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
('870413860', 'S77002823', 'S77002823', 'UT01', 'Now Care Clinic', 'Diane', 'E', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870418421', 'S77002824', 'S77002824', 'UT01', NULL, 'David', 'P', 'Lewis', 'MD', 'Ophthalmology', '', '', NULL, 'O', '990 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342097', NULL, '990 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342097', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487653218', 0, 'N', 0, '2014-03-20', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('870418818', 'S77002825', 'S77002825', 'UT01', 'Bear River Medical Associates', 'Dellray', 'H', 'Anderson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', NULL, '420 W 600 N', 'Tremonton', '', 'UT', '84337', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-03-21', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639166416', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77002826', 'S77002826', 'UT01', 'Central Valley Medical Center Pro Fees', NULL, NULL, 'Central Valley Medical Center Pro Fees', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834459', 0, 'Y', 0, '2006-10-27', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'S77002827', 'S77002827', 'UT01', 'Central Valley Medical Center Pro Fees', NULL, NULL, 'Central Valley Medical Center Pro Fees', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 412', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834459', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77002828', 'S77002828', 'UT01', 'Nephi Medical Clinic', 'James', 'M', 'Besendorfer', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1194741629', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77002830', 'S77002830', 'UT01', 'Nephi Medical Clinic', 'James', 'A', 'Tatton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', '', '', '0.00', '11.00', '0.00', 3, '2006-11-01', '2010-10-04', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396785341', 0, 'N', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002846', 'S77002846', 'UT01', NULL, 'Thomas', 'D', 'Rose', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336164466', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002847', 'S77002847', 'UT01', 'Rosquist Chiropractic', 'Gary', NULL, 'Rosquist', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '887 E Vine St', 'Murray', 'Salt Lake', 'UT', '84107', '8012661415', '8012661151', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-06-02', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427078666', 0, 'N', 0, '2008-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002848', 'S77002848', 'UT01', NULL, 'Gary', NULL, 'Rosquist', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427078666', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002849', 'S77002849', 'UT01', NULL, 'J', 'Stewart', 'Scoville', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '150 S 700 E Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356374822', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629108840', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002850', 'S77002850', 'UT01', NULL, 'J', 'Stewart', 'Scoville', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629108840', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002851', 'S77002851', 'UT01', NULL, 'Charles', 'P', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538290143', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002852', 'S77002852', 'UT01', 'Decker Lake Chiropractic', 'Edward', 'F', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2196 W 3500 S Ste C-7', 'West Valley', 'Salt Lake', 'UT', '84119', '8017467246', '8017467249', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578615761', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002853', 'S77002853', 'UT01', '', 'Derrick', 'L', 'Stanbridge', 'DC', 'Chiropractic', '', '', NULL, 'O', '5974 Fashion Point Dr Ste 110', 'So Ogden', 'Weber', 'UT', '84403', '8014756800', '8014756802', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', '8014756800', '8014756802', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-06-06', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326024977', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002854', 'S77002854', 'UT01', NULL, 'Randy', 'L', 'Stauffer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1025 E 11400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84094', '8015233898', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '920827', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002855', 'S77002855', 'UT01', '', 'Dee', 'Scott', 'Stevens', 'DC', 'Chiropractic', '', '', NULL, 'O', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962456681', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002856', 'S77002856', 'UT01', NULL, 'Harold', NULL, 'Stokes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669527040', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002857', 'S77002857', 'UT01', NULL, 'Joseph', 'W', 'Swenson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194843698', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002858', 'S77002858', 'UT01', NULL, 'Joel', 'D', 'Templeton', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1988 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8018783304', '8884667751', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-05-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578768172', 0, 'N', 0, '2009-05-09', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002859', 'S77002859', 'UT01', NULL, 'Michael', NULL, 'Thompson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861453219', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870422134', 'S77002861', 'S77002861', 'UT01', '', 'Richard', 'B', 'Nay', 'MD', 'Family Practice', '', '', NULL, 'O', '49 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287231', '4355287232', '49 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287231', '4355287232', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1780707711', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870423701', 'S77002862', 'S77002862', 'UT01', NULL, 'Dennis', 'L', 'Avner', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '1220 E 3900 S Ste -3C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629555', NULL, '1220 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDGSTR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832397', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870427052', 'S77002863', 'S77002863', 'UT01', 'Plastic Surgery Assoc', 'Louis', '', 'Morales', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821060948', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.6591, -111.866, NULL, NULL),
('870428249', 'S77002864', 'S77002864', 'UT01', 'Coalville Health Center', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'O', '82 N 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', '82 N 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-11-02', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'N', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('870428249', 'S77002865', 'S77002865', 'UT01', 'Coalville Health Center', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'Y', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('870428249', 'S77002866', 'S77002866', 'UT01', 'Kamas Health Center', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'O', '155 W 200 S', 'Kamas', 'Summit', 'UT', '84036', '4357834385', '4353365570', '155 W 200 S', 'Kamas', 'Summit', 'UT', '84036', '4357834385', '4353365570', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-16', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'N', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('870430297', 'S77002867', 'S77002867', 'UT01', 'Family Vision Clinic', 'Scott', 'D', 'Peterson', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '3988 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8016212883', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750351441', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870430297', 'S77002868', 'S77002868', 'UT01', 'Family Vision Clinic', 'Scott', 'D', 'Peterson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '3988 Washington Blvd', 'South Ogden', 'Weber', 'UT', '84403', '8016212883', NULL, '3988 Washington Blvd', 'South Ogden', 'Weber', 'UT', '84403', '8016212883', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750351441', 0, 'N', 0, '2013-11-04', NULL, NULL, 41.1907, -111.971, NULL, NULL),
('870430986', 'S77002870', 'S77002870', 'UT01', NULL, 'Bryce', '', 'Allred', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 400', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692456', '8015692080', '3584 W 9000 S Ste 400', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692456', '8015692080', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548317589', 0, 'N', 0, '2012-06-19', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870437364', 'S77002871', 'S77002871', 'UT01', '', 'Ace', '', 'Madsen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '175 N 100 W Ste 205B', 'Vernal', 'Uintah', 'UT', '84078', '4357896400', '4357899222', '175 N 100 W Ste 205B', 'Vernal', 'Uintah', 'UT', '84078', '4357896400', '4357899222', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-04-30', 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1699745711', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77002872', 'S77002872', 'UT01', 'Beaver Medical Clinic', 'Mitchell', NULL, 'Melling', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', '', 'UT', '84713', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-04-02', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528063617', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77002873', 'S77002873', 'UT01', 'Beaver Medical Clinic', 'B', 'N', 'Robinson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', '', '', '', 'HCFA|UB|', '1700881893', 0, 'Y', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002888', 'S77002888', 'UT01', NULL, 'Wade', 'C', 'Thompson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083722706', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002889', 'S77002889', 'UT01', NULL, 'Drew', NULL, 'Tribett', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '286 N Gateway Dr', 'Providence', 'Cache', 'UT', '84332', '4357557654', '4357537654', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982658605', 0, 'N', 0, '2009-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002891', 'S77002891', 'UT01', NULL, 'Jason', 'B', 'Welker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1514 S 800 W Ste 100', 'Preston', 'Franklin', 'ID', '83263', '2088522875', '2085635264', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760566699', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002892', 'S77002892', 'UT01', NULL, 'Jeffrey', NULL, 'Wheeler', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912012360', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77002896', 'S77002896', 'UT01', NULL, 'Jeffrey', 'S', 'White', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924952', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002897', 'S77002897', 'UT01', NULL, 'Philip', 'L', 'Wilkins', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609922319', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002899', 'S77002899', 'UT01', NULL, 'Darin', 'E', 'Wright', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316001050', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002900', 'S77002900', 'UT01', NULL, 'Stuart', 'J', 'Yeager', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356422828', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870398869', 'S77002931', 'S77002931', 'UT01', NULL, 'Gary', 'L', 'Wold', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8014910809', '8014893825', '120 N 1220 E', 'Ameican Fork', 'Utah', 'UT', '84003', '8014910809', '8014893825', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1194745091', 0, 'Y', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870400988', 'S77002933', 'S77002933', 'UT01', 'Behrmann, Gary L', 'Gary', 'L', 'Behrmann', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1172 E 100 N Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654877', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871680579', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870403523', 'S77002935', 'S77002935', 'UT01', 'West Valley Foot & Ankle', 'Craig', 'A', 'McManama', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '3540 S 4000 W Ste 480', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663556', NULL, '3540 S 4000 W', 'West Valley City', '', 'UT', '84120', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659430254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870406457', 'S77002937', 'S77002937', 'UT01', 'Tooele Foot Clinic', 'Kim', 'A', 'Halladay', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '82 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987035', NULL, '82 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987035', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-21', 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902809528', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002958', 'S77002958', 'UT01', 'Now Care Clinic', 'D', 'J', 'Balcombe', 'MD', 'Wound Care', 'Emergency Medicine', '', NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1629037361', 0, 'Y', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002961', 'S77002961', 'UT01', 'Now Care Clinic', 'Sean', 'J', 'Carver', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1548288020', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002966', 'S77002966', 'UT01', 'Now Care Clinic', 'Shiloh', 'C', 'Manning', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972536001', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002967', 'S77002967', 'UT01', 'Now Care Clinic', 'Bart', 'R', 'Nilson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834725', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002968', 'S77002968', 'UT01', 'Now Care Clinic', 'Bart', 'R', 'Nilson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834725', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77002969', 'S77002969', 'UT01', 'Now Care Clinic', 'Scott', 'M', 'Stallings', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1700818259', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'S77002970', 'S77002970', 'UT01', 'Cherry Tree Family Practice', 'Shelly', 'A', 'Day', 'NP', 'Family Practice', '', '', NULL, 'o', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235352188', 0, 'N', 0, '2010-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'S77002971', 'S77002971', 'UT01', 'Cherry Tree Family Practice', 'John', 'C', 'Allen', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W', 'Orem', '', 'UT', '84057', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-12-23', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000004970', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'S77003001', 'S77003001', 'UT01', 'Cherry Tree Family Practice', 'Gary', 'E', 'Cripe', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W', 'Orem', '', 'UT', '84057', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908495', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'S77003002', 'S77003002', 'UT01', 'Cherry Tree Family Practice', 'William', 'D', 'Preston', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W', 'Orem', '', 'UT', '84057', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396709903', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870418818', 'S77003003', 'S77003003', 'UT01', 'Bear River Medical Assoc', 'Rodney', 'W', 'Merrell', 'MD', 'Family Practice', '', '', NULL, 'O', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', NULL, '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-02-09', 0, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932196771', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003004', 'S77003004', 'UT01', 'Nephi Medical Clinic', 'Molly', 'M', 'Brotherson', 'PA', 'Family Practice', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, '', '0.00', '11.00', '0.00', 3, '2006-11-01', '2009-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578598132', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003006', 'S77003006', 'UT01', 'Nephi Medical Clinic', 'Michael', 'C', 'Peterson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1902827322', 0, 'Y', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003007', 'S77003007', 'UT01', 'Nephi Medical Clinic', 'Grant', 'J', 'Rasmussen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275563751', 0, 'N', 0, '2006-10-27', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'S77003010', 'S77003010', 'UT01', 'Nephi Medical Clinic', 'Jerald', 'B', 'Taylor', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1083631659', 0, 'N', 0, '2013-09-13', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870427052', 'S77003041', 'S77003041', 'UT01', 'Plastic Surgery Associates', 'Rodney', 'Evan', 'Schmelzer', 'MD', 'Plastic Surgery', 'Emergency Medicine', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882676', '8017430701', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882676', '8017430701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-12-31', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487626297', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870428249', 'S77003042', 'S77003042', 'UT01', 'Coalville Health Center', 'Jeanette', 'R', 'Vernon', 'PA-C', 'Family Practice', '', '', NULL, 'O', '82 N 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-02', NULL, 0, NULL, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487866208', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870428249', 'S77003043', 'S77003043', 'UT01', 'Coalville Health Center', 'Jeanette', 'R', 'Vernon', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487866208', 0, 'Y', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870428585', 'S77003044', 'S77003044', 'UT01', NULL, 'David', 'A', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '1002 E S Temple Ste 508', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015318634', NULL, '1002 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015318634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700890365', 0, 'N', 0, '2011-08-22', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('870432418', 'S77003045', 'S77003045', 'UT01', '', 'Keith', 'W', 'Linford', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1090 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999813', '8013999121', '1090 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999813', '8013999121', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-10', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275512493', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870436209', 'S77003046', 'S77003046', 'UT01', 'The Avenues Womens Clinic', 'Mary', 'K', 'Beard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', NULL, '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', '          ', 'WUSTDOBG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2007-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578574646', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870436210', 'S77003047', 'S77003047', 'UT01', 'The Avenues Womens Clinic', 'Vicki', 'L', 'Macy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', NULL, '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', '', 'WUSTDOBG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619985686', 0, 'N', 0, '2012-02-16', NULL, NULL, 40.7694, -111.878, NULL, NULL),
