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'O', '7390 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', '7390 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|DEN', '1326167354', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.617, -111.856, NULL, NULL),
('205967125', 'W12016357', 'W12016357', 'ID02', 'The Imaging Center of Idaho', 'Gerald', 'E', 'Carlson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', '2084557538', '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', '2084557538', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053339457', 0, 'N', 1, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W12016358', 'W12016358', 'ID02', 'The Imaging Center of Idaho', 'Gerald', 'E', 'Carlson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053339457', 0, 'N', 1, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12016360', 'W12016360', 'UT01', 'Omgea Interventional Pain Clinic', 'Laura', '', 'Chamberlain', 'NP', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164727335', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12016361', 'W12016361', 'UT01', 'Omgea Interventional Pain Clinic', 'Laura', '', 'Chamberlain', 'NP', 'Pain Management', '', '', NULL, 'B', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164727335', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('453008115', 'W12016362', 'W12016362', 'UT01', 'Advanced Pain Clinic', 'Joseph', 'G', 'Cunniff', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 101', 'Ogden', 'Weber', 'UT', '84405', '8014755244', '8014755286', '6028 S Ridgeline Dr Ste 101', 'Ogden', 'Weber', 'UT', '84405', '8014755244', '8014755286', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013980119', 0, 'N', 0, '2012-02-23', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('850459199', 'W12016364', 'W12016364', 'NM01', 'Bear Canyon Therapy Associates', 'William', 'A', 'Dunbar', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '', '', '', '0.00', '0.00', '75.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750457081', 0, 'N', 0, '2012-08-13', NULL, NULL, 35.1449, -106.583, NULL, NULL),
('330648346', 'W12016365', 'W12016365', 'Sinclair', 'Sun Valley Sports Rehab Clinic', 'Erin', 'L', 'Finnegan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', '2087268911', '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', '2087268911', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2014-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992983431', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('330648346', 'W12016366', 'W12016366', 'Sinclair', 'Sun Valley Sports Rehab Clinic', 'Erin', 'L', 'Finnegan', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2062', 'Ketchum', 'Blaine', 'ID', '83340', '2087884371', '2087268911', 'PO Box 2062', 'Ketchum', 'Blaine', 'ID', '83340', '2087884371', '2087268911', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2014-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992983431', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('330648346', 'W12016367', 'W12016367', 'Sinclair', 'Sun Valley Sports Rehab Clinic', 'Erin', 'L', 'Finnegan', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2750', 'Ketchum', 'Blaine', 'ID', '83340', '3123714756', '2087268911', 'PO Box 2750', 'Ketchum', 'Blaine', 'ID', '83340', '3123714756', '2087268911', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2014-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992983431', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W12016368', 'W12016368', 'ID02', 'The Imaging Center of Idaho', 'John', '', 'Gambino', 'MD', 'Radiology', '', '', NULL, 'O', '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', '2084557538', '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', '2084557538', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093773533', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W12016369', 'W12016369', 'ID02', 'The Imaging Center of Idaho', 'John', '', 'Gambino', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093773533', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800765107', 'W12016371', 'W12016371', 'UT01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('800765107', 'W12016372', 'W12016372', 'UT01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016374', 'W12016374', 'WY01', 'Gottsche Rehabilitation Center', 'Kelsey', 'L', 'Kolstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578850970', 0, 'N', 0, '2014-06-09', NULL, NULL, 44.7487, -108.766, NULL, NULL),
('830182821', 'W12016373', 'W12016373', 'WY01', 'Gottsche Rehabilitation Center', 'Kelsey', 'L', 'Kolstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578850970', 0, 'N', 0, '2014-06-09', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('850459199', 'W12016375', 'W12016375', 'NM01', 'Bear Canyon Therapy Associates', 'Melody', 'D', 'Krech', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003982323', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.1449, -106.583, NULL, NULL),
('850459199', 'W12016376', 'W12016376', 'NM01', 'Bear Canyon Therapy Associates', 'Linda', '', 'Oberdorfer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '6100 Seagull NE Ste B102', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058232411', '5058580650', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992791784', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.1449, -106.583, NULL, NULL),
