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
('311808380', 'W12016606', 'W12016606', 'Sinclair', '(Sinclair Health Services\rProvider) Personal Care Physical Therapy', 'Deborah ', '', 'Bodin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', NULL, '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992806020', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12016608', 'W12016608', 'UT01', 'Timpanogos Professional Services', 'Omar', '', 'Mendez-Figueroa', 'MD', 'Internal Medicine', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912034315', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12016609', 'W12016609', 'UT01', 'Timpanogos Professional Services', 'Omar', '', 'Mendez-Figueroa', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912034315', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('311808380', 'W12016610', 'W12016610', 'Sinclair', '(Sinclair Health Services\rProvider) Personal Care Physical Therapy', 'Holly ', '', 'Nester', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', NULL, '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770683807', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('412212686', 'W12016611', 'W12016611', 'ID02', 'Complex Care Hospital of Idaho', '', '', 'Vibra Hospital of Boise', 'GROUP', 'Long Term Acute Care Facility', '', '', NULL, 'B', 'PO Box 971805', 'Dallas', 'Dallas', 'TX', '75397', '2084899500', NULL, 'PO Box 971805', 'Dallas', 'Dallas', 'TX', '75397', '2084899500', '          ', 'IDSTD', '', 'ID01', '0.00', '100.00', '0.00', 3, '2011-12-12', '2013-05-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194908056', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12016612', 'W12016612', 'TX01', 'South Texas Oncology and Hematology', 'Mark', 'C', 'Rittenhouse', 'MD', 'General Surgery', '', '', NULL, 'O', '7940 Floyd Curl Ste 840', 'San Antonio', 'Bexar', 'TX', '78229', '2106143349', NULL, '7940 Floyd Curl Ste 840', 'San Antonio', 'Bexar', 'TX', '78229', '2106143349', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-12-12', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538155270', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('311808380', 'W12016613', 'W12016613', 'Sinclair', '(Sinclair Health Services\rProvider) Personal Care Physical Therapy', 'Linda ', '', 'Brabant', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', NULL, '2100 E Cedar Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282147430', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902906035', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('271387648', 'W12016614', 'W12016614', 'UTMH1', 'Mind Your Nature Counseling ', 'Janice', 'M', 'Speicher', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1700 Park Ave', 'Park City', 'Summit', 'UT', '84098', '4356594508', '4352142529', '1700 Park Ave', 'Park City', 'Summit', 'UT', '84098', '4356594508', '4352142529', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-12-12', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427191311', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820312041', 'W12016615', 'W12016615', 'ID01', 'Podiatry Center of Idaho', 'Scott', 'A', 'Graviet', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1578514618', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('203754285', 'W12016616', 'W12016616', 'UT01', 'Good Shepherd Home Care ', '', '', 'Good Shepherd Home Care', 'GROUP', 'Home Health Agency', 'Hospice', NULL, NULL, 'B', '5383 S 900 E Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012776474', '8012776475', '5383 S 900 E Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012776474', '8012776475', '', '', '4', '0.00', '100.00', '0.00', 3, '2011-12-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1457439705', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('204780557', 'W12016618', 'W12016618', 'UT01', '', 'David', 'H', 'Warby', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '275 N 300 W Ste 403', 'Kaysville', 'Davis', 'UT', '84037', '8015549441', '8019287515', '275 N 300 W Ste 403', 'Kaysville', 'Davis', 'UT', '84037', '8015549441', '8019287515', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1912949421', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.0394, -111.944, NULL, NULL),
('820312041', 'W12016619', 'W12016619', 'ID01', 'Podiatry Center of Idaho', 'Clinton', 'H', 'Clark', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1710924345', 0, 'N', 0, '2013-08-30', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312041', 'W12016620', 'W12016620', 'ID01', 'Podiatry Center of Idaho', 'Gary', 'J', 'Millward', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063462075', 0, 'N', 0, '2011-12-12', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('450486684', 'W12016621', 'W12016621', 'UT01', '', 'Ali', '', 'Ben-Jacob', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1281 N 600 W', 'Logan', 'Cache', 'UT', '84341', '4357525999', NULL, '1281 N 600 W', 'Logan', 'Cache', 'UT', '84341', '4357525999', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083611669', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870507600', 'W12016622', 'W12016622', 'UT01', 'Love Air Healthcare', '', '', 'Love Air Healthcare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '383 W Vine St Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019730900', '          ', '383 W Vine St Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019730900', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639105125', 0, 'N', 0, '2014-05-02', NULL, NULL, 40.6632, -111.916, NULL, NULL),
('870507600', 'W12016623', 'W12016623', 'UT01', 'Love Air Healthcare', '', '', 'Love Air Healthcare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2550 S Decker Lake Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019730900', '          ', '2550 S Decker Lake Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019730900', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639105125', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('611466948', 'W12016624', 'W12016624', 'UTMH1', 'Center for Human Potential', 'C', 'B', 'Hallett', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014832447', NULL, '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014832447', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134107881', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('200933683', 'W12016625', 'W12016625', 'UT01', 'Hospice specialists', '', '', 'Homecare Specialists', 'GROUP', 'Hospice', '', '', NULL, 'O', '72 W Gentile', 'Layton', 'Davis', 'UT', '84040', '8012948600', NULL, '72 W Gentile', 'Layton', 'Davis', 'UT', '84040', '8012948600', '          ', '', '', '3', '0.00', '30.00', '0.00', 3, '2011-12-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006764', 0, 'N', 0, '2011-12-12', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12016626', 'W12016626', 'NM01', 'New Mexico Heart Institute', 'Seema', '', 'Sabu', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1841590353', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12016627', 'W12016627', 'NM01', 'New Mexico Heart Institute', 'Seema', '', 'Sabu', 'PA', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1841590353', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('820537405', 'W12016628', 'W12016628', 'ID01', 'Better Health & Play Therapy Inc', 'Rona', '', 'Brumpton', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084668267', NULL, '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084668267', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-12-15', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720265465', 0, 'N', 0, '2012-03-22', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W12016633', 'W12016633', 'ID01', 'Access Behavioral Health Services', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083384699', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W12016634', 'W12016634', 'ID01', 'Access Behavioral Health Services', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12016637', 'W12016637', 'IDREC', 'St Lukes Pediatric Surgery of Idaho (Recognized PPO but not contracted pre-auth required)', 'Allyson', 'R', 'Reynolds', 'NP (Recognized PPO but not contracted)', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093033102', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('272095332', 'W12016638', 'W12016638', 'WY01', 'Hearing Solutions', 'Alica', 'R', 'Long', 'SLP', 'Audiology', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076893611', '3076866167', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076893611', '3076866167', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2012-04-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659385813', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('272095332', 'W12016639', 'W12016639', 'WY01', 'Hearing Solutions', 'Alica', 'R', 'Long', 'SLP', 'Audiology', '', '', NULL, 'O', '809 S 9th', 'Douglas', 'Converse', 'WY', '82633', '3076893611', '3076866167', '809 S 9th', 'Douglas', 'Converse', 'WY', '82633', '3076893611', '3076866167', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659385813', 0, 'N', 0, '2012-06-04', NULL, NULL, 42.7497, -105.376, NULL, NULL),
('272095332', 'W12016640', 'W12016640', 'WYT1', 'Hearing Solutions', 'Alica', 'R', 'Long', 'SLP', 'Audiology', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076893611', '3076866167', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076893611', '3076866167', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', '2012-04-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659385813', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('272095332', 'W12016641', 'W12016641', 'WYT1', 'Hearing Solutions', 'Alica', 'R', 'Long', 'SLP', 'Audiology', '', '', NULL, 'O', '809 S 9th', 'Douglas', 'Converse', 'WY', '82633', '3076893611', '3076866167', '809 S 9th', 'Douglas', 'Converse', 'WY', '82633', '3076893611', '3076866167', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659385813', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12016643', 'W12016643', 'WY01', 'West Park Hospital District', 'Andrew', '', 'Rashkow', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782980', '3075782979', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782980', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811974207', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.517, -109.083, NULL, NULL),