('870437878', 'S77003049', 'S77003049', 'UT01', 'Beaver Medical Clinic', 'Kenneth', 'L', 'Hussey', 'PA', 'Family Practice', '', '', NULL, 'O', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', '', '', '', 'HCFA|UB|', '1841295938', 0, 'Y', 0, '2014-04-11', NULL, NULL, 38.2882, -112.643, NULL, NULL),
('870437878', 'S77003050', 'S77003050', 'UT01', 'Beaver Medical Clinic', 'Kenneth', 'L', 'Hussey', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', '', '', '', 'HCFA|UB|', '1841295938', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77003051', 'S77003051', 'UT01', 'Milford Medical Clinic', 'Roger', 'H', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4353872471', '4354387210', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4353872471', '4354387210', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, NULL, 'Beaver Valley Hospital', 'Beaver Valley Hospital', NULL, NULL, 'HCFA|UB|', '1043217268', 0, 'N', 0, '2011-09-21', NULL, NULL, 38.2882, -112.643, NULL, NULL),
('870437878', 'S77003052', 'S77003052', 'UT01', 'Beaver Medical Clinic', 'Roger', 'H', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital', NULL, NULL, 'HCFA|UB|', '1043217268', 0, 'Y', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870441813', 'S77003053', 'S77003053', 'UT01', 'Rowley, Steven D', 'Steven', 'D', 'Rowley', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '1461 E 840 N', 'Orem', 'Utah', 'UT', '84097', '8013735211', '8013737803', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124121538', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870410999', 'S77003065', 'S77003065', 'UT01', 'Freedom Medical Center', 'Dennis', 'W', 'Remington', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1675 N Freedom Blvd Ste 11 E', 'Provo', 'Utah', 'UT', '84604', '8013738500', '8013733426', '1675 N Freedom Blvd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396730115', 0, 'N', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003067', 'S77003067', 'UT01', 'Now Care Clinic', 'D', 'J', 'Balcombe', 'MD', 'Wound Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', NULL, 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1629037361', 0, 'Y', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003096', 'S77003096', 'UT01', 'Now Care Clinic', 'Sean', 'J', 'Carver', 'PA', 'Family Practice', '', '', NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1548288020', 0, 'Y', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003097', 'S77003097', 'UT01', 'Now Care Clinic', 'Sean', 'J', 'Carver', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1548288020', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003101', 'S77003101', 'UT01', 'Now Care Clinic', 'Joelle', '', 'Creager', 'NP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016214600', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016214600', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558394692', 0, 'Y', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003106', 'S77003106', 'UT01', 'Now Care Clinic', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003107', 'S77003107', 'UT01', 'Now Care Clinic', 'Scott', 'M', 'Stallings', 'MD', 'Family Practice', '', '', NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1700818259', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77003109', 'S77003109', 'UT01', 'Now Care Clinic', 'Diane', 'EH', 'Wilson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870444057', 'S77003112', 'S77003112', 'UT01', 'Roosevelt Vision Clinic', 'Jon', 'P', 'Wilson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '165 W 200 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357222981', '4357223732', '165 W 200 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357222981', '4357223732', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760477731', 0, 'N', 0, '2013-12-11', NULL, NULL, 40.3021, -109.995, NULL, NULL),
('870413860', 'S77003138', 'S77003138', 'UT01', 'Now Care Clinic', 'Diane', 'EH', 'Wilson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'S77003140', 'S77003140', 'UT01', 'Cherry Tree Family Practice', 'Gary', 'E', 'Cripe', 'PA', 'Family Practice', '', '', NULL, 'o', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780801753', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870416750', 'S77003142', 'S77003142', 'UT01', NULL, 'Catherine', 'M', 'Jones', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014790361', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790733756', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870416750', 'S77003143', 'S77003143', 'UT01', '', 'Rodney', 'G', 'Marriott', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014790361', NULL, '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014790361', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2013-09-12', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1922066646', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870418818', 'S77003145', 'S77003145', 'UT01', 'Bear River Medical Assoc', 'Chad', 'L', 'Merrell', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', NULL, '420 W 600 N', 'Tremonton', '', 'UT', '84337', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-02-09', NULL, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730176512', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003146', 'S77003146', 'UT01', 'Nephi Medical Clinic', 'James', 'M', 'Besendorfer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1194741629', 0, 'N', 0, '2013-09-13', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870452022', 'S77003148', 'S77003148', 'UT01', 'Mt Timpanogos Womens Healthcare', 'E', 'William', 'Parker', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801855010', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870459414', 'S77003158', 'S77003158', 'UT01', 'Allergy Associates of Utah', 'Charles', 'M', 'Rogers', 'MD', 'Allergy and Immunology', NULL, NULL, NULL, 'O', '6095 Fashion Blvd Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012638700', '8012638693', '6095 Fashion Blvd Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012638700', '8012638693', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1912906330', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.6386, -111.883, NULL, NULL),
('870419324', 'S77003174', 'S77003174', 'UT01', 'Nephi Medical Clinic', 'Mark', 'C', 'Oveson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417974098', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003175', 'S77003175', 'UT01', 'Nephi Medical Clinic', 'Mark', 'C', 'Oveson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1417974098', 0, 'Y', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003176', 'S77003176', 'UT01', 'Nephi Medical Clinic', 'Grant', 'J', 'Rasmussen', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275563751', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77003177', 'S77003177', 'UT01', 'Nephi Medical Clinic', 'Jerald', 'B', 'Taylor', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1083631659', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870423701', 'S77003178', 'S77003178', 'UT01', NULL, 'Dennis', 'L', 'Avner', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1220 E 3900 S Ste 3C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629555', NULL, '1220 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDGSTR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-04-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346250875', 0, 'N', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870427052', 'S77003179', 'S77003179', 'UT01', 'Plastic Surgery Assoc', 'Louis', '', 'Morales', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882676', '8017430701', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882676', '8017430701', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821060948', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.7663, -111.837, 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
('870430986', 'S77003180', 'S77003180', 'UT01', '', 'Bryce', '', 'Allred', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '324 10th Ave Ste 254', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083584', NULL, '324 10th Ave Ste 254', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083584', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-29', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548317589', 0, 'N', 0, '2012-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870436531', 'S77003181', 'S77003181', 'UT01', NULL, 'Robert', 'P', 'Strebel', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '550 E 1400 N Ste I', 'Logan', 'Cache', 'UT', '84341', '4357531545', NULL, '550 E 1400 N Ste I', 'Logan', 'Cache', 'UT', '84341', '4357531545', '', 'Wise++', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629013248', 0, 'N', 0, '2012-05-29', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('870437364', 'S77003182', 'S77003182', 'UT01', 'Madsen, Ace', 'Ace', NULL, 'Madsen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '175 N 100 W Ste 205B', 'Vernal', 'Uintah', 'UT', '84078', '4357896400', '4357899222', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699745711', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'S77003190', 'S77003190', 'UT01', 'South Valley Womens Health', 'Michael', 'L', 'Draper', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-03-02', NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992769368', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'S77003191', 'S77003191', 'UT01', 'South Valley Womens Health', 'Scott', 'E', 'Hansen', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164402897', 0, 'N', 0, '2012-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'S77003194', 'S77003194', 'UT01', 'South Valley Womens Health', 'Kimberly', 'S', 'Moreland', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871572008', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('010748188', 'S77003198', 'S77003198', 'UT01', 'Emergency Medical Billing', NULL, NULL, 'Emergency Medical Billing LLC', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146570', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487792255', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010748188', 'S77003199', 'S77003199', 'UT01', 'Emergency Medical Billing', 'Ronald', NULL, 'Barlow', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1098', 'Salem', 'Utah', 'UT', '84653', '8017146570', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833275', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010748188', 'S77003200', 'S77003200', 'UT01', 'Emergency Medical Billing', 'L Dean', NULL, 'Egbert', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146570', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-12-31', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366436768', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870460998', 'S77003558', 'S77003558', 'UT01', 'Prevention & Medical Screening', 'Lombardo', '', 'Palma', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6095 Fashion Blvd Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012652604', NULL, '6095 Fashion Blvd Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012652604', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356388730', 0, 'N', 0, '2012-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'S77003559', 'S77003559', 'UT01', 'South Valley Womens Health', 'Mitchell', 'F', 'Barney', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-31', NULL, 0, NULL, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912986142', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('202717899', 'S77003575', 'S77003575', 'UT01', 'Evolutionary Healthcare', 'Carol', '', 'Osborn', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', NULL, '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1568464030', 0, 'N', 0, '2012-06-13', NULL, NULL, 40.765, -111.878, NULL, NULL),
('202797407', 'S77003576', 'S77003576', 'UT01', 'ENT Surgical Associates', 'Peter', 'G', 'Ventura', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '2376 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358339600', '4358339601', '2376 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358339600', '4358339601', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144201690', 0, 'N', 0, '2010-08-30', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('202965326', 'S77003578', 'S77003578', 'UT01', NULL, 'Dale', 'R', 'Gerstmann', 'MD', 'Neonatology', NULL, NULL, NULL, 'B', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8016555425', NULL, '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8016555425', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1205834843', 0, 'Y', 0, '2013-08-13', NULL, NULL, 0, 0, NULL, NULL),
('203088245', 'S77003579', 'S77003579', 'UT01', NULL, 'Gregory', 'J', 'Gulso', 'DPM', 'Podiatry', '', '', NULL, 'O', '415 Medical Dr Ste C200', 'Bountiful', 'Davis', 'UT', '84010', '8012948266', NULL, '415 Medical Dr Ste C200', 'Bountiful', 'Davis', 'UT', '84010', '8012948266', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-02-28', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1316025323', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('203350494', 'S77003580', 'S77003580', 'UT01', 'Oasis Family Medicine', 'Jay', 'M', 'Spector', 'MD', 'Family Practice', '', '', NULL, 'O', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358330229', '4358330231', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358330229', '4358330231', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-30', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386630259', 0, 'N', 0, '2013-09-13', NULL, NULL, 40.5651, -112.298, NULL, NULL),
('203589948', 'S77003582', 'S77003582', 'UT01', NULL, 'Matthew', 'J', 'Welter', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2380 N 400 E Ste H', 'N Logan', 'Cache', 'UT', '84341', '4357879600', NULL, '2380 N 400 E', 'North Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164486064', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'S77003583', 'S77003583', 'UT01', 'Mountain Valley Eye Institute', 'John', 'B', 'Fassio', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2012-09-01', 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1689671638', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870470654', 'S77003599', 'S77003599', 'UT01', NULL, 'Robert', 'G', 'Naylor', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4A', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012638511', NULL, '1220 E 3900 S Ste 4A', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012638511', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215047287', 0, 'N', 0, '2014-03-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870462017', 'S77003600', 'S77003600', 'UT01', 'South Valley Womens Health', 'Kathleen', 'M', 'Langer', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710959416', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870463394', 'S77003602', 'S77003602', 'UT01', NULL, 'Blaine', 'P', 'Andersen', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '1300 N 500 E Ste 260', 'Logan', 'Cache', 'UT', '84341', '4357533400', NULL, '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357533400', '', 'WULOGANI5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538279609', 0, 'N', 0, '2011-08-22', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('870465798', 'S77003603', 'S77003603', 'UT01', NULL, 'David', 'H', 'Jaramillo', 'DPM', 'Podiatry', '', '', NULL, 'O', '1678 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356491017', NULL, '1678 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356491017', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1154437655', 0, 'N', 0, '2014-06-25', NULL, NULL, 40.6622, -111.5, NULL, NULL),