('262703946', 'W12016377', 'W12016377', 'NM01', 'Albuquerque New Mexico Physicians', '', '', 'Albuquerque New Mexico Physicians', '', 'Emergency Medicine', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', '9543678433', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', '9543678433', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073772547', 0, 'Y', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('262703946', 'W12016378', 'W12016378', 'NM01', 'Albuquerque New Mexico Physicians', '', '', 'Albuquerque New Mexico Physicians', '', 'Emergency Medicine', '', '', NULL, 'M', '861 SW 78th Ave Ste 100B', 'Fort Lauderdale', 'Broward', 'FL', '33324', '5057278000', NULL, '861 SW 78th Ave Ste 100B', 'Fort Lauderdale', 'Broward', 'FL', '33324', '5057278000', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073772547', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('850360320', 'W12016379', 'W12016379', 'NM01', 'Anesthesia Specialists of Albuquerque', '', '', 'Anesthesia Specialists of Albuquerque', '', 'Anesthesiology', '', '', NULL, 'O', '4401 Masthead St NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052437729', '          ', '4401 Masthead St NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052437729', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831104215', 0, 'Y', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('850360320', 'W12016380', 'W12016380', 'NM01', 'Anesthesia Specialists of Albuquerque', '', '', 'Anesthesia Specialists of Albuquerque', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 36840', 'Albuquerque', 'Bernalillo', 'NM', '87176', '5052437729', NULL, 'PO Box 36840', 'Albuquerque', 'Bernalillo', 'NM', '87176', '5052437729', '', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831104215', 0, 'Y', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('523274132', 'W12016381', 'W12016381', 'UT01', '', 'Douglas', 'S', 'Lister', 'DPM', 'Podiatry', '', '', NULL, 'O', '2720 Homestead Rd Ste 50', 'Park City', 'Summit', 'UT', '84098', '4356040449', '4356499202', '2720 Homestead Rd Ste 50', 'Park City', 'Summit', 'UT', '84098', '4356040449', '4356499202', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1295958312', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.756, -111.57, NULL, NULL),
('523274132', 'W12016382', 'W12016382', 'UT01', '', 'Douglas', 'S', 'Lister', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 34120', 'Reno', 'Washoe', 'NV', '89533', '4356040249', '4356499202', 'PO Box 34120', 'Reno', 'Washoe', 'NV', '89533', '4356040249', '4356499202', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1295958312', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016383', 'W12016383', 'WY01', 'Gottsche Rehab and Wellness Center', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', NULL, '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016385', 'W12016385', 'WY01', 'Gottsche Rehab and Wellness Center', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', NULL, '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016384', 'W12016384', 'WYT2', 'Gottsche Rehab and Wellness Center', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', NULL, '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016386', 'W12016386', 'WYT2', 'Gottsche Rehab and Wellness Center', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', NULL, '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016387', 'W12016387', 'WYT2', 'Gottsche Rehabilitation Center', 'Kelsey', 'L', 'Kolstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578850970', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12016388', 'W12016388', 'WYT2', 'Gottsche Rehabilitation Center', 'Kelsey', 'L', 'Kolstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578850970', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12016389', 'W12016389', 'UT01', 'Silverton Group', 'Branden', 'D', 'Rosenhan', '', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912160060', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12016390', 'W12016390', 'UT01', 'Silverton Group', 'Branden', 'D', 'Rosenhan', '', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912160060', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12016391', 'W12016391', 'UT01', 'Cache Valley Community Health Center', 'A. Teresa', 'G', 'Shelton', 'PA', 'Family Practice', '', '', NULL, 'O', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357556061', '4357556091', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357556061', '4357556091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2012-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134401326', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12016392', 'W12016392', 'UT01', 'Omgea Interventional Pain Clinic', 'Katie', 'A', 'Toledo', 'NP', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881884252', 0, 'N', 0, '2012-03-10', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12016393', 'W12016393', 'UT01', 'Omgea Interventional Pain Clinic', 'Katie', 'A', 'Toledo', 'NP', 'Pain Management', '', '', NULL, 'B', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881884252', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12016397', 'W12016397', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12016395', 'W12016395', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