('830207671', 'W12016642', 'W12016642', 'WY01', 'West Park Hospital District', 'Andrew', '', 'Rashkow', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811974207', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.526, -109.074, NULL, NULL),
('830207671', 'W12016644', 'W12016644', 'WYT1', 'West Park Hospital District', 'Andrew', '', 'Rashkow', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782980', '3075782979', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782980', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811974207', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12016645', 'W12016645', 'WYT1', 'West Park Hospital District', 'Andrew', '', 'Rashkow', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811974207', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('204673147', 'W12016646', 'W12016646', 'UT01', 'The Foot and Ankle Health Center', 'Mark', 'E', 'Woolley', 'DPM', 'Podiatry', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 205', 'Ogden', 'Weber', 'UT', '84405', '8014092100', '8014756169', '6028 S Ridgeline Dr Ste 205', 'Ogden', 'Weber', 'UT', '84405', '8014092100', '8014756169', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1629213780', 0, 'N', 0, '2012-01-26', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('263981143', 'W12016647', 'W12016647', 'UT01', 'Peak ENT Associates ', 'Kirt', 'S', 'Beus', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', NULL, '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396765871', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.2476, -111.664, NULL, NULL),
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('453124074', 'W12016680', 'W12016680', 'UT01', 'Integrity Hearing and Balance', 'Caroline', 'C', 'Bjarnason', 'AUD', 'Audiology', '', '', NULL, 'O', '1401 N 1075 W Ste 230', 'Farmington', 'Davis', 'UT', '84025', '8014479456', '8014479458', '1401 N 1075 W Ste 230', 'Farmington', 'Davis', 'UT', '84025', '8014479456', '8014479458', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336224906', 0, 'N', 0, '2013-01-15', NULL, NULL, 41.0035, -111.911, NULL, NULL),
('870616107', 'W12016704', 'W12016704', 'UT01', 'University Health Care', 'Toni', 'V', 'LaMalfa', 'CNM APRN', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', NULL, '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-19', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154424950', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12016682', 'W12016682', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Robin', '', 'Fox', 'CRNP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447220801', 0, 'N', 0, '2011-12-16', NULL, NULL, 0, 0, NULL, NULL),
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('270254476', 'W12016688', 'W12016688', 'UT01', 'Mark Lindsay Dialysis Center', '', '', 'Mark Lindsay Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015813983', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015813983', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013144872', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('270254476', 'W12016689', 'W12016689', 'UT01', 'Mark Lindsay Dialysis Center', '', '', 'Mark Lindsay Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015813983', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015813983', '          ', '', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013144872', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12016691', 'W12016691', 'UT01', 'University Health Care', 'Kevin ', '', 'Wilson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', NULL, '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-19', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780701003', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('870574059', 'W12016697', 'W12016697', 'UT01', 'Mountain Land Eagle', 'Kevin', 'Lawrence', 'Allred', 'PT', 'Physical Therapy', '', '', NULL, 'O', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '2089390886', '2089391131', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '2089390886', '2089391131', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2013-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467749788', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
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('820382500', 'W12016717', 'W12016717', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1202 E Locust ', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2088552740', '1202 E Locust ', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2088552740', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('820382500', 'W12016718', 'W12016718', 'SACN', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2088552740', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2088552740', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 43.8791, -116.485, 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
('271740523', 'W12016720', 'W12016720', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1818 S 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', '1818 S 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', '2013-08-26', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('271740523', 'W12016719', 'W12016719', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1828 Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088555955', '2088558740', '1828 Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088555955', '2088558740', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', '2013-08-26', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('271740523', 'W12016721', 'W12016721', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'B', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084598628', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084598628', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', '2013-08-26', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('271740523', 'W12016722', 'W12016722', 'SACN', 'Foot & Ankle Medical Center', 'Phillip', 'N', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'B', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084598628', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084598628', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-06-06', '2013-08-26', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1699763540', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12016725', 'W12016725', 'ID02', 'Saltzer Medical Group- Caldwell', 'John', 'T', 'Ader', 'DO', 'Rheumatology', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992789564', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12016727', 'W12016727', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'John', 'T', 'Ader', 'DO', 'Rheumatology', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992789564', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12016731', 'W12016731', 'ID02', 'Saltzer Medical Group', 'John', 'T', 'Ader', 'DO', 'Rheumatology', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992789564', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('870543342', 'W12016732', 'W12016732', 'UT01', 'Moab Regional Hosptial', 'Alexander', '', 'Meininger', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '', '', '', '0.00', '10.00', '0.00', 6, '2011-12-16', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1730375940', 0, 'N', 0, '2011-12-28', NULL, NULL, 0, 0, NULL, NULL),
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('205099898', 'W12016777', 'W12016777', 'UTDT01', 'Haws Family Dentistry', 'Jayson', '', 'Haws', 'DDS', 'Dentist', '', '', NULL, 'O', '862 S Main St Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', NULL, '862 S Main St Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', '', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083747927', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('061506129', 'W12016898', 'W12016898', 'UT01', 'Wee Care Pediatrics', 'Bob', '', 'Bunnell', 'PA', 'Pediatrics', '', '', NULL, 'O', '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019271591', '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831175272', 0, 'N', 0, '2012-01-05', NULL, NULL, 41.1899, -112.049, NULL, NULL),
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('275023525', 'W12016902', 'W12016902', 'UT01', 'Canyon Eye Center', 'Gilbert', 'C', 'Wong', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477265', '8017477237', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477265', '8017477237', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1194900498', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12016903', 'W12016903', 'UTMH1', 'Heber Valley Counseling', 'Corinna', '', 'Porter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '48 N Main St Ste 6', 'Oak City', 'Millard', 'UT', '84649', '4356543003', '4356540309', '48 N Main St Ste 6', 'Oak City', 'Millard', 'UT', '84649', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-02-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588871321', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12016904', 'W12016904', 'UTMH1', 'Heber Valley Counseling', 'Corinna', '', 'Porter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '150 N Main St Ste 106', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', '150 N Main St Ste 106', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-02-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588871321', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('262518076', 'W12016905', 'W12016905', 'ID01', 'Journey Mental Health Inc', 'Gregory', 'J', 'Dunkley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', NULL, '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-10-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265653190', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016907', 'W12016907', 'UT01', '', 'Spence', 'D', 'Harper', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', 'St Marks Hospital', 'Park City Medical Center', NULL, 'HCFA|UB|', '1851394803', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016908', 'W12016908', 'UT01', '', 'Spence', 'D', 'Harper', 'DPM', 'Podiatry', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', NULL, '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, 'Heber Valley Medical Center', 'St Marks Hospital', 'Park City Medical Center', NULL, 'HCFA|UB|', '1851394803', 0, 'N', 0, '2012-01-05', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('261996389', 'W12016909', 'W12016909', 'UT01', 'Utah Podiatry Group PC', 'Scott', 'A', 'Clark', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700865748', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016910', 'W12016910', 'UT01', 'Utah Podiatry Group PC', 'Scott', 'A', 'Clark', 'DPM', 'Podiatry', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', NULL, '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700865748', 0, 'N', 0, '2012-01-05', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('261996389', 'W12016911', 'W12016911', 'UT01', '', 'David', 'C', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', NULL, '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619914751', 0, 'N', 0, '2012-01-23', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('261996389', 'W12016912', 'W12016912', 'UT01', '', 'David', 'C', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619914751', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016913', 'W12016913', 'WY01', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.8441, -106.261, NULL, NULL),