('870465963', 'S77003604', 'S77003604', 'UT01', NULL, 'Charles', 'E', 'Holt', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 88', 'Tooele', 'Tooele', 'UT', '84074', '4358828610', '4358820186', 'PO Box 88', 'Tooele', 'Tooele', 'UT', '84074', '4358828610', '4358820186', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1689772519', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('870466859', 'S77003605', 'S77003605', 'UT01', 'Foot Clinic of Logan', 'W Bryce', '', 'Cook', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '990 Medical Dr Ste 3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349623', '4357527159', '550 E 1400 N', 'Logan', 'Box Elder', 'UT', '84341', '4357349623', '4357527159', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1316989569', 0, 'N', 0, '2012-01-05', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('870467007', 'S77003606', 'S77003606', 'UT01', NULL, 'George', 'C', 'Wootton', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355636211', '4355639481', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730246299', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('245710270', 'S77003627', 'S77003627', 'UT01', 'Epic Associates for Inpatient Medicine', NULL, NULL, 'Associates for Inpat', 'GROUP', 'Hospitalist', 'Multi Specialty (Clinic)', NULL, NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905532', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260043031', 'S77003628', 'S77003628', 'UT01', 'Utah Hematology Oncology', 'Harold', 'M', 'Johnson', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '5290 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014761777', '8013877155', '4403 Harrison Bvld', 'Ogden', 'Weber', 'UT', '84403', '8014761777', '8013877155', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1326156191', 0, 'N', 0, '2011-12-21', NULL, NULL, 41.1688, -111.971, NULL, NULL),
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('870479370', 'S77004102', 'S77004102', 'UT01', 'Mountain West Cardiovascular Associates', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, 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', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'S77004103', 'S77004103', 'UT01', 'Mountain West Cardiovascular Associates', 'Keith', 'L', 'Ritchie', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834071', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77004104', 'S77004104', 'UT01', 'Mountain West Cardiovascular Associates', 'Nicole', NULL, 'Switzer', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831895', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77004105', 'S77004105', 'UT01', 'Mountain West Cardiovascular Associates', 'J Kent', NULL, 'Thorne', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012844512', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356335970', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77004106', 'S77004106', 'UT01', 'Mountain West Cardiovascular Associates', 'James', 'Scott', 'Zebrack', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '24 S 1100 E Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015219800', NULL, '24 S 1100 E Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015219800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1003808940', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.7689, -111.86, 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
('680562677', 'S77004111', 'S77004111', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Richard', 'W', 'Nielsen', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', NULL, '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1427183052', 0, 'N', 0, '2012-05-25', NULL, NULL, 40.7689, -111.865, NULL, NULL),
('680562677', 'S77004113', 'S77004113', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Richard', 'W', 'Nielsen', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '7138 Highland Dr Ste 213 A', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013282522', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427183052', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('710871556', 'S77004115', 'S77004115', 'UT01', 'Providence Family Medicine', 'Kevin', 'R', 'Duke', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 609', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'PO Box 609', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003882713', 0, 'Y', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'S77004161', 'S77004161', 'UT01', 'Westside Medical Clinic', 'Rodney', 'K', 'Grogan', 'PA', 'Family Practice', 'Family Practice', NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114915170', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004163', 'S77004163', 'UT01', 'Millcreek Anesthesia', 'Will', NULL, 'Chamberlain', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194823922', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('710922709', 'S77004165', 'S77004165', 'UT01', NULL, 'Thomas', 'D', 'Myers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '280 W River Park Dr Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012243565', NULL, '280 W River Park Dr Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012243565', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023074093', 0, 'N', 0, '2014-03-18', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('731650218', 'S77004166', 'S77004166', 'UT01', NULL, 'Nathan', 'W', 'Davis', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '154 Myrtle Ave Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8017432909', NULL, '154 Myrtle Ave Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8017432909', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730165572', 0, 'N', 0, '2012-03-15', NULL, NULL, 40.6613, -111.887, NULL, NULL),
('731652742', 'S77004167', 'S77004167', 'UT01', 'Alpine Spine, Sports And Rehabilitation', 'Kristy', 'L', 'Janssen', 'PA', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014790312', '8014793364', '5404 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871698084', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'S77004168', 'S77004168', 'UT01', 'Alpine Spine  Sports and Rehabilitation', 'Matthew', 'J', 'Pingree', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014790312', '8014793364', '5405 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-04', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225149883', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'S77004170', 'S77004170', 'UT01', 'Alpine Spine, Sports And Rehabilitation', 'Jean', NULL, 'Stanford', 'PA', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014790312', '8014793364', '5405 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '935296', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870478213', 'S77004189', 'S77004189', 'UT01', 'Eyre Dermatology Clinic', 'Russell', 'W', 'Eyre', 'MD', 'Dermatology', '', '', NULL, 'O', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851395529', 0, 'N', 0, '2014-02-05', NULL, NULL, 40.3121, -111.708, NULL, NULL),
('870478213', 'S77004190', 'S77004190', 'UT01', 'Eyre Dermatology Clinic', 'Steven', 'P', 'Eyre', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '486 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', '486 W 800 N', 'Orem', '', 'UT', '84057', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174520597', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004205', 'S77004205', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Thomas', 'R', 'Meuleman', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407840200', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004206', 'S77004206', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Dennis', NULL, 'Morris', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023109618', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77004207', 'S77004207', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Dustin', 'G', 'Morris', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194822338', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77004208', 'S77004208', 'UT01', 'Millcreek Anesthesia', 'Matthew', 'L', 'Peterson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013008077', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004210', 'S77004210', 'UT01', 'Millcreek Anesthesia', 'Mark', 'W', 'Rallison', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012728481', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396743282', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77004211', 'S77004211', 'UT01', 'Millcreek Anesthesia', 'Terry', 'A', 'Smith', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114027877', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004212', 'S77004212', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Jeffrey', NULL, 'Peters', 'NP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285731281', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('742412898', 'S77004227', 'S77004227', 'UT01', 'Community Health Centers', 'Melissa', 'S', 'Briley', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', NULL, '1798 S W Temple', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265439376', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77004228', 'S77004228', 'UT01', 'Community Health Centers', 'Camille', '', 'Collett', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8014126950', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530305', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77004229', 'S77004229', 'UT01', 'Community Health Centers', 'Marilyn', 'L', 'Curran', 'MD', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2014-04-20', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1285631358', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77004230', 'S77004230', 'UT01', 'Community Health Centers', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', NULL, '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-10-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870478213', 'S77004232', 'S77004232', 'UT01', 'Eyre Dermatology Clinic', 'Warren', 'G', 'Eyre', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-03-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629072384', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('870478213', 'S77004233', 'S77004233', 'UT01', 'Eyre Dermatology Clinic', 'Warren', 'G', 'Eyre', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '486 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', '486 W 800 N', 'Orem', '', 'UT', '84057', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629072384', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77004278', 'S77004278', 'UT01', 'Community Health Centers', 'Carlos', 'A', 'Guerra', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', NULL, '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1891772612', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77004283', 'S77004283', 'UT01', 'Central City Clinic Medical', 'Kenneth', 'P', 'Libre', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801873534', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.7593, -111.88, NULL, NULL),
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('870489599', 'S77004427', 'S77004427', 'UT01', 'Intermountain Pediatric Clinic', 'Alan (Rob)', 'N', 'Lindsay', 'MD', 'Pediatrics', 'Pediatric Endocrinology', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1538281050', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
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('870479370', 'S77004467', 'S77004467', 'UT01', 'Mountain West Cardiovascular Associates', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, 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', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'S77004469', 'S77004469', 'UT01', 'Mountain West Cardiovascular Associates', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870479370', 'S77004470', 'S77004470', 'UT01', 'Mountain West Cardiovascular Assoc', 'Rex', 'A', 'Outtrim', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', NULL, '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558355313', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77004471', 'S77004471', 'UT01', 'Mountain West Cardiovascular Associates', 'James', 'Scott', 'Zebrack', 'MD', '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', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1003808940', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479551', 'S77004473', 'S77004473', 'UT01', 'The Avenues Womens Clinic', 'L Jeanne', '', 'Gemmell', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'O', '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', NULL, '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', '', 'WUSTDOBG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063420651', 0, 'N', 0, '2012-03-01', NULL, NULL, 40.7694, -111.878, NULL, NULL),
('870491342', 'S77004535', 'S77004535', 'UT01', 'Rocky Mountain Associated Physicians', 'Sherman', 'C', 'Smith', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', 'WCSTRMAP5', 'WUSTDSURG5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134136468', 0, 'N', 0, '2012-02-29', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870491824', 'S77004538', 'S77004538', 'UT01', '', 'John', 'F', 'Boyle', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '230 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356370474', NULL, '230 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356370474', '          ', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-01-31', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1154489698', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870492206', 'S77004539', 'S77004539', 'UT01', '', 'Rodney', 'M', 'Jex', 'DPM', 'Podiatry', '', '', NULL, 'O', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '          ', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1912986662', 0, 'N', 0, '2014-07-23', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870492272', 'S77004541', 'S77004541', 'UT01', 'Utah Cardiology', 'Gregory', 'T', 'Almony', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', NULL, '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', '', '', 'HCFA|UB|', '1023003142', 0, 'N', 0, '2014-06-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('870492272', 'S77004542', 'S77004542', 'UT01', 'Utah Cardiology', 'Eric', 'S', 'Anding', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '520 Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012921315', NULL, '520 Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012921315', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1487649521', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('870492272', 'S77004543', 'S77004543', 'UT01', 'Utah Cardiology', 'Eric', 'S', 'Anding', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487649521', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004544', 'S77004544', 'UT01', 'Utah Cardiology', 'Demosthenes', 'N', 'Iskos', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', NULL, '520 E Medical Dr', 'Bountiful', 'Weber', 'UT', '84010', '8014790184', '          ', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', '2011-11-07', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1710972864', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'S77004578', 'S77004578', 'UT01', 'Westside Medical Clinic', 'Nelson', 'L', 'Astle', 'MD', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1548366552', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('870481685', 'S77004582', 'S77004582', 'UT01', 'Kathryn Allen, MD', 'Kathryn', NULL, 'Allen', 'MD', 'Family Practice', 'Sports Medicine', NULL, NULL, 'B', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023058278', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870481685', 'S77004583', 'S77004583', 'UT01', 'Kathryn Allen, MD', 'Steven', 'R', 'Nielson', 'PA', NULL, NULL, NULL, NULL, 'B', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908288', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870492272', 'S77004588', 'S77004588', 'UT01', 'Utah Cardiology', 'Stephanie', 'L', 'Olsen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396730404', 0, 'Y', 0, '2006-12-15', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004589', 'S77004589', 'UT01', 'Utah Cardiology', 'Scott', 'H', 'West', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '520 Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012921315', NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225023328', 0, 'N', 0, '2006-11-09', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('753026770', 'S77004601', 'S77004601', 'UT01', 'Cascade Foot and Ankle Clinic', 'Jared', 'T', 'Clegg', 'DPM', 'Podiatry', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '8013739200', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '8013739200', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1588664759', 0, 'N', 0, '2013-07-26', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('753097476', 'S77004602', 'S77004602', 'UT01', 'Mountain West Family Practice', 'Sergio', '', 'Abarca', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822309', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822309', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245238617', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('760797373', 'S77004604', 'S77004604', 'UT01', 'Farmington Family Medicine', 'Julie', 'C', 'Hibbard', 'MD', 'Family Practice', '', '', NULL, 'O', '1401 N 1075 W Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014514538', NULL, '1401 N 1075 W Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014514538', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457312845', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.0035, -111.911, 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