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('202148889', 'W12014064', 'W12014064', 'TX01', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '          ', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', '2014-06-22', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W12012579', 'W12012579', 'TX01', 'The Podiatry Group of South Texas', 'Steven', 'P', 'Kissel', 'DPM', 'Podiatry', '', '', NULL, 'O', '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', '2102221215', '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', '2102221215', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1081052451', 0, 'N', 0, '2012-02-21', NULL, NULL, 29.4256, -98.4895, 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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('113676182', 'W12012581', 'W12012581', 'TX01', 'The Podiatry Group of South Texas', 'Steven', 'P', 'Kissel', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', '2102221215', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', '2102221215', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1081052451', 0, 'N', 0, '2012-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820481354', 'W12016481', 'W12016481', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Robert ', 'W.', 'Hall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '180 W 1st St Ste 214', 'Ketchum', 'Blaine', 'ID', '83340', '2087265996', NULL, '180 W 1st St Ste 214', 'Ketchum', 'Blaine', 'ID', '83340', '2087265996', '          ', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699718791', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('270671464', 'W12016482', 'W12016482', 'UT01', 'Castle Valley Foot & Ankle PC', 'Brian', 'J', 'Griffeth', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 540610', 'Morgan', 'Morgan', 'UT', '84050', '8015050823', '8018330044', 'PO Box 540610', 'Morgan', 'Morgan', 'UT', '84050', '8015050823', '8018330044', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2012-01-22', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1487833406', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W12016483', 'W12016483', 'UTMH1', 'Clinical Consultants ', 'Frederick', 'T', 'King', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7601 S Redwood Rd Ste E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', NULL, '7601 S Redwood Rd Ste E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518131622', 0, 'N', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
('020475625', 'W12016484', 'W12016484', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Orthopedic and Sports Medicine', 'Glen', 'D', 'Shapiro', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '513 N Main', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', '513 N Main', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1336283779', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('870462018', 'W12016490', 'W12016490', 'UT01', 'Sugar House Vision', 'Jennifer', '', 'Keiser', 'OD', 'Pediatric Optometry', '', '', NULL, 'O', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275789208', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.7237, -111.865, NULL, NULL),
('870476172', 'W12016492', 'W12016492', 'UTMH1', 'Christian Counseling Centers of Utah', 'Gerard (Jerry)', 'J', 'Meade', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '193 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8015619987', '8015619987', '193 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8015619987', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073590253', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12016491', 'W12016491', 'UTMH1', 'Christian Counseling Centers of Utah', 'Gerard (Jerry)', 'J', 'Meade', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073590253', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016494', 'W12016494', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '1471 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '8015055277', '8015055280', '1471 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.4893, -111.41, NULL, NULL),
('942854057', 'W12049270', 'W12049270', 'UTIHCPHY', 'Utah Valley Ear Nose & Throat - North Valley', 'Glen', 'T', 'Porter', '', 'Ear, Nose and Throat', 'Sleep Medicine', '', NULL, 'O', '98 N 1100 E Ste 203', 'American Fork', 'Utah', 'UT', '84003', '8014922245', '8014922470', '98 N 1100 E Ste 203', 'American Fork', 'Utah', 'UT', '84003', '8014922245', '8014922470', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205825973', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016493', 'W12016493', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '1660 W Antelope Dr Ste 110', 'Layton', 'Davis', 'UT', '84041', '8015055277', '8015055280', '1660 W Antelope Dr Ste 110', 'Layton', 'Davis', 'UT', '84041', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('261996389', 'W12016500', 'W12016500', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '1885 W 4400 S', 'Heber City', 'Wasatch', 'UT', '84607', '8015055277', '8015055280', '1885 W 4400 S', 'Heber City', 'Wasatch', 'UT', '84607', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016496', 'W12016496', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '2178 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015055277', '8015055280', '2178 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.7237, -111.865, NULL, NULL),