('731684200', 'W12016914', 'W12016914', 'WY01', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016915', 'W12016915', 'WY01', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2013-06-24', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016916', 'W12016916', 'WYT2', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', NULL, '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016917', 'W12016917', 'WYT2', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016918', 'W12016918', 'WYT2', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2013-06-24', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016919', 'W12016919', 'UT01', 'Utah Podiatry Group', 'Richard', 'G', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1174539449', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016920', 'W12016920', 'UT01', 'Utah Podiatry Group', 'Richard', 'G', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1174539449', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('731684200', 'W12016921', 'W12016921', 'WY01', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.8441, -106.261, NULL, NULL),
('731684200', 'W12016922', 'W12016922', 'WY01', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016923', 'W12016923', 'WYT2', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', NULL, 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2013-06-24', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016924', 'W12016924', 'WYT2', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016925', 'W12016925', 'WYT2', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12016926', 'W12016926', 'WY01', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', NULL, 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-02-01', '2013-06-24', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016927', 'W12016927', 'UT01', 'Utah Podiatry Group PC', 'Terry', 'P', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013972157', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12016928', 'W12016928', 'UT01', 'Utah Podiatry Group PC', 'Terry', 'P', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', NULL, '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-12', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013972157', 0, 'N', 0, '2012-01-05', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870323929', 'W12016929', 'W12016929', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1250 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', NULL, '1250 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-12-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870323929', 'W12016930', 'W12016930', 'UTDT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1250 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357505082', NULL, '1250 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357505082', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2004-02-01', '2011-07-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('800739996', 'W12016931', 'W12016931', 'UTMH1', 'Synergism Counseling', 'Michelle', '', 'Greene', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8013501671', '8014466511', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8013501671', '8014466511', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2012-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508971276', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('800739996', 'W12016932', 'W12016932', 'UTMH1', 'Synergism Counseling', 'Michelle', '', 'Greene', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '3318 Canyon Meadow Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013501671', '8014466511', '3318 Canyon Meadow Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013501671', '8014466511', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508971276', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820537405', 'W12016935', 'W12016935', 'ID01', 'Better Health & Play Therapy Inc', 'Rona', '', 'Brumpton', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'B', 'PO Box 768', 'Star', 'Ada', 'ID', '83669', '2088597435', '2084617230', 'PO Box 768', 'Star', 'Ada', 'ID', '83669', '2088597435', '2084617230', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720265465', 0, 'N', 0, '2012-03-22', NULL, NULL, 0, 0, NULL, NULL),
('820537405', 'W12016934', 'W12016934', 'ID01', 'Better Health & Play Therapy Inc', 'Rona', '', 'Brumpton', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '213 11th Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2088597435', '2084617230', '213 11th Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2088597435', '2084617230', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720265465', 0, 'N', 0, '2012-10-03', NULL, NULL, 0, 0, NULL, NULL),
('529548615', 'W12016936', 'W12016936', 'UTMH1', 'SL Counseling Center', 'Velia', '', 'Coleman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7069 S Highland Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018357300', '8012777300', '7069 S Highland Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018357300', '8012777300', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154475929', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870543342', 'W12016939', 'W12016939', 'UT01', 'Moab Regional Hospital', 'Kay', '', 'Osteen', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'O', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '', '', '', '43.00', '0.00', '0.00', 6, '2012-01-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1881665537', 0, 'Y', 0, '2012-01-05', NULL, NULL, 38.5743, -109.56, NULL, NULL),
('621801973', 'W12016940', 'W12016940', 'UT01', 'Legacy Point Family Medicine', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'O', '3110 W 300 N Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8016145140', '8016145144', '3110 W 300 N Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8016145140', '8016145144', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2011-12-01', '2014-04-30', 0, 30, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.1181, -112.086, NULL, NULL),
('621801973', 'W12016941', 'W12016941', 'UT01', 'Legacy Point Family Medicine', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2011-12-01', '2014-04-30', 0, 30, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870543342', 'W12016942', 'W12016942', 'UT01', 'Moab Specialty Clinic', 'Juan', 'C', 'Vasquez', 'MD', 'General Surgery', '', '', NULL, 'O', '476 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357195550', '4357195551', '476 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357195550', '4357195551', '', '', '', '0.00', '10.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1477593713', 0, 'N', 0, '2014-05-09', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('870543342', 'W12016943', 'W12016943', 'UT01', 'Moab Specialty Clinic', 'Juan', 'C', 'Vasquez', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357195550', '4357195551', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357195550', '4357195551', '', '', '', '0.00', '10.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1477593713', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12016944', 'W12016944', 'UT01', 'Granger Medical Clinic', 'Julie', 'I', 'Wilkerson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-15', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447283932', 0, 'N', 0, '2012-05-08', NULL, NULL, 40.5877, -111.967, NULL, NULL),
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('452937060', 'W12016948', 'W12016948', 'UT01', 'Cook Foot and Ankle Specialists', 'Gregory', 'B', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', '990 S Medical Dr Ste U3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349623', '4357327139', '990 S Medical Dr Ste U3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349623', '4357327139', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2011-12-01', NULL, 0, 35, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558504548', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('680562507', 'W12016949', 'W12016949', 'UT01', 'Wasatch Peak Physical Therapy', 'Lindsi', '', 'Sparks', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1492 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018258091', '8018258142', '1492 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018258091', '8018258142', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1497988406', 0, 'N', 0, '2012-01-05', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('452937060', 'W12016950', 'W12016950', 'UT01', 'Cook Foot and Ankle Specialists', 'W Bryce', '', 'Cook', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '550 W 1400 N Ste B', 'Logan', 'Cache', 'UT', '84341', '4357529011', '4357527159', '550 W 1400 N Ste B', 'Logan', 'Cache', 'UT', '84341', '4357529011', '4357527159', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2011-12-01', NULL, 0, 35, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1316989569', 0, 'N', 0, '2012-01-05', 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