('760797373', 'S77004605', 'S77004605', 'UT01', 'Farmington Family Medicine', 'Sally', 'S', 'Tan', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1401 N 1075 W Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014514538', NULL, '1401 N Highway 89', 'Farmington', 'Davis', 'UT', '84025', '8014514538', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-05-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1760443154', 0, 'N', 0, '2011-12-21', NULL, NULL, 0, 0, NULL, NULL),
('800013869', 'S77004607', 'S77004607', 'UT01', 'Wasatch Medical Clinic', 'Stanton', 'B', 'McDonald', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 247', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', NULL, 'PO Box 247', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982636890', 0, 'Y', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('810583412', 'S77004609', 'S77004609', 'UT01', '', 'Karen', 'M', 'Radley', 'MD', 'Family Practice', '', '', NULL, 'O', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356376271', '4356371904', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356376271', '4356371904', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-11-10', 0, 0, 0, 'Castleview Hospital', '', '', '', 'HCFA|UB|', '1508868563', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('810608733', 'S77004648', 'S77004648', 'UT01', 'Nexus Pain Care', 'Richard', '', 'Rosenthal', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073512745', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('870482642', 'S77004672', 'S77004672', 'UT01', 'Millcreek Anesthesia', 'Randy', NULL, 'Thurgood', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245238146', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77004673', 'S77004673', 'UT01', 'Millcreek Anesthesia', 'Jeffrey', NULL, 'Peters', 'NP', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285731281', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
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('870501344', 'S77004682', 'S77004682', 'UT01', 'Pediatric Care', 'Todd', 'L', 'Chidester', 'NP', 'Pediatrics', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 311', 'Provo', 'Utah', 'UT', '84604', '8013577800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908425', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870491824', 'S77004717', 'S77004717', 'UT01', '', 'John', 'F', 'Boyle', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 856', 'Price', 'Carbon', 'UT', '84501', '4435637047', NULL, 'PO Box 856', 'Price', 'Carbon', 'UT', '84501', '4435637047', '          ', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-01-31', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1154489698', 0, 'Y', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004718', 'S77004718', 'UT01', 'Utah Cardiology', 'Gregory', 'T', 'Almony', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', '', '', 'HCFA|UB|', '1023003142', 0, 'Y', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004720', 'S77004720', 'UT01', 'Utah Cardiology', 'Michael', 'C', 'Cody', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '          ', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', '2011-09-09', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1629063755', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004721', 'S77004721', 'UT01', 'Utah Cardiology', 'Michael', 'J', 'Diehl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1265427371', 0, 'Y', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004722', 'S77004722', 'UT01', 'Utah Cardiology', 'Daniel', 'J', 'Humiston', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780679829', 0, 'Y', 0, '2006-12-15', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004737', 'S77004737', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '5642 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012740101', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '8012740101', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 40.6488, -111.866, NULL, NULL),
('870503286', 'S77004741', 'S77004741', 'UT01', 'Hearing Zone', 'Kent', 'J', 'Nielsen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1689744138', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004742', 'S77004742', 'UT01', 'Hearing Zone', 'Dave', '', 'Robinson', 'AUD', 'Audiology', '', '', NULL, 'O', '129 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357537171', NULL, '129 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357537171', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386703767', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004743', 'S77004743', 'UT01', 'Hearing Zone', 'Dave', NULL, 'Robinson', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '70 S Fairfield', 'Layton', '', 'UT', '84041', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386703767', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004744', 'S77004744', 'UT01', 'Hearing Zone', 'Alan', '', 'Young', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '5642 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017130101', NULL, '5642 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017130101', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588691380', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870509414', 'S77004750', 'S77004750', 'UT01', 'Mountain Utah Family Medicine', 'David', 'M', 'Pope', 'MD', 'Family Practice', '', '', NULL, 'O', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1467554451', 0, 'N', 0, '2013-11-04', NULL, NULL, 38.781, -112.085, NULL, NULL),
('841388863', 'S77004752', 'S77004752', 'UT01', NULL, 'Scott', 'W', 'Knorpp', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '370 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015328540', '8015328542', '370 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015328540', '8015328542', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760589378', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.7693, -111.88, NULL, NULL),
('841394394', 'S77004753', 'S77004753', 'UT01', 'Eye Care for You', 'Phillip', 'G', 'Cromwell', 'OD', 'Optometry', '', '', NULL, 'O', '46 S State St', 'Preston', 'Franklin', 'ID', '83263', '2088523030', '4357526486', '46 S State St', 'Preston', 'Franklin', 'ID', '83263', '2088523030', '4357526486', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-02-09', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1720194632', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('841401118', 'S77004754', 'S77004754', 'UT01', 'Urology Clinic of Utah Valley', 'Stewart', 'T', 'Landau', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 271520', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013577530', NULL, 'PO Box 271520', 'Salt Lake City', '', 'UT', '841271520', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174559728', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77004757', 'S77004757', 'UT01', 'Alpine Internal Medicine', 'Kelly', 'D', 'Beams', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'USTDCARD', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548234750', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77004762', 'S77004762', 'UT01', 'Alpine Medical Group', 'Mary', 'Elena', 'James', 'MD', 'Neurology', '', '', NULL, 'O', '1002 E S Temple Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2008-10-25', NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710927975', 0, 'N', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004764', 'S77004764', 'UT01', 'Utah Cardiology', 'Demosthenes', 'N', 'Iskos', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '          ', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', '2011-11-07', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1710972864', 0, 'Y', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004767', 'S77004767', 'UT01', 'Utah Cardiology', 'Scott', 'H', 'West', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225023328', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870662713', 'S77004807', 'S77004807', 'UT01', 'Alpine Medical Group OBGYN & Pediatrics', 'Christine', NULL, 'Kapsa', 'NP', 'Gynecology', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265400568', 0, 'N', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77004808', 'S77004808', 'UT01', 'Alpine Medical Group OBGYN & Pediatrics', 'Stephen', 'D', 'Lash', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', '          ', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-01-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447228572', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77004813', 'S77004813', 'UT01', 'Alpine Medical Group OBGYN & Pediatrics', 'Sharon', 'K', 'Schriewer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1538137625', 0, 'N', 0, '2012-02-23', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('841407804', 'S77004817', 'S77004817', 'UT01', '', 'Christine', 'A', 'Cheng', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'o', '1002 E South Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012989774', '8015939626', '415 S Medical Dr', 'Bountiful', 'Salt Lake', 'UT', '84010', '8012989774', '8015939626', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, NULL, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306848338', 1, 'N', 0, '2011-08-30', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('870498345', 'S77004819', 'S77004819', 'UT01', '', 'Michael', 'R', 'Swinyer', 'PA', 'Dermatology', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-09-20', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790724847', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870498495', 'S77004820', 'S77004820', 'UT01', NULL, 'David', 'A', 'Spencer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '164 E 5900 S Ste A101', 'Murray', 'Salt Lake', 'UT', '84107', '8012623344', NULL, '164 E 5900 S Ste A101', 'Murray', 'Salt Lake', 'UT', '84107', '8012623344', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841225828', 0, 'N', 0, '2014-02-28', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870498727', 'S77004821', 'S77004821', 'UT01', 'The Avenues Womens Clinic', 'Lucinda', 'J', 'Robinson', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'O', '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', NULL, '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', '', 'WUSTDOBG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700894375', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.7694, -111.878, NULL, NULL),
('870500059', 'S77004823', 'S77004823', 'UT01', NULL, 'Paul', 'A', 'Paxman', 'OD', 'Optometry', '', '', NULL, 'O', '24 W Main St', 'American Fork', 'Utah', 'UT', '84003', '8017567996', '8017561690', '24 W Main St', 'American Fork', 'Utah', 'UT', '84003', '8017567996', '8017561690', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124097068', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.3768, -111.799, NULL, NULL),
('870501344', 'S77004827', 'S77004827', 'UT01', 'Pediatric Care', 'Kenneth', 'A', 'Zollo', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1675 N Freedom Blvd Bldg 3', 'Provo', 'Utah', 'UT', '84604', '8013778000', NULL, '1675 N Freedom Blvd Bldg 3', 'Provo', 'Utah', 'UT', '84604', '8013778000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1770545931', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.257, -111.662, NULL, NULL),
('870484603', 'S77004842', 'S77004842', 'UT01', NULL, 'Scott', 'K', 'Christensen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015833395', NULL, 'PO Box 58202', 'Salt Lake City', '', 'UT', '841580202', '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2006-11-01', '2008-11-05', 1, 12, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1770512238', 0, 'Y', 0, '2008-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'S77004854', 'S77004854', 'UT01', 'Utah County Surgical Associates', 'David', 'P', 'Garry', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497702252', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'S77004855', 'S77004855', 'UT01', 'Utah County Surgical Associates', 'Richard', 'M', 'Thomas', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215977517', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870517201', 'S77004856', 'S77004856', 'UT01', 'Central Utah Radiology', 'Connie', NULL, 'Vail', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356231242', '4355287358', 'PO Box 908', 'Bountiful', '', 'UT', '84011', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689675076', 0, 'Y', 0, '2006-12-21', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('841411398', 'S77004858', 'S77004858', 'UT01', 'Foothill Family Clinic', 'Ross', '', 'Brunetti', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700811023', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('841411398', 'S77004859', 'S77004859', 'UT01', 'Foothill Family Clinic', 'Tyler', 'L', 'Collins', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1376617563', 0, 'N', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004860', 'S77004860', 'UT01', 'Foothill Family Clinic', 'Tyler', 'L', 'Collins', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1376617563', 0, 'Y', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004861', 'S77004861', 'UT01', 'Foothill Family Clinic', 'Anne', NULL, 'Donohue', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', NULL, NULL, '', NULL, '84109', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832068', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004863', 'S77004863', 'UT01', 'Foothill Family Clinic', 'James', 'C', 'Jensen', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', NULL, NULL, '', NULL, NULL, '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833225', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004865', 'S77004865', 'UT01', 'Foothill Family Clinic', 'Steven', 'K', 'Miller', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942313796', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004866', 'S77004866', 'UT01', 'Foothill Family Clinic', 'Alfred', 'H', 'Namba', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', NULL, NULL, '', 'UT', '84109', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588791834', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004867', 'S77004867', 'UT01', 'Foothill Family Clinic', 'Bryan', '', 'Nelson', 'MD', 'Internal Medicine', 'Pediatrics', NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346265477', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841411398', 'S77004869', 'S77004869', 'UT01', 'Foothill Family Clinic', 'Mark', 'A', 'Rosen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', NULL, NULL, '', NULL, NULL, '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609823426', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870502782', 'S77004871', 'S77004871', 'UT01', 'North Valley Surgical Associates', 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841202397', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870502782', 'S77004872', 'S77004872', 'UT01', 'North Valley Surgical Associates', 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017633885', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841202397', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77004876', 'S77004876', 'UT01', 'Mountain West Ear Nose and Throat', 'Demetrios', 'G', 'Skedros', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', NULL, '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', NULL, NULL, 'HCFA|UB|', '1821146242', 0, 'N', 0, '2013-08-19', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870503202', 'S77004879', 'S77004879', 'UT01', 'Mountain West Ear Nose and Throat', 'Curt', 'R', 'Stock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-01-19', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Star Valley Medical Center', 'HCFA|UB|', '1275681686', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77004880', 'S77004880', 'UT01', 'Mountain West Ear Nose and Throat', 'Kelly', 'E', 'Stoker', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-12-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740338136', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004881', 'S77004881', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '8012946200', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 40.8843, -111.879, NULL, NULL),