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('261996389', 'W12016501', 'W12016501', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '620 E Medical Dr Ste 150', 'Heber City', 'Wasatch', 'UT', '84032', '8015055277', '8015055280', '620 E Medical Dr Ste 150', 'Heber City', 'Wasatch', 'UT', '84032', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016495', 'W12016495', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '82 S 1100 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055277', '8015055280', '82 S 1100 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('261996389', 'W12016499', 'W12016499', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'O', '8822 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015055277', '8015055280', '8822 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('261996389', 'W12016497', 'W12016497', 'UT01', 'Utah Podiatry Group PC', 'Gary', 'N', 'Oaks', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8015055277', '8015055280', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8015055277', '8015055280', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922294768', 0, 'N', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('273300487', 'W12016503', 'W12016503', 'NM01', 'Wendy Buckels and Associates ', 'Wendy', 'D', 'Buckels', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '1706 Ridgecrest Dr SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5056107020', '5057554311', '1706 Ridgecrest Dr SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5056107020', '5057554311', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', '2013-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588729107', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('273300487', 'W12016502', 'W12016502', 'NM01', 'Wendy Buckels and Associates ', 'Wendy', 'D', 'Buckels', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1803 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5056167020', '5057554311', '1803 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5056167020', '5057554311', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', '2013-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588729107', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('270816889', 'W12016504', 'W12016504', 'NM01', '', 'Michelle', 'R', 'Croteau', 'LPC', 'Mental Health', '', '', NULL, 'O', '4425 Juan Tabo Blvd NE Ste 206', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052594291', NULL, '4425 Juan Tabo Blvd NE Ste 206', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052594291', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295867224', 0, 'N', 0, '2011-12-22', NULL, NULL, 35.1311, -106.516, NULL, NULL),
('870281028', 'W12016508', 'W12016508', 'UT01', 'Central Utah Clinic PC', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014650606', '15 S 1000 E Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014650606', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-31', '2014-07-16', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12016507', 'W12016507', 'UT01', 'Central Utah Clinic PC', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '8014890777', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '8014890777', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-31', '2014-07-16', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870281028', 'W12016506', 'W12016506', 'UT01', 'Central Utah Clinic PC', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '97 Professional Way', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', '97 Professional Way', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-31', '2014-07-16', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.0429, -111.712, NULL, NULL),
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('272937959', 'W12016595', 'W12016595', 'UT01', 'Mountain View Family Eyecare', 'Tory', 'J', 'Goode', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 511', 'Heber City', 'Wasatch', 'UT', '84032', '4356571555', '4356571556', 'PO Box 511', 'Heber City', 'Wasatch', 'UT', '84032', '4356571555', '4356571556', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154569796', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W12016596', 'W12016596', 'UTMH1', 'Clinical Consultants ', 'Melissa', 'A', 'Bradford', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922387596', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('261703236', 'W12016600', 'W12016600', 'UTMH1', 'Clinical Consultants ', 'Marvin', '', 'Goldstein', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386621910', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('800522450', 'W12016602', 'W12016602', 'UT01', 'Omega Interventional Pain', 'Thomas', 'K', 'Trauba', 'MD', 'Mental Health', 'Psychiatry', 'Pain Management', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699427', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', '2014-04-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891793147', 0, 'Y', 0, '2014-04-16', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12016603', 'W12016603', 'UT01', 'Omega Interventional Pain', 'Thomas', 'K', 'Trauba', 'MD', 'Mental Health', 'Psychiatry', 'Pain Management', NULL, 'B', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699427', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699427', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', '2014-04-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891793147', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('271530893', 'W12016604', 'W12016604', 'NM01', 'Autism Communication Consultants', 'James', 'F', 'Scott', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '2521 San Pedro Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058814618', '5052120496', '2521 San Pedro Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058814618', '5052120496', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740363662', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.1084, -106.578, NULL, NULL),
('271530893', 'W12016605', 'W12016605', 'NM01', 'Autism Communication Consultants', 'James', 'F', 'Scott', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '9636 Prospect Ave', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5058814618', '5052120496', '9636 Prospect Ave', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5058814618', '5052120496', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740363662', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL);