('452937060', 'W12016951', 'W12016951', 'UT01', 'Cook Foot and Ankle Specialists', 'W Bryce', '', 'Cook', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '990 S Medical Dr Ste U3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357529011', '4357527159', '990 S Medical Dr Ste U3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357529011', '4357527159', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2011-12-01', NULL, 0, 35, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1316989569', 0, 'N', 0, '2012-01-05', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('621801973', 'W12016955', 'W12016955', 'UT01', 'Associates in Orthopaedic Surgery', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', '3336 S Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2012-01-21', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12016954', 'W12016954', 'UT01', 'Associates in Orthopaedic Surgery', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2012-01-21', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('621801973', 'W12016956', 'W12016956', 'UT01', 'Associates in Orthopaedic Surgery', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2012-01-21', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('547627473', 'W12016957', 'W12016957', 'UT01', 'Utah Pain Relief Institute', 'Gary', 'L', 'Child', 'DO', 'Pain Management', '', '', NULL, 'O', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063492304', 0, 'N', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('127407050', 'W12016958', 'W12016958', 'NM01', '', 'Holly', 'S', 'Lehman', 'DC', 'Chiropractic', '', '', NULL, 'O', '10401 Montgomery Pkwy NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052997077', '5052926369', '10401 Montgomery Pkwy NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052997077', '5052926369', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548410319', 0, 'N', 0, '2012-03-10', NULL, NULL, 35.1314, -106.524, NULL, NULL),
('208632028', 'W12016963', 'W12016963', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '10501 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052980301', '5053235203', '10501 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.206, -106.675, NULL, NULL),
('208632028', 'W12016971', 'W12016971', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052980301', '5053235203', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.0743, -106.497, NULL, NULL),
('208632028', 'W12016968', 'W12016968', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '17210 Rio Rancho Blvd NW', 'Albuquerque', 'Sandoval', 'NM', '87124', '5052980301', '5053235203', '17210 Rio Rancho Blvd NW', 'Albuquerque', 'Sandoval', 'NM', '87124', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('208632028', 'W12016973', 'W12016973', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052980301', '5053235203', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.027, -106.655, NULL, NULL),
('208632028', 'W12016969', 'W12016969', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '2121 Juan Tabo NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052980301', '5053235203', '2121 Juan Tabo NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('208632028', 'W12016972', 'W12016972', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '2929 Coors Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5052980301', '5053235203', '2929 Coors Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1168, -106.702, NULL, NULL),
('208632028', 'W12016967', 'W12016967', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '3901 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5052980301', '5053235203', '3901 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1252, -106.604, NULL, NULL),
('208632028', 'W12016964', 'W12016964', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '4701 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', '4701 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.131, -106.591, NULL, NULL),
('208632028', 'W12016961', 'W12016961', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'M', '4801 Lang Ave NW Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', '4801 Lang Ave NW Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('208632028', 'W12016966', 'W12016966', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('208632028', 'W12016965', 'W12016965', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052980301', '5053235203', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('208632028', 'W12016962', 'W12016962', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052980301', '5053235203', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.0857, -106.64, NULL, NULL),
('208632028', 'W12016970', 'W12016970', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052980301', '5053235203', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('208632028', 'W12016960', 'W12016960', 'NM01', 'Zia Diagnostic Imaging', '', '', 'Zia Diagnostic Imaging', 'Group', 'Radiology', 'Imaging Center', '', NULL, 'B', 'Dept 129 PO Box 4346', 'Houston', 'Harris', 'TX', '77210', '5052980301', '5053235203', 'Dept 129 PO Box 4346', 'Houston', 'Harris', 'TX', '77210', '5052980301', '5053235203', 'NMZIA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558555003', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('272106315', 'W12016952', 'W12016952', 'ID01', 'Liberty Dialysis', '', '', 'Liberty Dialysis', 'Group', 'Dialysis Center', '', '', NULL, 'O', '4620 Enterprise Way Ste 101', 'Caldwell', 'Canyon', 'ID', '83605', '2084541101', NULL, '4620 Enterprise Way Ste 101', 'Caldwell', 'Canyon', 'ID', '83605', '2084541101', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255643243', 0, 'N', 0, '2012-01-24', NULL, NULL, 43.6613, -116.641, NULL, NULL),
('272106315', 'W12016953', 'W12016953', 'ID01', 'Liberty Dialysis', '', '', 'Liberty Dialysis', 'Group', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 10458', 'Uniondale', 'Nassau', 'NY', '11555', '2084541101', NULL, 'PO Box 10458', 'Uniondale', 'Nassau', 'NY', '11555', '2084541101', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255643243', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('710953225', 'W12017083', 'W12017083', 'UTDT01', 'Aspen Family Dental', 'Jeffrey', '', 'Lambert', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 210', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560808', NULL, '10011 S Centennial Pkwy Ste 210', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560808', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007183', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('274606071', 'W12017084', 'W12017084', 'UTDT01', '', 'Todd', '', 'Lee', 'DDS', 'Dentist', '', '', NULL, 'O', '46 W 100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358932190', NULL, '46 W 100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358932190', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002010', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870622821', 'W12017086', 'W12017086', 'UTDT01', '', 'Craig', '', 'Mattinson', 'DDS', 'Dentist', '', '', NULL, 'O', '1355 N Main St Ste 9', 'Bountiful', 'Davis', 'UT', '84010', '8012943345', NULL, '1355 N Main St Ste 9', 'Bountiful', 'Davis', 'UT', '84010', '8012943345', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009813', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870542485', 'W12017088', 'W12017088', 'UTDT01', 'Oral Maxillofacial Surgery', 'William', '', 'McBee', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '777 N 500 W Ste 102', 'Provo', 'Utah', 'UT', '84601', '8013754707', NULL, '777 N 500 W Ste 102', 'Provo', 'Utah', 'UT', '84601', '8013754707', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009814', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017099', 'W12017099', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 300', 'Sandy', 'Salt Lake', 'UT', '84070', '8012583700', NULL, '10011 S Centennial Pkwy Ste 300', 'Sandy', 'Salt Lake', 'UT', '84070', '8012583700', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017100', 'W12017100', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017091', 'W12017091', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017095', 'W12017095', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017094', 'W12017094', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017093', 'W12017093', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '3730 W 4700 S', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8019551900', NULL, '3730 W 4700 S', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8019551900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017097', 'W12017097', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017096', 'W12017096', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017098', 'W12017098', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017092', 'W12017092', 'UTDT01', 'Monarch Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('010757908', 'W12017090', 'W12017090', 'UTDT01', 'Payson Family and Cosmetic Dental', 'Sean', '', 'McKeown', 'DDS', 'Periodontist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009815', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('452446102', 'W12017102', 'W12017102', 'UTDT01', 'Burch Creek Family Dental', 'Brian', '', 'Miles', 'DMD', 'Dentist', '', '', NULL, 'O', '5640 Wasatch Blvd Ste A', 'Ogden', 'Weber', 'UT', '84403', '8014796590', NULL, '5640 Wasatch Blvd Ste A', 'Ogden', 'Weber', 'UT', '84403', '8014796590', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1639357254', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12017103', 'W12017103', 'Group', 'Eye Associates of New Mexico', '', '', 'Eye Associates of New Mexico', '', 'Ophthalmology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87113', '          ', '5052462479', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87113', '          ', '5052462479', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104868520', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('270806125', 'W12017104', 'W12017104', 'Group', 'Breathe America Albuquerque Inc', '', '', 'Breathe America Albuquerque Inc', '', 'Allergy and Immunology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5058830725', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5058830725', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009790', 0, 'N', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