('870503286', 'S77004882', 'S77004882', 'UT01', 'Hearing Zone', 'Garr', NULL, 'Crookston', 'AUD', 'Audiology', NULL, NULL, NULL, 'B', '129 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357537171', NULL, '70 S Fairfield', 'Layton', '', 'UT', '84041', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104999200', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004883', 'S77004883', 'UT01', 'Hearing Zone', 'Garr', NULL, 'Crookston', 'AUD', 'Audiology', NULL, NULL, NULL, 'B', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', NULL, '70 S Fairfield', 'Layton', '', 'UT', '84041', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104999200', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870484603', 'S77004884', 'S77004884', 'UT01', NULL, 'Scott', 'K', 'Christensen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 58202', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015833395', NULL, 'PO Box 58202', 'Salt Lake City', '', 'UT', '841580202', '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2006-11-01', '2008-11-05', 1, 12, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1770512238', 0, 'Y', 0, '2008-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77004885', 'S77004885', 'UT01', 'Oculoplastic Surgery', 'Richard', 'L', 'Anderson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', '8015339613', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295784759', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77004888', 'S77004888', 'UT01', 'Oculoplastic Surgery', 'John', 'D', 'McCann', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', NULL, NULL, 'B', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', '8015339613', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326006917', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870488943', 'S77004889', 'S77004889', 'UT01', 'Antelope Womens Center', 'Craig', 'L', 'Hurst', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 210', 'Layton', 'Davis', 'UT', '84041', '8017748714', NULL, '1660 W Antelope Dr Ste 210', 'Layton', 'Davis', 'UT', '84041', '8017748714', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-13', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1073554044', 0, 'N', 0, '2014-04-16', 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
('870489599', 'S77004890', 'S77004890', 'UT01', 'Intermountain Pediatric Clinic', 'Sandra', 'A', 'Phillips', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205059458', 0, 'Y', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('870489599', 'S77004891', 'S77004891', 'UT01', 'Intermountain Pediatric Clinic', 'Paul', 'H', 'Swensen', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477676112', 0, 'Y', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'S77004892', 'S77004892', 'UT01', 'Millcreek Womens Center', 'Toni', 'V', 'LaMalfa', 'CNM APRN', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-04', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1154424950', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'S77004893', 'S77004893', 'UT01', 'Millcreek Womens Center', 'Stephen', 'E', 'Lamb', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447227467', 0, 'N', 0, '2013-07-17', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870518374', 'S77004901', 'S77004901', 'UT01', 'ENT Specialists', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', NULL, '4000 S 700 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870518391', 'S77004903', 'S77004903', 'UT01', '', 'Amanda', 'S', 'Montiel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1002 E S Temple Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019080930', '          ', '1002 E S Temple Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019080930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2014-06-23', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1689716888', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('870518863', 'S77004904', 'S77004904', 'UT01', 'Jordan Meadows Medical Center', 'Frederic', 'M', 'Civish', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3534 S 6000 W', 'West Valley', 'Salt Lake', 'UT', '84128', '8019696264', '8019696333', '3534 S 6000 W', 'West Valley', '', 'UT', '84128', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124137278', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870518919', 'S77004905', 'S77004905', 'UT01', '', 'James', 'F', 'Allen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357894797', '4357894958', '175 N 100 W Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357894797', '4357894958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-08-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902833148', 0, 'N', 0, '2010-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004906', 'S77004906', 'UT01', 'Utah Heart Clinic', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004907', 'S77004907', 'UT01', 'Utah Heart Clinic', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004909', 'S77004909', 'UT01', 'Utah Heart Clinic', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004910', 'S77004910', 'UT01', 'Utah Heart Clinic', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965122', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004911', 'S77004911', 'UT01', 'Foothill Family Clinic', 'Sharon', NULL, 'Strong', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-10-26', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053343566', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004913', 'S77004913', 'UT01', 'Foothill Family Clinic', 'Robert', 'P', 'Vickerman', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', NULL, NULL, '', NULL, NULL, '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832110', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77004914', 'S77004914', 'UT01', 'Foothill Family Clinic', 'Dorothy', 'L', 'Williams', 'MD', 'Neurology', 'Family Practice', NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619992708', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('841428839', 'S77004915', 'S77004915', 'UT01', 'Provo Allergy & Asthma Clinic', 'Evan', 'J', 'Matheson', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '745 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013759292', NULL, '745 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013759292', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649251646', 0, 'N', 0, '2014-06-13', NULL, NULL, 40.2436, -111.667, NULL, NULL),
('841429813', 'S77004916', 'S77004916', 'UT01', '', 'Gordon', 'P', 'George', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8014310100', '8014317354', '800 N 700 W', 'Orem', 'Juab', 'UT', '84057', '8014310100', '8014317354', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-26', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1730109158', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('841429813', 'S77004917', 'S77004917', 'UT01', '', 'Gordon', 'P', 'George', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '700 W 800 N Ste 340A', 'Orem', 'Utah', 'UT', '84057', '8014310100', NULL, '800 N 700 W', 'Orem', 'Utah', 'UT', '84057', '8014310100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-26', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1730109158', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77004927', 'S77004927', 'UT01', 'Hearing Zone', 'Kent', 'J', 'Nielsen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '70 S Fairfield', 'Layton', 'Davis', 'UT', '84041', '8012946200', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1689744138', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870504725', 'S77004928', 'S77004928', 'UT01', '', 'Robert', 'L', 'Orme', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1434 E 9400 S Ste 105', 'Sandy', 'Salt Lake', 'UT', '84093', '8015728043', '8015764285', '1434 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8015728043', '8015764285', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-09-19', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1174635403', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870512479', 'S77004935', 'S77004935', 'UT01', NULL, 'Todd', 'M', 'Haderlie', 'MD', 'Family Practice', '', '', NULL, 'O', '1465 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356541234', '4356540337', '1465 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356541234', '4356540337', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326059155', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.4895, -111.41, NULL, NULL),
('870519172', 'S77004950', 'S77004950', 'UT01', 'Utah Heart Clinic', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5292 College Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8014083900', NULL, '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811965122', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004951', 'S77004951', 'UT01', 'Utah Heart Clinic', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043288368', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004952', 'S77004952', 'UT01', 'Utah Heart Clinic', 'Sherman', 'G', 'Sorensen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164490280', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77004953', 'S77004953', 'UT01', 'Utah Heart Clinic', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528036654', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77004955', 'S77004955', 'UT01', 'Utah Cancer Specialists', 'Vilija', '', 'Avizonis', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003865932', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'S77004959', 'S77004959', 'UT01', 'Utah Cancer Specialists', 'Nitin', 'B', 'Chandramouli', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '2490 S State St Ste 218', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014660556', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1801845730', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77004960', 'S77004960', 'UT01', 'Utah Cancer Specialists', 'Nitin', 'B', 'Chandramouli', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '196 E 2000 N Ste 107', 'Tooele', 'Tooele', 'UT', '84074', '4358433619', NULL, '196 E 2000 N Ste 107', 'Tooele', 'Tooele', 'UT', '84074', '4358433619', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-02', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1801845730', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77004961', 'S77004961', 'UT01', 'Utah Cancer Specialists', 'Kent', '', 'Difiore', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649229618', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870212456', 'S77004964', 'S77004964', 'UT01', 'Jackson Family Clinic', 'Christine', 'L', 'Jackson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 669', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287752', NULL, 'PO Box 669', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287752', '          ', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-09-12', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1114087996', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870217443', 'S77004967', 'S77004967', 'UT01', 'East Carbon Medical Service', 'Kurt', 'V', 'King', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'B', 'PO Box 930', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884441', '4358882270', 'PO Box 930', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884441', '4358882270', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649267949', 0, 'Y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77004968', 'S77004968', 'UT01', 'Tanner Memorial Clinic', 'Gary', 'J', 'Alexander', 'MD', 'Internal Medicine', 'Pulmonary', NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265418024', 0, 'Y', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77004969', 'S77004969', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'G', 'Allred', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811973829', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77004970', 'S77004970', 'UT01', 'Tanner Memorial Clinic', 'Marc', 'O', 'Anderson', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1154307197', 0, 'N', 0, '2014-07-18', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77004971', 'S77004971', 'UT01', 'Tanner Memorial Clinic', 'Marc', 'O', 'Anderson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1154307197', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77004972', 'S77004972', 'UT01', 'Tanner Memorial Clinic', 'Eric', 'R', 'Ashby', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2009-08-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1962488908', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77004973', 'S77004973', 'UT01', 'Tanner Memorial Clinic', 'Layne', 'T', 'Barker', 'MD', 'Family Practice', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', NULL, '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992781918', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'S77004974', 'S77004974', 'UT01', 'Tanner Memorial Clinic', 'Mark', 'E', 'Baxter', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437135290', 0, 'N', 0, '2011-09-29', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77004975', 'S77004975', 'UT01', 'Tanner Memorial Clinic', 'Norman', 'C', 'Bos', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2011-04-15', NULL, 0, NULL, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1104805118', 0, 'Y', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870514054', 'S77004976', 'S77004976', 'UT01', NULL, 'Tao', 'D', 'Tran', 'MD', 'General Practice', NULL, NULL, NULL, 'B', '3695 S Redwood Rd Ste 1', 'West Valley', 'Salt Lake', 'UT', '84119', '8015398283', '8015398283', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477520831', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77004992', 'S77004992', 'UT01', 'Utah Cardiology', 'Michael', 'E', 'Crawford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', NULL, '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', 'Lakeview Hospital', '', 'HCFA|UB|', '1699760397', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('870492272', 'S77004993', 'S77004993', 'UT01', 'Utah Cardiology', 'Michael', 'J', 'Diehl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', NULL, '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1265427371', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('870492272', 'S77004995', 'S77004995', 'UT01', 'Utah Cardiology', 'Demosthenes', 'N', 'Iskos', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3400', 'Ogden', 'Weber', 'UT', '84403', '8013873400', NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710972864', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005006', 'S77005006', 'UT01', 'Utah Cancer Specialists', 'Richard', 'N', 'Frame', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073563516', 0, 'Y', 0, '2011-09-02', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005007', 'S77005007', 'UT01', 'Utah Cancer Specialists', 'W', 'G', 'Harker', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1679522569', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'S77005008', 'S77005008', 'UT01', 'Utah Cancer Specialists', 'Regina', 'C', 'Klein', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', NULL, '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457300980', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('870519691', 'S77005009', 'S77005009', 'UT01', 'Utah Cancer Specialists', 'Robert', 'J', 'Lee', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548219991', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005010', 'S77005010', 'UT01', 'Utah Cancer Specialists', 'Robert', 'J', 'Lee', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548219991', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6874, -111.871, NULL, NULL),