('850460777', 'W12017105', 'W12017105', 'Group', 'Hematology Oncology Associates', '', '', 'Hematology Oncology Associates', '', 'Hematology and Oncology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87106', '          ', NULL, 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87106', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009794', 0, 'Y', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'W12017106', 'W12017106', '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 Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912986142', 0, 'N', 0, '2012-01-10', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017107', 'W12017107', '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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164402897', 0, 'N', 0, '2012-02-10', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017108', 'W12017108', 'UT01', 'South Valley Womens Health', 'Arlen', 'K', 'Jarrett', '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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366421596', 0, 'N', 0, '2012-03-21', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017109', 'W12017109', '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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710959416', 0, 'N', 0, '2013-07-08', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017110', 'W12017110', '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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871572008', 0, 'N', 0, '2012-02-16', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017111', 'W12017111', 'UT01', 'South Valley Womens Health', 'John', 'M', 'Nichols', 'DO', '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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114906252', 0, 'N', 0, '2012-01-10', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870462017', 'W12017112', 'W12017112', 'UT01', 'South Valley Womens Health', '', '', 'South Valley Womens Health', 'GROUP', '', '', '', 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', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008840', 0, 'N', 0, '2012-01-10', NULL, NULL, 40.588, -111.975, NULL, NULL),
('452810152', 'W12017114', 'W12017114', 'UTDT01', '', 'Jared', '', 'Richardson ', 'DDS', 'Dentist', '', '', NULL, 'O', '47 E Crestwood Rd Ste 4', 'Kaysville', 'Davis', 'UT', '84037', '8015440091', NULL, '47 E Crestwood Rd Ste 4', 'Kaysville', 'Davis', 'UT', '84037', '8015440091', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009817', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12017115', 'W12017115', 'UTDT01', 'All Around Dental Care', 'Ryan', '', 'Rush', 'DDS', 'Dentist', '', '', NULL, 'O', '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', NULL, '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1750694907', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870678029', 'W12017117', 'W12017117', 'UTDT01', '', 'Kevin', '', 'Torres', 'DDS', 'Dentist', '', '', NULL, 'O', '241 W Forrest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236120', NULL, '241 W Forrest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236120', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009818', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12017119', 'W12017119', 'UTDT01', 'All Around Dental', 'Tyler', '', 'Williams', 'DDS', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013568420', NULL, '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013568420', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009819', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870656131', 'W12017180', 'W12017180', 'UTDT01', 'Legacy Dental', 'Justin', '', 'Nylander', 'DMD', 'Dentist', '', '', NULL, 'O', '1345 E 3900 S Ste 116', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012779110', NULL, '1345 E 3900 S Ste 116', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012779110', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009844', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('452709965', 'W12017123', 'W12017123', 'UTDT01', 'Boston Dental', 'Brian', '', 'Boston', 'DDS', 'Dentist', '', '', NULL, 'O', '1320 N 600 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357523343', NULL, '1320 N 600 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357523343', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000009820', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12017125', 'W12017125', 'UTDT01', 'All Around Dental Care', 'Randy', '', 'Braithwaite', 'DDS', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', NULL, '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009821', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452688615', 'W12017126', 'W12017126', 'UTDT01', 'Utah Valley Oral Surgery', 'Christopher C', '', 'Burton', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '480 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241200', '8012246890', '480 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241200', '8012246890', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005497', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('262503928', 'W12017128', 'W12017128', 'UTDT01', '', 'Reed A', '', 'Dana', 'DDS', 'Dentist', '', '', NULL, 'O', '2630 W 3500 S Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8015420126', NULL, '2630 W 3500 S Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8015420126', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009822', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('451659913', 'W12017129', 'W12017129', 'UTDT01', 'Summit Oral & Maxillofacial Surgery', 'Cameron', '', 'Egbert', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '642 E Kirby Ln Ste 101', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989500', NULL, '642 E Kirby Ln Ste 101', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989500', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004210', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12012782', 'W12012782', 'UTDT01', 'The Center of Dental Professionals', 'Cameron', '', 'Egbert', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478000', NULL, '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478000', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004210', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12017131', 'W12017131', 'UTDT01', 'Northview Dental Associates', 'Jeffrey', '', 'Johnson', 'DDS', 'Dentist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009825', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('272249440', 'W12017133', 'W12017133', 'UTDT01', 'Copper Hills Dental', 'Steven', '', 'Lambourne', 'DDS', 'Dentist', '', '', NULL, 'O', '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', NULL, '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009826', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('451802896', 'W12017135', 'W12017135', 'UTDT01', 'Canyon Dental Care', 'Anthony', '', 'Larson', 'DDS', 'Dentist', '', '', NULL, 'O', '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009827', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870565064', 'W12017139', 'W12017139', 'UTDT01', '', 'Quinn', '', 'Schiffman', 'DDS', 'Dentist', '', '', NULL, 'O', '1355 N University Ave Ste 320', 'Provo', 'Utah', 'UT', '84604', '8013751750', NULL, '1355 N University Ave Ste 320', 'Provo', 'Utah', 'UT', '84604', '8013751750', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009829', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202670861', 'W12017137', 'W12017137', 'UTDT01', 'ABC Pediatric Dentistry', 'Jesse', '', 'Low', 'DDS', 'Pedodontist', '', '', NULL, 'O', '169 N Gateway Dr Ste 200', 'Providence', 'Cache', 'UT', '84332', '4357872223', NULL, '169 N Gateway Dr Ste 200', 'Providence', 'Cache', 'UT', '84332', '4357872223', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009828', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('451802896', 'W12017141', 'W12017141', 'UTDT01', 'Canyon Dental Care', 'Jake', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009830', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017143', 'W12017143', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Stringham', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 300', 'Sandy', 'Salt Lake', 'UT', '84070', '8012583700', NULL, '10011 S Centennial Pkwy Ste 300', 'Sandy', 'Salt Lake', 'UT', '84070', '8012583700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009831', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017144', 'W12017144', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Stringham', 'DDS', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009831', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017145', 'W12017145', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Stringham', 'DDS', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009831', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017146', 'W12017146', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Stringham', 'DDS', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009831', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('741849254', 'W12015805', 'W12015805', 'TX01', 'Southeast Surgical Associates', 'Christopher', 'W', 'Salzman', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1679741524', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('741849254', 'W12015806', 'W12015806', 'TX01', 'Southeast Surgical Associates', 'Christopher', 'W', 'Salzman', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1679741524', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('830237313', 'W12024416', 'W12024416', 'WY01', 'Sheridan Pathology Associates', 'William', '', 'Doughty', '', 'Clinical Pathology', '', '', NULL, 'B', 'PO Box 767', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', NULL, 'PO Box 767   ', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871677914', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('870674520', 'W12017149', 'W12017149', 'UTDT01', 'Crosspointe Dental', 'Damon', '', 'Swenson', 'DDS', 'Dentist', '', '', NULL, 'O', '1643 N State St', 'Orem', 'Utah', 'UT', '84057', '8012247337', NULL, '1643 N State St', 'Orem', 'Utah', 'UT', '84057', '8012247337', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009832', 0, 'N', 0, '2012-01-11', NULL, NULL, 0, 0, NULL, NULL),
('452712344', 'W12017152', 'W12017152', 'UTDT01', 'Intermountain Dental Associates', 'Llyod', '', 'Tilt', 'DDS', 'Periodontist', '', '', NULL, 'O', '2721 N 400 E Ste 2', 'Ogden', 'Weber', 'UT', '84414', '8017860500', NULL, '2721 N 400 E Ste 2', 'Ogden', 'Weber', 'UT', '84414', '8017860500', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009833', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('262999138', 'W12017153', 'W12017153', 'UTDT01', '', 'Michael', '', 'Van Leeuwen', 'DDS', 'Dentist', '', '', NULL, 'O', '6936 S Promenade Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431612', NULL, '6936 S Promenade Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431612', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002075', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('270814183', 'W12017157', 'W12017157', 'UTDT01', 'Cobble Creek Dental', 'Kelly', '', 'Wilkins', 'DDS', 'Dentist', '', '', NULL, 'O', '2274 N 400 E Ste 204', 'Ogden', 'Weber', 'UT', '84414', '8013990458', NULL, '2274 N 400 E Ste 204', 'Ogden', 'Weber', 'UT', '84414', '8013990458', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-09-01', '2012-01-15', 0, 0, 0, '', '', '', '', 'DEN|', '0000009834', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('272250271', 'W12017159', 'W12017159', 'UTDT01', 'Beta & Baldwin Family Dental', 'Travis', '', 'Baldwin', 'DDS', 'Dentist', '', '', NULL, 'O', '1260 S 700 E Ste 9', 'Logan', 'Cache', 'UT', '84321', '4357528000', NULL, '1260 S 700 E Ste 9', 'Logan', 'Cache', 'UT', '84321', '4357528000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009835', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('452688615', 'W12017160', 'W12017160', 'UTDT01', 'Utah Valley Oral Surgery', 'David', '', 'Nicholls', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '480 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241200', NULL, '480 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241200', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007872', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870680283', 'W12017161', 'W12017161', 'UTDT01', 'Coppercreek Endodontics', 'Steven', '', 'Facer', 'DMD', 'Endodontist', '', '', NULL, 'O', '3409 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84065', '8014328200', NULL, '3409 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84065', '8014328200', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004093', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12006932', 'W12006932', 'WY01', 'Big Horn Urgent Care', 'Sylvia', 'A', 'Rife', 'ARNP', 'Urgent Care', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245292242', 0, 'Y', 0, '2014-07-22', NULL, NULL, 41.1607, -104.789, NULL, NULL),
('272923067', 'W12006930', 'W12006930', 'WY01', 'Big Horn Urgent Care', 'Paula', 'S', 'Giovanini-Morris', 'NP', 'Family Practice', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', NULL, '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932116803', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('452532371', 'W12017162', 'W12017162', 'UTDTNUCOR', '', 'Stuart', '', 'Wilkinson', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '1320 N 600 E Ste 3', 'Logan', 'Cache', 'UT', '84341', '4357525681', NULL, '1320 N 600 E Ste 3', 'Logan', 'Cache', 'UT', '84341', '4357525681', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009622', 0, 'N', 0, '2012-01-12', NULL, NULL, 0, 0, NULL, NULL),
('272345109', 'W12017164', 'W12017164', 'UTDT01', 'Cascade Family Dental', 'Renn', '', 'Flinders', 'DDS', 'Dentist', '', '', NULL, 'O', '1795 W 500 S Ste 82', 'Springville', 'Utah', 'UT', '84663', '8014916921', NULL, '1795 W 500 S Ste 82', 'Springville', 'Utah', 'UT', '84663', '8014916921', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009837', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('527255124', 'W12017166', 'W12017166', 'UTDT01', 'Center Creek Dental ', 'Preston', '', 'Huang', 'DDS', 'Dentist', '', '', NULL, 'O', '10 E State St', 'Lehi', 'Utah', 'UT', '84043', '8017663700', NULL, '10 E State St', 'Lehi', 'Utah', 'UT', '84043', '8017663700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000009838', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('412112364', 'W12017168', 'W12017168', 'UTDT01', 'Lone Peak Dental', 'M Sean', '', 'Lorscheider', 'DMD', 'Dentist', '', '', NULL, 'O', '10060 N 4600 W', 'Cedar Hills', 'Utah', 'UT', '84602', '8014920402', NULL, '10060 N 4600 W', 'Cedar Hills', 'Utah', 'UT', '84602', '8014920402', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009836', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('421733752', 'W12017170', 'W12017170', 'UTDT01', 'Southtowne Implants & Periodontics', 'Kathleen', '', 'McCombs', 'DMD', 'Periodontist', '', '', NULL, 'O', '826 E 12300 S Ste 2', 'Draper', 'Salt Lake', 'UT', '84020', '8015718821', NULL, '826 E 12300 S Ste 2', 'Draper', 'Salt Lake', 'UT', '84020', '8015718821', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009839', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('452712344', 'W12017172', 'W12017172', 'UTDT01', 'Intermountain Dental Associates', 'Sean', '', 'McKeon', 'DDS', 'Periodontist', '', '', NULL, 'O', '2721 N 400 E Ste 2', 'Ogden', 'Weber', 'UT', '84414', '8017860500', NULL, '2721 N 400 E Ste 2', 'Ogden', 'Weber', 'UT', '84414', '8017860500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009840', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('611651071', 'W12017175', 'W12017175', 'UTDT01', 'Oquirrh Park Pediatric Dentistry', 'Benjamin', '', 'Menlove', 'DDS', 'Pedodontist', '', '', NULL, 'O', '6973 S 4800 W Ste C', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', NULL, '6973 S 4800 W Ste C', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009842', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('263716255', 'W12017177', 'W12017177', 'UTDT01', 'Lake View Dental ', 'Rebecca', '', 'Mielnik', 'DDS', 'Dentist', '', '', NULL, 'O', '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252273', NULL, '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252273', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009843', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870289127', 'W12017178', 'W12017178', 'UTDT01', 'A1 Dental', 'Kody', '', 'Mund', 'DMD', 'Dentist', '', '', NULL, 'O', '3785 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8016212111', NULL, '3785 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8016212111', '          ', 'UT00MB', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007757', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('568638655', 'W12017182', 'W12017182', 'UTDT01', 'Panguitch Dental', 'Shawn', '', 'Parkin', 'DDS', 'Dentist', '', '', NULL, 'O', '75 N 200 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356762443', NULL, '75 N 200 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356762443', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'DEN|', '0000009845', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870686580', 'W12017184', 'W12017184', 'UTDT01', 'Genesis Dental', 'Eric Michael', '', 'Visser', 'DMD', 'Dentist', '', '', NULL, 'O', '1060 E 100 S Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013553286', NULL, '1060 E 100 S Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013553286', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009846', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870306618', 'W12017186', 'W12017186', 'UTDT01', '', 'W Michael', '', 'Black', 'DDS', 'Dentist', '', '', NULL, 'O', '1375 E 800 N Ste 103', 'Orem', 'Utah', 'UT', '84097', '8012252310', NULL, '1375 E 800 N Ste 103', 'Orem', 'Utah', 'UT', '84097', '8012252310', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009847', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12017187', 'W12017187', 'UTDT01', 'Professional Dental', 'David', '', 'Blackhurst', 'DDS', 'Dentist', '', '', NULL, 'O', '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', NULL, '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005321', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('753051218', 'W12017190', 'W12017190', 'UTDT01', 'A Kids Dental Place', 'Devon', '', 'Call', 'DDS', 'Dentist', '', '', NULL, 'O', '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478019', NULL, '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478019', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1386801868', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12017189', 'W12017189', 'UTDT01', 'Professional Dental', 'Gregory', '', 'Cahoon', 'DDS', 'Dentist', '', '', NULL, 'O', '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', NULL, '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009848', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
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('850327237', 'W12017215', 'W12017215', 'NM01', 'SED Medical Laboratories', '', '', 'SED Medical Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '500 Walter NE Ste 216', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276445', '5052462236', '500 Walter NE Ste 216', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276445', '5052462236', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009841', 0, 'N', 0, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('850327237', 'W12017222', 'W12017222', 'NM01', 'SED Medical Laboratories', '', '', 'SED Medical Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627189', '5058651632', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627189', '5058651632', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009841', 0, 'N', 0, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('850327237', 'W12017220', 'W12017220', 'NM01', 'SED Medical Laboratories', '', '', 'SED Medical Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754214', '5058651632', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754214', '5058651632', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009841', 0, 'N', 0, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12017225', 'W12017225', 'NM01', 'ABQ Health Partners', 'Nina', '', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277600', '5057277640', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277600', '5057277640', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-09-03', 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1811185036', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('452958326', 