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('870519691', 'S77005014', 'S77005014', 'UT01', 'Utah Cancer Specialists', 'William', 'E', 'Nibley', 'MD', 'Hematology and Oncology', 'Pediatric Hematology and Oncolocy', 'Oncology', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1437108974', 0, 'Y', 0, '2011-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005015', 'S77005015', 'UT01', 'Tanner Memorial Clinic', 'Ted', 'H', 'Burningham', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174509129', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005016', 'S77005016', 'UT01', 'Tanner Memorial Clinic', 'Darin', 'D', 'Checketts', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2011-08-15', NULL, 0, NULL, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1639158512', 0, 'N', 0, '2011-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'S77005020', 'S77005020', 'UT01', 'Tanner Memorial Clinic', 'Duane', 'E', 'Farley', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538145586', 0, 'Y', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005021', 'S77005021', 'UT01', 'Tanner Memorial Clinic', 'Todd', 'B', 'Flitton', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699751461', 0, 'Y', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005022', 'S77005022', 'UT01', 'Tanner Memorial Clinic', 'Stephen', 'M', 'Foote', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689650632', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005024', 'S77005024', 'UT01', 'Tanner Memorial Clinic', 'Stephen', 'M', 'Foote', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689650632', 0, 'Y', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('870498921', 'S77005050', 'S77005050', 'UT01', NULL, 'Duane', 'E', 'Townsend', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '1485 S Highway 40', 'Heber City', 'Wasatch', 'UT', '84032', '4359018123', NULL, '112 Ryans Lane', 'Midway', '', 'UT', '84049', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114986502', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005053', 'S77005053', 'UT01', 'Utah Cancer Specialists', 'William', 'E', 'Nibley', 'MD', 'Pediatric Hematology and Oncolocy', 'Pediatric Hematology and Oncolocy', NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437108974', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005054', 'S77005054', 'UT01', 'Utah Cancer Specialists', 'Nancy', '', 'Weber', 'PA', 'Hematology and Oncology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', '', '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1194774554', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('870520042', 'S77005057', 'S77005057', 'UT01', 'Nephrology Associates', 'Phyllis', 'T', 'Aseltine', 'NP', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1376545251', 0, 'N', 0, '2011-07-20', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005058', 'S77005058', 'UT01', 'Nephrology Associates', 'Richard', 'G', 'Lambert', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1043217847', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005059', 'S77005059', 'UT01', 'Nephrology Associates', 'Melinda', 'J', 'McAnulty', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1902803661', 0, 'N', 0, '2012-06-07', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005060', 'S77005060', 'UT01', 'Nephrology Associates', 'Terrence', 'F', 'Oder', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000907183', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005061', 'S77005061', 'UT01', 'Nephrology Associates', 'Christy', 'A', 'Rabetoy', 'NP', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834265', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77005062', 'S77005062', 'UT01', 'Nephrology Associates', 'Christy', 'A', 'Rabetoy', 'NP', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S', 'Salt Lake City', '', 'UT', '84104', '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834265', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870523626', 'S77005064', 'S77005064', 'UT01', 'Blake O Zobell DPM', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577482', '4358930227', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525465', 'S77005065', 'S77005065', 'UT01', 'Bookcliffs Pathology', NULL, NULL, 'Bookcliffs Pathology', 'GROUP', 'Pathology', NULL, NULL, NULL, 'B', 'PO Box 974', 'Price', 'Carbon', 'UT', '84501', '4357349471', NULL, '300 N Hospital Dr', 'Price', '', 'UT', '84501', '', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871650218', 0, 'Y', 0, '2007-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005066', 'S77005066', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813030', NULL, '1250 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005067', 'S77005067', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'D', 'Kirkham', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1861478638', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005068', 'S77005068', 'UT01', 'Tanner Memorial Clinic', 'Gary', 'D', 'Lee', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760468706', 0, 'Y', 0, '2011-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005069', 'S77005069', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'R', 'Martineau', 'MD', 'Dermatology', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790761559', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77005070', 'S77005070', 'UT01', 'Tanner Memorial Clinic', 'Steven', 'C', 'Meek', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1346228723', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77005071', 'S77005071', 'UT01', 'Tanner Memorial Clinic', 'Steven', 'C', 'Meek', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1346228723', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005072', 'S77005072', 'UT01', 'Tanner Memorial Clinic', 'David', 'G', 'Morrell', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720064694', 0, 'N', 0, '2011-10-03', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'S77005073', 'S77005073', 'UT01', 'Tanner Memorial Clinic', 'David', 'G', 'Morrell', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720064694', 0, 'Y', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005074', 'S77005074', 'UT01', 'Tanner Memorial Clinic', 'Laurence', 'M', 'Nelson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730165697', 0, 'Y', 0, '2011-11-16', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005076', 'S77005076', 'UT01', 'Tanner Memorial Clinic', 'Brooks', 'H', 'Potter', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629054580', 0, 'N', 0, '2011-11-14', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'S77005077', 'S77005077', 'UT01', 'Tanner Memorial Clinic', 'Brooks', 'H', 'Potter', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629054580', 0, 'Y', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005078', 'S77005078', 'UT01', 'Tanner Memorial Clinic', 'James', 'R', 'Reynolds', 'MD', 'Urology', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1568448504', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77005079', 'S77005079', 'UT01', 'Tanner Memorial Clinic', 'James', 'R', 'Reynolds', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1568448504', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005080', 'S77005080', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'P', 'Schaelling', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861478737', 0, 'Y', 0, '2014-02-07', 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
('870518391', 'S77005086', 'S77005086', 'UT01', 'Sue A Montiel CNM', 'Amanda', 'S', 'Montiel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 25413', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8019080930', NULL, 'PO Box 25413', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8019080930', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1689716888', 0, 'Y', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870518863', 'S77005087', 'S77005087', 'UT01', 'Jordan Meadows Medical Center', 'Frederic', 'M', 'Civish', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3534 S 6000 W', 'West Valley', 'Salt Lake', 'UT', '84128', '8019696264', NULL, '3534 S 6000 W', 'West Valley', 'Salt Lake', 'UT', '84128', '8019696264', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124137278', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6957, -112.034, NULL, NULL),
('870519025', 'S77005088', 'S77005088', 'UT01', NULL, 'Bradley', 'K', 'Summers', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '550 E 1400 N Ste R', 'Logan', 'Cache', 'UT', '84341', '4357559484', NULL, '550 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357559484', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1164403259', 0, 'N', 0, '2011-10-03', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('870519172', 'S77005091', 'S77005091', 'UT01', 'Utah Heart Clinic', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811965122', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77005094', 'S77005094', 'UT01', 'Utah Heart Clinic', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870499839', 'S77005095', 'S77005095', 'UT01', 'Seitz Eyecare', 'Gordon', 'A', 'Seitz', 'OD', 'Optometry', '', '', NULL, 'O', '185 N Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357891552', '4357891551', '185 N Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357891552', '4357891551', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215034202', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.4584, -109.529, NULL, NULL),
('870501344', 'S77005097', 'S77005097', 'UT01', 'Pediatric Care', 'Ronald', 'C', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'O', '1675 N Freedom Blvd Bldg 3', 'Provo', 'Utah', 'UT', '84604', '8013778000', NULL, '1675 N Freedom Blvd Bldg 3', 'Provo', 'Utah', 'UT', '84604', '8013778000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1245290295', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77005104', 'S77005104', 'UT01', 'Mountain West Ear Nose and Throat', 'Steven', 'M', 'Kelly', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Davis Hospital', '', 'HCFA|UB|', '1841348240', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870503202', 'S77005106', 'S77005106', 'UT01', 'Mountain West Ear Nose and Throat', 'Demetrios', 'G', 'Skedros', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', NULL, NULL, 'HCFA|UB|', '1821146242', 0, 'N', 0, '2013-08-19', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870503286', 'S77005107', 'S77005107', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '129 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357537171', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '4357537171', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 41.7575, -111.831, NULL, NULL),
('870503286', 'S77005108', 'S77005108', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '8016120202', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 41.197, -111.979, NULL, NULL),
('870525682', 'S77005112', 'S77005112', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '1250 E 3900 S', 'Salt Lake City', 'Cache', 'UT', '84124', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005113', 'S77005113', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005118', 'S77005118', 'UT01', 'Retina Associates of Utah', 'Robert', NULL, 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813030', NULL, '1250 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005120', 'S77005120', 'UT01', 'Retina Associates Of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005123', 'S77005123', 'UT01', 'Tanner Memorial Clinic', 'Anna', NULL, 'Siciliano', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '923623', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77005124', 'S77005124', 'UT01', 'Tanner Memorial Clinic', 'Teela', 'S', 'Sorensen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1871579920', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870235759', 'S77005126', 'S77005126', 'UT01', 'Central Utah Foot & Ankle Clinic', 'Mark', 'F', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1619958345', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870235759', 'S77005127', 'S77005127', 'UT01', 'Central Utah Foot & Ankle Clinic', 'Thomas', 'G', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720069446', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870235759', 'S77005128', 'S77005128', 'UT01', 'Central Utah Foot & Ankle Clinic', 'Thomas', 'G', 'Rogers', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '150 W 800 N', 'Provo', 'Utah', 'UT', '84601', '8013735353', '8017568252', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720069446', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77005134', 'S77005134', 'UT01', 'Pediatric Anesthesiologists', 'Simon', 'P', 'Durcan', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598872988', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870519172', 'S77005137', 'S77005137', 'UT01', 'Utah Heart Clinic', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609845734', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77005138', 'S77005138', 'UT01', 'Utah Heart Clinic', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750359253', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519276', 'S77005139', 'S77005139', 'UT01', 'Salt Lake Eye Associates', 'Rachel', 'S', 'Benator', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053316976', 0, 'N', 0, '2012-06-14', NULL, NULL, 40.6999, -111.862, NULL, NULL),
('870519691', 'S77005140', 'S77005140', 'UT01', 'Utah Cancer Specialists', 'Anna', '', 'Beck', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1719036265', 0, 'Y', 0, '2012-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005141', 'S77005141', 'UT01', 'Utah Cancer Specialists', 'Anna', 'C', 'Beck', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710936265', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005142', 'S77005142', 'UT01', 'Utah Cancer Specialists', 'Anna', 'C', 'Beck', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '2490 S State St Ste 218', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014660556', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710936265', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005144', 'S77005144', 'UT01', 'Utah Cancer Specialists', 'Nitin', 'B', 'Chandramouli', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 107', 'Tooele', 'Tooele', 'UT', '84074', '4358433619', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1801845730', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005145', 'S77005145', 'UT01', 'Utah Cancer Specialists', 'Nitin', 'B', 'Chandramouli', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1801845730', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'S77005146', 'S77005146', 'UT01', 'Utah Cancer Specialists', 'Melissa', 'C', 'Corcoran', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114976032', 0, 'Y', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005147', 'S77005147', 'UT01', 'Utah Cancer Specialists', 'Ann', 'J', 'Eisenbraun', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832028', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77005151', 'S77005151', 'UT01', 'Hearing Zone', 'Marilyn', 'K', 'Howe', 'ST', 'Speech Therapy', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-11-01', NULL, 0, NULL, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508941543', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77005152', 'S77005152', 'UT01', 'Hearing Zone', 'Dave', '', 'Robinson', 'AUD', 'Audiology', '', '', NULL, 'O', '973 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232727', NULL, '973 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232727', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386703767', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870503931', 'S77005153', 'S77005153', 'UT01', 'Southwestern OB/GYN', 'Steven', 'J', 'Dewey', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '39 Professional Way Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014659263', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356358147', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870506731', 'S77005154', 'S77005154', 'UT01', NULL, 'Stanley', 'C', 'Clark', 'MD', 'Urology', NULL, NULL, NULL, 'O', '9690 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015715121', NULL, '9690 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015715121', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770591620', 0, 'N', 0, '2013-09-30', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('870507858', 'S77005155', 'S77005155', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8014654809', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870509414', 'S77005156', 'S77005156', 'UT01', 'Mountain Utah Family Medicine', 'Robert', 'W', 'Nentwich', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659402774', 0, 'N', 0, '2013-10-07', NULL, NULL, 38.781, -112.085, NULL, NULL),
('870509468', 'S77005157', 'S77005157', 'UT01', 'Neurology Associates', 'David', 'J', 'Smith', 'MD', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-08-30', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1578574182', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870511278', 'S77005159', 'S77005159', 'UT01', NULL, 'Bryson', '', 'Smith', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1669507984', 0, 'N', 0, '2013-08-14', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870525882', 'S77005163', 'S77005163', 'UT01', 'Mountain View Anesthesia', 'Janie', 'S', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8019939555', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834373', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005164', 'S77005164', 'UT01', 'Mountain View Anesthesia', 'Janie', 'S', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834373', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005165', 'S77005165', 'UT01', 'Mountain View Anesthesia', 'Daren', 'J', 'Felix', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '23.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832510', 0, 'Y', 0, '2007-03-27', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870525882', 'S77005166', 'S77005166', 'UT01', 'Mountain View Anesthesia', 'Jerry', 'A', 'Matthiesen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834084', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005168', 'S77005168', 'UT01', 'Mountain View Anesthesia', 'Paul', 'B', 'Reichert', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, '1954 E Fort Uniion Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316042732', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005169', 'S77005169', 'UT01', 'Mountain View Anesthesia', 'Fred', NULL, 'Starr', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834017', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005170', 'S77005170', 'UT01', 'Mountain View Anesthesia', 'Richard', 'G', 'Watts', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '23.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023113545', 0, 'Y', 0, '2012-04-10', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870526286', 'S77005171', 'S77005171', 'UT01', 'Wasatch Internal Medicine', 'Zaneta', 'J', 'Bulaj', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1598869026', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77005172', 'S77005172', 'UT01', 'Wasatch Internal Medicine', 'Todd', 'R', 'Nelson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1902917495', 0, 'N', 0, '2012-06-07', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77005173', 'S77005173', 'UT01', 'Wasatch Internal Medicine', 'Lynn', '', 'Price', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1669583134', 0, 'N', 0, '2012-05-16', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77005174', 'S77005174', 'UT01', 'Wasatch Internal Medicine', 'David', 'J', 'Shaskey', 'MD', 'Sports Medicine', 'Rheumatology', 'Internal Medicine', NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1033220603', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526294', 'S77005175', 'S77005175', 'UT01', NULL, 'James', 'Douglas', 'Burrows', 'MD', 'Hand Surgery', NULL, NULL, NULL, 'B', '4052 Pioneer Pkwy Ste 208', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663977', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833094', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77005177', 'S77005177', 'UT01', 'Pediatric Anesthesiologists', 'Kim', NULL, 'Hissong', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '9.00', NULL, 3, '2006-09-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833822', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77005178', 'S77005178', 'UT01', 'Pediatric Anesthesiologists', 'Amy', 'N', 'Phelps', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518072818', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280459', 'S77005182', 'S77005182', 'UT01', 'Western GYN & OB Clinic', 'Joylyn', '', 'Cluny', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2014-06-30', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1578603932', 0, 'N', 0, '2014-06-10', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870281028', 'S77005183', 'S77005183', 'UT01', 'Central Utah Clinic', NULL, NULL, 'Central Utah Clinic', 'GROUP', 'Radiologist', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013758858', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834774', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005184', 'S77005184', 'UT01', 'Central Utah Clinic', 'James', 'N', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 122', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', '1055 N 500 W Ste 122', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932201647', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
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('870514054', 'S77005204', 'S77005204', 'UT01', '', 'Tao', 'D', 'Tran', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3695 S Redwood Rd Ste 1', 'West Valley', 'Salt Lake', 'UT', '84119', '8015398283', '8015398283', '3695 S Redwood Rd', 'West Valley', 'Salt Lake', 'UT', '84119', '8015398283', '8015398283', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-12-06', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1477520831', 0, 'Y', 0, '2010-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870514074', 'S77005205', 'S77005205', 'UT01', NULL, 'Jon', 'W', 'Hughes', 'MD', 'Internal Medicine', '', '', NULL, 'O', '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357899272', NULL, '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357899272', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851382493', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('870527339', 'S77005219', 'S77005219', 'UT01', '', 'F', 'Rex', 'Nielsen', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '620 S 400 E Ste 108', 'St George', 'Washington', 'UT', '84770', '4356373098', '4356529173', '280 N Hospital Dr', 'Price', 'Washington', 'UT', '84501', '4356373098', '4356529173', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-09-13', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1508811639', 0, 'Y', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870528056', 'S77005220', 'S77005220', 'UT01', '', 'Christopher', 'J', 'Jolles', 'MD', 'Gynecologic Oncology', NULL, NULL, NULL, 'O', '508 E S Temple Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012660878', '8012662074', '508 E S Temple Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012660878', '8012662074', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841346756', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870528957', 'S77005221', 'S77005221', 'UT01', 'The Practice of Medicine', 'Paul', 'E', 'Pilgram', 'MD', 'Internal Medicine', 'Emergency Medicine', 'Sports Medicine', NULL, 'O', '1561 W 7000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015625300', '8012808749', '1561 W 7000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015625300', '8012808749', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1265490791', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6241, -111.935, NULL, NULL),
('870532396', 'S77005222', 'S77005222', 'UT01', 'Pioneer Anesthesia Group', 'Robert', 'L', 'Langston', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 108', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939526', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366557407', 0, 'Y', 0, '2007-03-27', NULL, NULL, 40.6243, -111.836, NULL, NULL),
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('870532738', 'S77005226', 'S77005226', 'UT01', 'Davis Family Physicians', 'Craig', 'K', 'Julien', 'MD', 'Family Practice', '', '', NULL, 'O', '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-06-01', NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245340173', 0, 'N', 0, '2011-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77005227', 'S77005227', 'UT01', 'Davis Family Physicians', 'James', 'H', 'Rees', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187653', 0, 'N', 0, '2012-02-16', NULL, NULL, 41.0747, -112.027, NULL, NULL),
('870533611', 'S77005229', 'S77005229', 'UT01', 'North Davis Anesthesiology', 'Blake', 'J', 'Brown', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 98', 'Farmington', 'Davis', 'UT', '84025', '8014510858', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-06-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427060912', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S77005230', 'S77005230', 'UT01', 'North Davis Anesthesiology', 'Brian', 'C', 'Hales', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearffield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053396770', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005231', 'S77005231', 'UT01', 'Central Utah Clinic', 'Michael', 'E', 'Callahan', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104864651', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005233', 'S77005233', 'UT01', 'Central Utah Clinic', 'Charles', 'F', 'Dahl', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912965344', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005234', 'S77005234', 'UT01', 'Central Utah Clinic', 'Mark', 'L', 'Donaldson', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982662102', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005235', 'S77005235', 'UT01', 'Central Utah Clinic', 'Peter', NULL, 'Duros', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669498119', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'S77005238', 'S77005238', 'UT01', 'Wasatch Otolaryngology Group', 'Bradford', 'Kelly', 'Ence', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '39 Professional Way Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654805', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588766299', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005239', 'S77005239', 'UT01', 'Central Utah Clinic', 'Jonathan', 'R', 'Faux', 'MD', 'Orthopedic Surgery', 'Foot and Ankle', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538250287', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005240', 'S77005240', 'UT01', 'Central Utah Clinic', 'Walstir', NULL, 'Fonseca', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '702 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012218811', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013933506', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005241', 'S77005241', 'UT01', 'Central Utah Clinic', 'Randal', 'B', 'Gibb', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679675383', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005242', 'S77005242', 'UT01', 'Central Utah Clinic Nephrology', 'Terry', 'A', 'Hammond', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8013776832', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124064845', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005243', 'S77005243', 'UT01', 'Central Utah Clinic', 'Terry', 'A', 'Hammond', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124064845', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005244', 'S77005244', 'UT01', 'Central Utah Clinic', 'Wynn', 'H', 'Hemmert', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '36 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8017720705', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003874736', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005245', 'S77005245', 'UT01', 'Central Utah Clinic', 'Richard', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144323163', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005252', 'S77005252', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1250 E 3900 S', 'Salt Lake City', 'Utah', 'UT', '84124', '8013577999', '8013577020', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', 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
('870525682', 'S77005253', 'S77005253', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005254', 'S77005254', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005256', 'S77005256', 'UT01', 'Retina Associates of Utah', 'Mano', NULL, 'Swartz', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013212020', NULL, '1250 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005257', 'S77005257', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005258', 'S77005258', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'S77005270', 'S77005270', 'UT01', 'Utah County Surgical Associates', 'R Richard', '', 'Rasmussen', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1528008588', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870517201', 'S77005271', 'S77005271', 'UT01', 'Central Utah Radiology', 'Bevan', 'V', 'Bastian', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '64 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4356231242', '4355287358', 'PO Box 908', 'Bountiful', '', 'UT', '84011', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821098088', 0, 'Y', 0, '2006-12-21', NULL, NULL, 39.1567, -111.816, NULL, NULL),
('870517201', 'S77005272', 'S77005272', 'UT01', 'Central Utah Radiology', 'Bevan', 'V', 'Bastian', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 908', 'Bountiful', 'Davis', 'UT', '84011', '4356231242', '4355287358', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821098088', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870517201', 'S77005273', 'S77005273', 'UT01', 'Central Utah Radiology', 'Connie', NULL, 'Vail', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '64 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4356231242', '4355287358', 'PO Box 908', 'Bountiful', '', 'UT', '84011', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689675076', 0, 'Y', 0, '2006-12-21', NULL, NULL, 39.1567, -111.816, NULL, NULL),
('870533611', 'S77005274', 'S77005274', 'UT01', 'North Davis Anesthesiology', 'Melvin', 'K', 'Richardson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013932249', NULL, 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467401737', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S77005275', 'S77005275', 'UT01', 'North Davis Anesthesiology', 'Melvin', 'K', 'Richardson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467401737', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533854', 'S77005277', 'S77005277', 'UT01', 'West Jordan Medical Center', 'Mary', 'E', 'Ding', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669211', NULL, '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-12-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000013009', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870535901', 'S77005279', 'S77005279', 'UT01', 'Childrens Evening Clinic', 'Kathie', 'Ellen', 'Coopersmith', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-08-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447359039', 0, 'y', 0, '2009-01-12', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005280', 'S77005280', 'UT01', 'Jordan Valley Family Health', 'Joni', 'W', 'Hougaard', 'MD', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1508801606', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870539775', 'S77005282', 'S77005282', 'UT01', 'HealthSouth Rehabilitation Hospital', 'Milan', '', 'Djurich', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656600', '8015656774', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656600', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912992454', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.6046, -111.853, NULL, NULL),
('870539775', 'S77005283', 'S77005283', 'UT01', 'HealthSouth Rehabilitation Hospital', 'Milan', '', 'Djurich', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '8015656774', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912992454', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870541126', 'S77005286', 'S77005286', 'UT01', 'Evergreen Medical', 'Scott', '', 'Adelman', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', NULL, '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84047', '8016767627', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1750351847', 0, 'N', 0, '2011-08-17', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870541126', 'S77005287', 'S77005287', 'UT01', 'Evergreen Medical', 'Angela', 'M', 'Krull', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', NULL, '10011 Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1649377540', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870281028', 'S77005288', 'S77005288', 'UT01', 'Central Utah Clinic', 'Robert', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407959695', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005289', 'S77005289', 'UT01', 'Central Utah Clinic', 'Robert', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407959695', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005290', 'S77005290', 'UT01', 'Central Utah Clinic', 'Scott', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578666533', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005292', 'S77005292', 'UT01', 'Central Utah Clinic', 'Curtis', 'C', 'Johnson', 'MD', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1205939089', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005293', 'S77005293', 'UT01', 'Central Utah Clinic', 'Umaprasanna', 'S', 'Karnam', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-10-03', NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689623852', 0, 'Y', 0, '2011-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005294', 'S77005294', 'UT01', 'Central Utah Clinic', 'Umaprasanna', 'S', 'Karnam', 'MD', 'Gastroenterology', 'Internal Medicine', NULL, NULL, 'O', '36 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8017720705', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689623852', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005295', 'S77005295', 'UT01', 'Central Utah Clinic', 'Kirt', 'M', 'Kimball', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548363419', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005296', 'S77005296', 'UT01', 'Central Utah Clinic', 'Kirt', 'M', 'Kimball', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548363419', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005299', 'S77005299', 'UT01', 'Central Utah Clinic', 'Mitchell', 'W', 'Larsen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8013742615', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928546', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005300', 'S77005300', 'UT01', 'Central Utah Clinic', 'Kent', 'G', 'Marshall', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '700 W 800 N Ste 220', 'Orem', 'Utah', 'UT', '84057', '8012218811', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962422543', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005302', 'S77005302', 'UT01', 'Mountain View Anesthesia', 'Kurt', 'L', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8019939555', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832147', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005303', 'S77005303', 'UT01', 'Mountain View Anesthesia', 'Kurt', 'L', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832147', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005305', 'S77005305', 'UT01', 'Mountain View Anesthesia', 'Kenneth', 'A', 'Money', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832109', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005306', 'S77005306', 'UT01', 'Mountain View Anesthesia', 'Wayne', 'R', 'Riding', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '23.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972608495', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870525882', 'S77005307', 'S77005307', 'UT01', 'Mountain View Anesthesia', 'Fred', NULL, 'Starr', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834017', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870526286', 'S77005308', 'S77005308', 'UT01', 'Wasatch Internal Medicine', 'Thomas', 'F', 'Barman', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1881704286', 0, 'N', 0, '2011-08-22', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77005309', 'S77005309', 'UT01', 'Wasatch Internal Medicine', 'Matthew', 'C', 'Hansen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1598860041', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77005310', 'S77005310', 'UT01', 'Wasatch Internal Medicine', 'Jessica', 'A', 'Morgan', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891806295', 0, 'N', 0, '2012-06-14', NULL, NULL, 0, 0, NULL, NULL),