'W12017226', 'W12017226', 'UTDT01', 'Ridge View Dental ', 'Paul', '', 'Mackley', 'DDS', 'Dentist', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007383', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12017227', 'W12017227', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', NULL, '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002045', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12017228', 'W12017228', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', NULL, '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870681984', 'W12017231', 'W12017231', 'UTDT01', 'Cadenza Family Dental ', 'Sarah', '', 'Naisbitt', 'DDS', 'Dentist', '', '', NULL, 'O', '999 E Murray Holladay Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012813500', NULL, '999 E Murray Holladay Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012813500', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1497730022', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12017230', 'W12017230', 'UTDT01', 'Monarch Dental', 'Sarah', '', 'Naisbitt', 'DDS', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1497730022', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12017232', 'W12017232', 'UTDT01', 'Professional Dental', 'Bret', '', 'Osborne', 'DMD', 'Dentist', '', '', NULL, 'O', '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', NULL, '2592 S 5600 W Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019829999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008002', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('270471253', 'W12017234', 'W12017234', 'UTDT01', 'Gavin Hunington DDS', 'Paul', '', 'Rogers', 'DDS', 'Dentist', '', '', NULL, 'O', '340 E Main St Ste 5', 'Santaquin', 'Utah', 'UT', '84655', '8017543100', NULL, '340 E Main St Ste 5', 'Santaquin', 'Utah', 'UT', '84655', '8017543100', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009858', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
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('870284448', 'W12017301', 'W12017301', 'UT01', 'Utah Valley Pain Management ', 'John', 'A', 'Dana', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 657', 'Orem', 'Utah', 'UT', '84059', '8012357246', NULL, 'PO Box 657', 'Orem', 'Utah', 'UT', '84059', '8012357246', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114091105', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
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('870344080', 'W12017305', 'W12017305', 'UTDT01', '', 'Dennis ', 'L', 'DeDecker', 'DDS', 'Oral and Maxillofacial Surgery', '', '', NULL, 'O', '625 W 500 S Ste 204', 'Bountiful', 'Davis', 'UT', '84010', '8012982242', '8017739790', '625 W 500 S Ste 204', 'Bountiful', 'Davis', 'UT', '84010', '8012982242', '8017739790', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|DEN|', '1073516688', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('046483744', 'W12017306', 'W12017306', 'UTMH1', '', 'Benson', 'H', 'Dobbin', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '370 E S Temple Ste 550', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015677565', '8013559322', '370 E S Temple Ste 550', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015677565', '8013559322', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396815072', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('454071992', 'W12017307', 'W12017307', 'UT01', 'Brookview Pain Management', 'Brett', 'J', 'Earl', 'MD', 'Pain Management', 'Emergency Medicine', 'Family Practice', NULL, 'O', '1186 E 4600 S Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8014757246', '8013037329', '1186 E 4600 S Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8014757246', '8013037329', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1568423564', 0, 'N', 0, '2013-12-23', NULL, NULL, 41.1796, -111.95, NULL, NULL),
('452510038', 'W12017308', 'W12017308', 'ID02', 'Boise Family Eye Center', 'Brent ', 'A', 'Galvan', 'OD', 'Optometry', '', '', NULL, 'O', '3421 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083771102', '2083775853', '3421 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083771102', '2083775853', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-12-17', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285759753', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('820315557', 'W12017309', 'W12017309', 'ID01', 'Boise Psychological Services', 'Jane', '', 'Krumm', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', NULL, '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578559308', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('275276520', 'W12017310', 'W12017310', 'UT01', 'The Sleep Institute of Utah', 'Syed', 'I', 'Nabi', 'MD', 'Internal Medicine', 'Sleep Medicine', '', NULL, 'O', '8706 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012542895', '8012684174', '8706 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012542895', '8012684174', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1831205731', 0, 'N', 0, '2012-09-12', NULL, NULL, 40.5933, -111.872, NULL, NULL),
('452695757', 'W12017312', 'W12017312', 'UTMH1', 'Hopeful Beginnings', 'Gregory', 'C', 'Nickles', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3536 Mason Vista Way', 'Magna', 'Salt Lake', 'UT', '84044', '8019791351', '8015691857', '3536 Mason Vista Way', 'Magna', 'Salt Lake', 'UT', '84044', '8019791351', '8015691857', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114904646', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('452695757', 'W12017311', 'W12017311', 'UTMH1', 'Hopeful Beginnings', 'Gregory', 'C', 'Nickles', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '623 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019791351', '8015691857', '623 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019791351', '8015691857', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114904646', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870284448', 'W12017314', 'W12017314', 'UT01', 'Utah Valley Pain Management ', 'Robin', 'R', 'Ockey', 'MD', 'Pain Management', NULL, NULL, NULL, 'M', '283 E 930 S', 'Orem', 'Utah', 'UT', '84058', '8012357246', NULL, '283 E 930 S', 'Orem', 'Utah', 'UT', '84058', '8012357246', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326046160', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870284448', 'W12017315', 'W12017315', 'UT01', 'Utah Valley Pain Management ', 'Robin', 'R', 'Ockey', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '412 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012357246', NULL, '412 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012357246', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326046160', 0, 'N', 0, '2013-08-05', NULL, NULL, 40.3121, -111.706, NULL, NULL),
('870284448', 'W12017313', 'W12017313', 'UT01', 'Utah Valley Pain Management ', 'Robin', 'R', 'Ockey', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 657', 'Orem', 'Utah', 'UT', '84059', '8012357246', NULL, 'PO Box 657', 'Orem', 'Utah', 'UT', '84059', '8012357246', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326046160', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('273359707', 'W12017316', 'W12017316', 'ID02', 'Rutter Chiropractic', 'Timothy', 'J', 'Rutter', 'DC', 'Chiropractic', '', '', NULL, 'O', '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083881895', '2083881996', '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083881895', '2083881996', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144538554', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('432043556', 'W12017317', 'W12017317', 'ID01', 'Rocky Mountain Health and Wellness', 'Colleen', 'M', 'Shackelford', 'NP', 'Family Practice', '', '', NULL, 'O', '951 E Plaza Dr Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2089385680', '2089385679', '951 E Plaza Dr Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2089385680', '2089385679', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104107317', 0, 'N', 0, '2012-03-10', NULL, NULL, 43.6913, -116.342, NULL, NULL),
('451870439', 'W12016959', 'W12016959', 'UT01', 'Ashley Valley Foot and Ankle, Inc.', 'Jeremy', 'A', 'Strange', 'DPM', 'Podiatry', '', '', NULL, 'O', '75 N 200 W Ste 7', 'Vernal', 'Uintah', 'UT', '84078', '4357892062', '4357892063', '75 N 200 W Ste 7', 'Vernal', 'Uintah', 'UT', '84078', '4357892062', '4357892063', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1023256120', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.4568, -109.532, NULL, NULL),
('876000312', 'W12017318', 'W12017318', 'UTPEHP', 'Utah County Health Department', '', '', 'Utah County Health Department', 'GROUP', 'Health Department', '', '', NULL, 'O', '151 S University Ave Ste 1900', 'Provo', 'Utah', 'UT', '84601', '8018517027', '8018517055', '151 S University Ave Ste 1900', 'Provo', 'Utah', 'UT', '84601', '8018517027', '8018517055', 'UTCHD', '', '', '0.00', '100.00', '0.00', 3, '2012-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891865010', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('271448325', 'W12017323', 'W12017323', 'WYT1', 'Bone & Joint Radiology ', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '19.50', '0.00', 3, '2011-11-07', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205165727', 0, 'Y', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('452431139', 'W12017455', 'W12017455', 'WY01', 'Casper Aesthetics', 'Razi', '', 'Saydjari', 'MD', 'General Surgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', '', '', '', '0.00', '25.00', '0.00', 3, '2012-01-18', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902880628', 0, 'N', 0, '2012-01-18', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('954893928', 'W12017325', 'W12017325', 'UT01', 'Exodus Healthcare Network', 'Suzanne', 'E', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962660969', 0, 'N', 0, '2014-06-06', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12017324', 'W12017324', 'UT01', 'Exodus Healthcare Network', 'Suzanne', 'E', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'O', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962660969', 0, 'N', 0, '2014-06-06', NULL, NULL, 40.693, -112.092, NULL, NULL),