('870527264', 'S77005314', 'S77005314', 'UT01', 'Alta View Sports Medicine Center', 'Anthony', 'S', 'Gordon', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', NULL, '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1811983380', 0, 'N', 0, '2013-07-16', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('870518374', 'S77005322', 'S77005322', 'UT01', 'ENT Specialists', 'Karin', 'A', 'Cox', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', NULL, '4000 S 700 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005820', 0, 'N', 0, '2006-12-15', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('870519172', 'S77005326', 'S77005326', 'UT01', 'Utah Heart Clinic', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', 'Internal Medicine', NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154399459', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005345', 'S77005345', 'UT01', 'Central Utah Clinic Urology Services', 'McKay', 'L', 'Platt', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 300', 'Provo', 'Utah', 'UT', '84604', '8013577327', '8013758860', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336230085', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005348', 'S77005348', 'UT01', 'Central Utah Clinic', 'Paul', 'K', 'Ritchie', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017633885', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720021678', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005349', 'S77005349', 'UT01', 'Central Utah Clinic', 'John', 'K', 'Staheli', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275591620', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005350', 'S77005350', 'UT01', 'Central Utah Clinic Nephrology', 'Gerald', NULL, 'Stephanz', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8013776832', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932138195', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005351', 'S77005351', 'UT01', 'Central Utah Clinic', 'Brian', 'P', 'Tudor', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1699877308', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005352', 'S77005352', 'UT01', 'Central Utah Clinic', 'Jerry', 'Dale', 'Walker, Jr', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649238866', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005353', 'S77005353', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'M', 'Wallentine', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124121934', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005354', 'S77005354', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'M', 'Wallentine', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124121934', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005357', 'S77005357', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'M', 'Wallentine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124121934', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('870527703', 'S77005358', 'S77005358', 'UT01', 'HealthSouth Rehabilitation Hospital', 'Joseph', 'W', 'VickRoy', 'MD', 'Neurology', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '          ', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-05-19', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1104818442', 0, 'Y', 0, '2014-07-07', NULL, NULL, 40.6046, -111.853, NULL, NULL),
('870528056', 'S77005359', 'S77005359', 'UT01', NULL, 'Kathleen', NULL, 'Rodman', 'NP', 'Gynecologic Oncology', NULL, NULL, NULL, 'O', '508 E S Temple Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012660878', '8012662074', 'Dept 2078', 'Phoenix', '', 'AZ', '85038', '', '', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-10-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760439574', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870528918', 'S77005360', 'S77005360', 'UT01', NULL, 'Warren', 'A', 'Peterson', 'DO', 'Dermatology', NULL, NULL, NULL, 'O', '1385 E 750 N', 'Orem', 'Utah', 'UT', '84097', '8012245200', NULL, '1385 E 750 N', 'Orem', 'Utah', 'UT', '84097', '8012245200', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1134198807', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.3113, -111.664, NULL, NULL),
('870532396', 'S77005361', 'S77005361', 'UT01', 'Pioneer Anesthesia Group', 'Robert', 'L', 'Langston', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8012339300', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366557407', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532396', 'S77005363', 'S77005363', 'UT01', 'Pioneer Anesthesia Group', 'David', 'D', 'Miller', 'CRNA', 'Anesthesiology', 'Nurse Anesthetist', NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 108', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939526', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205838745', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870532396', 'S77005364', 'S77005364', 'UT01', 'Pioneer Anesthesia Group', 'Sudha', 'B', 'Shah', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643650', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174628978', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77005367', 'S77005367', 'UT01', 'Davis Family Physicians', 'Zachary', 'M', 'Campbell', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-02-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905569', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77005368', 'S77005368', 'UT01', 'Davis Family Physicians', 'D', 'C', 'Christensen', 'NP', 'Family Practice', 'Emergency Medicine', NULL, NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619086501', 0, 'N', 0, '2011-09-09', NULL, NULL, 41.0747, -112.027, NULL, NULL),
('870519172', 'S77005370', 'S77005370', 'UT01', 'Utah Heart Clinic', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77005373', 'S77005373', 'UT01', 'Utah Heart Clinic', 'Sherman', 'G', 'Sorensen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164490280', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77005374', 'S77005374', 'UT01', 'Utah Heart Clinic', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1528036654', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77005376', 'S77005376', 'UT01', 'Utah Heart Clinic', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005378', 'S77005378', 'UT01', 'Utah Cancer Specialists', 'Kent', '', 'Difiore', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649229618', 0, 'Y', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77005397', 'S77005397', 'UT01', 'Central Utah Clinic', 'David', 'H', 'Watters', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77005398', 'S77005398', 'UT01', 'American Fork Clinic', 'Timo', NULL, 'Hoggard', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639288798', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77005399', 'S77005399', 'UT01', 'Lehi Clinic', 'Douglas', 'R', 'Jones', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2007-06-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006988', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77005400', 'S77005400', 'UT01', 'American Fork Clinic', 'Toran', 'J', 'MacArthur', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553850', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063521177', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77005401', 'S77005401', 'UT01', 'American Fork Clinic', 'Douglas', 'R', 'Mower', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033228283', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281707', 'S77005402', 'S77005402', 'UT01', 'Cache Valley Eye Associates', 'Jon', 'A', 'Siler', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-01-19', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407885007', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870282100', 'S77005403', 'S77005403', 'UT01', 'Medical Arts Center Clinic', 'Jeffrey', 'R', 'Lish', 'MD', 'Family Practice', '', '', NULL, 'O', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', NULL, '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', '', '', '', 'HCFA|UB|', '1003848797', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('870283576', 'S77005404', 'S77005404', 'UT01', 'Excel Eye Center of Provo', 'Todd', 'B', 'Engen', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013792900', '8013740163', '1735 N State St', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-03-18', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295705697', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77005405', 'S77005405', 'UT01', 'Excel Eye Center of Provo', 'Jesse', 'N', 'Hunsaker', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013792900', NULL, '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013792900', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1104895507', 0, 'Y', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77005406', 'S77005406', 'UT01', 'Excel Eye Center', 'N', 'Kent', 'Linton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1172 E 100 N Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014652575', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114991429', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77005407', 'S77005407', 'UT01', 'Excel Eye Center of Orem', 'W', 'Scott', 'Lohner', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'o', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013792900', NULL, '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013792900', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992764187', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77005408', 'S77005408', 'UT01', 'Excel Eye Center', 'Steven', 'J', 'Weaver', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '700 W 800 N Ste 160', 'Orem', 'Utah', 'UT', '84057', '8014269800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '937244', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283830', 'S77005409', 'S77005409', 'UT01', 'Intermountain Allergy', 'Joseph', 'R', 'Anderson', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1682 E 5600 S', 'Ogden', 'Weber', 'UT', '84403', '8014760052', '', '1682 E 5600 S', 'Ogden', 'Weber', 'UT', '84403', '8014760052', '', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-11-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1720080062', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S77005410', 'S77005410', 'UT01', 'North Davis Anesthesiology', 'Brian', 'C', 'Hales', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', NULL, 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053396770', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533854', 'S77005411', 'S77005411', 'UT01', 'West Jordan Medical Center', 'Joan', 'N', 'Bentley', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669211', NULL, '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467485342', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533854', 'S77005413', 'S77005413', 'UT01', 'West Jordan Medical Center', 'Maria', 'A', 'Oneida', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669211', NULL, '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154350239', 0, 'N', 0, '2006-10-17', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870533868', 'S77005414', 'S77005414', 'UT01', NULL, 'Steven', 'Little', 'Merrill', 'MD', 'Internal Medicine', 'Cardiovascular Disease', NULL, NULL, 'O', '421 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8017640200', NULL, '421 N Orem Bvld', 'Orem', '', 'UT', '84057', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104983824', 0, 'N', 0, '2009-10-13', NULL, NULL, 40.3048, -111.701, NULL, NULL),
('870533883', 'S77005415', 'S77005415', 'UT01', 'Brigham Orthopedic Clinic', 'Michael', 'H', 'Sumko', 'DO', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '990 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342151', NULL, '990 S Medical Dr', 'Brigham City', '', 'UT', '84302', '', '', 'WUBRIGOR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-05-01', 0, NULL, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609987270', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870534017', 'S77005417', 'S77005417', 'UT01', 'Mt View Foot Clinic', 'Steven', 'P', 'Royall', 'DPM', 'Podiatry', '', '', NULL, 'O', '1060 E 100 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013646444', NULL, '1060 E 100 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013646444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-12-16', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962442822', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005419', 'S77005419', 'UT01', 'Jordan Valley Family Health', 'Joanne', '', 'Haeffele', 'FNP', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1952326795', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005420', 'S77005420', 'UT01', 'Jordan Valley Family Health', 'David', 'M', 'Lorah', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831677', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870539775', 'S77005422', 'S77005422', 'UT01', 'Djurich DO, Milan', 'Milan', NULL, 'Djurich', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '680 E Main St Ste 200', 'Lehi', 'Utah', 'UT', '84043', '8015656600', '8015656774', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912992454', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870539841', 'S77005423', 'S77005423', 'UT01', 'Mountain View Eye Center', 'Robert', 'L', 'Treft', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 175', 'Layton', 'Davis', 'UT', '84041', '8017732233', NULL, '1580 W Antelope Dr Ste 175', 'Layton', 'Davis', 'UT', '84041', '8017732233', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1851361539', 0, 'N', 0, '2014-03-27', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870543318', 'S77005427', 'S77005427', 'UT01', 'Mountain West Gastroenterology', 'Mark', 'E', 'Boschert', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346252236', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005428', 'S77005428', 'UT01', 'Mountain West Gastroenterology', 'Deborah', 'D', 'Cobb', 'FNP', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', NULL, '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912013632', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005429', 'S77005429', 'UT01', 'Mountain West Gastroenterology', 'Christopher', NULL, 'Cutler', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437162013', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005430', 'S77005430', 'UT01', 'Mountain West Gastroenterology', 'Christopher', NULL, 'Cutler', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437162013', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005431', 'S77005431', 'UT01', 'Mountain West Gastroenterology', 'Gordon', 'E', 'Harmston', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84120', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972516748', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005432', 'S77005432', 'UT01', 'Mountain West Gastroenterology', 'Clarke', 'A', 'Hilbig', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861404758', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005433', 'S77005433', 'UT01', 'Mountain West Gastroenterology', 'I', 'R', 'Thomason', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1649282542', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005440', 'S77005440', 'UT01', 'Granger Medical Clinic', 'Brandon', 'R', 'Allen', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952333106', 0, 'Y', 0, '2011-07-06', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005441', 'S77005441', 'UT01', 'Granger Medical Clinic', 'Dana', 'A', 'Andersen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8013525900', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578595724', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5878, -111.959, NULL, NULL),
('870284475', 'S77005443', 'S77005443', 'UT01', 'Granger Medical Clinic', 'T', 'L', 'Bourne', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', '', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2013-07-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1225060478', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005444', 'S77005444', 'UT01', 'Granger Medical Clinic', 'Alton', 'D', 'Burgett', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124059514', 0, 'Y', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005445', 'S77005445', 'UT01', 'Granger Medical Clinic', 'William', 'H', 'Burleigh', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023040276', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.682, -111.979, NULL, NULL);