('205934739', 'W12017327', 'W12017327', 'ID02', 'Family Medicine Health Center', 'Julie', 'L', 'Gendler', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-16', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932146388', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12017326', 'W12017326', 'ID02', 'Family Medicine Health Center', 'Julie', 'L', 'Gendler', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-16', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932146388', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12017328', 'W12017328', 'UTMH1', 'Alpine Center for Behavioral Health', 'Jared', '', 'Landvatter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '8017563698', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '8017563698', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417010190', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12017330', 'W12017330', 'ID02', 'Family Medicine Residency of Idaho', 'Babette', 'N', 'Munting', '', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-02-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417910506', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12017329', 'W12017329', 'ID02', 'Family Medicine Residency of Idaho', 'Babette', 'N', 'Munting', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-02-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417910506', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12017333', 'W12017333', 'UT01', 'Cache Valley Health Center', 'Melissa', 'A', 'Foster', 'FNP', 'Family Practice', '', '', NULL, 'O', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '3077898290', '3077898975', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '3077898290', '3077898975', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-04-01', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928108', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12017331', 'W12017331', 'WY01', 'Evanston Community Health Center', 'Melissa', 'A', 'Foster', 'FNP', 'Family Practice', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928108', 0, 'N', 0, '2012-04-02', NULL, NULL, 41.2591, -110.967, NULL, NULL),
('810587644', 'W12017332', 'W12017332', 'WYT1', 'Evanston Community Health Center', 'Melissa', 'A', 'Foster', 'FNP', 'Family Practice', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928108', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12017334', 'W12017334', 'NM01', 'Womens Specialists of NM', 'Julie', 'E', 'Carlson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1477723518', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('800759366', 'W12017335', 'W12017335', 'UTMH1', 'Serenity Counseling Services', 'Tonya', 'S', 'Gloshen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8015568080', '8017797808', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8015568080', '8017797808', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043237860', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12017337', 'W12017337', 'TX01', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12017336', 'W12017336', 'TX01', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5212, -98.5714, NULL, NULL),
('202148889', 'W12017338', 'W12017338', 'TX01', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12017343', 'W12017343', 'UT01', 'Central Utah Clinic PC', 'M', 'S', 'Nizam', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '1055 N 500 W Ste 205 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014298095', NULL, '1055 N 500 W Ste 205 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014298095', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326203514', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12017342', 'W12017342', 'UT01', 'Central Utah Clinic PC', 'M', 'S', 'Nizam', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014298008', NULL, '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014298008', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326203514', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.3757, -111.77, NULL, NULL),
('870281028', 'W12017341', 'W12017341', 'UT01', 'Central Utah Clinic', 'M', 'S', 'Nizam', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014298008', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014298008', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326203514', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('271534643', 'W12017344', 'W12017344', 'UT01', 'Horizon Home Health', '', '', 'Home Health Specialists', 'Group', 'Home Health Agency', '', '', NULL, 'O', '204 W 540 N', 'Orem', 'Utah', 'UT', '84057', '8012251919', '8012244081', '204 W 540 N', 'Orem', 'Utah', 'UT', '84057', '8012251919', '8012244081', '', '', '4', '0.00', '40.00', '0.00', 3, '2011-12-01', '2012-02-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811226772', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('271534643', 'W12017345', 'W12017345', 'UT01', 'Horizon Home Health', '', '', 'Home Health Specialists', 'Group', 'Home Health Agency', '', '', NULL, 'O', '444 S Main St Ste C8', 'Cedar City', 'Iron', 'UT', '84720', '4358657481', '4358659319', '444 S Main St Ste C8', 'Cedar City', 'Iron', 'UT', '84720', '4358657481', '4358659319', '', '', '4', '0.00', '40.00', '0.00', 3, '2011-12-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811226772', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('820511121', 'W12017346', 'W12017346', 'ID02', '', 'Arthur', 'G', 'Hamblin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083364408', NULL, '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083364408', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-08-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366488132', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820511121', 'W12017347', 'W12017347', 'SACN', '', 'Arthur', 'G', 'Hamblin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083364408', NULL, '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083364408', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', '2013-02-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366488132', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12017348', 'W12017348', 'UT01', 'Ogden Clinic', 'John', 'S', 'Wolthuis', 'MD', 'Urology', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753160', '8014753161', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753160', '8014753161', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', '2014-05-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093703811', 0, 'N', 0, '2014-06-06', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('870286381', 'W12017349', 'W12017349', 'UT01', 'Ogden Clinic', 'Kevin', 'G', 'Walker', 'DPM', 'Podiatry', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1013905819', 0, 'N', 0, '2013-11-11', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('205934739', 'W12017352', 'W12017352', 'ID02', 'Family Medicine Residency of Idaho', 'Heather', 'K', 'Moon', '', 'Mental Health', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821261199', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12017351', 'W12017351', 'ID02', 'Family Medicine Residency of Idaho', 'Heather', 'K', 'Moon', '', 'Mental Health', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821261199', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12017350', 'W12017350', 'ID02', 'Family Medicine Residency of Idaho', 'Heather', 'K', 'Moon', '', 'Mental Health', '', '', NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821261199', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12017353', 'W12017353', 'UT01', 'Ogden Clinic', 'Tyler', 'L', 'Christensen', 'MD', 'Urology', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014573000', '8014762670', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014573000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811097629', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('205934739', 'W12017355', 'W12017355', 'ID02', 'Family Medicine Health Center', 'Mark', 'E', 'Mering', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578527990', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12017356', 'W12017356', 'UT01', 'Ogden Clinic Professional Center South', 'Robert', 'D', 'Wayment', 'MD', 'Urology', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753160', '8014753161', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753160', '8014753161', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295957280', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('800561374', 'W12017357', 'W12017357', 'ID01', 'Words of Wisdom Counseling Center', 'Michele', '', 'Harris', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3724 N Buckingham Ct', 'Boise', 'Ada', 'ID', '83704', '2086026130', '2089068411', '3724 N Buckingham Ct', 'Boise', 'Ada', 'ID', '83704', '2086026130', '2089068411', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881870095', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('201312583', 'W12017359', 'W12017359', 'ID01', 'Life Counseling Center', 'Matthew', '', 'Boyd', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663302', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12007636', 'W12007636', 'ID02', 'Life Counseling Center', 'Matthew', '', 'Boyd', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-01-24', '2011-01-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558663302', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017360', 'W12017360', 'UT01', 'Center of Orthopedic and Rehabilitation Excellence', 'Jeremiah', 'M', 'Jorgensen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669704045', 0, 'N', 0, '2012-01-16', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12017361', 'W12017361', 'UT01', 'Center of Orthopedic and Rehabilitation Excellence', 'Jeremiah', 'M', 'Jorgensen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-12-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669704045', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('451797157', 'W12017363', 'W12017363', 'UT01', 'Sleep Alternatives Salt Lake ', 'Rodolfo', '', 'Martinez-Ferrate', 'MD', 'Family Practice', '', '', NULL, 'O', '1226 W S Jordan Pkay Ste B101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028172', '8668982703', '1226 W S Jordan Pkay Ste B101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028172', '8668982703', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-24', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1598738270', 0, 'N', 0, '2014-06-30', NULL, NULL, 40.5618, -111.926, NULL, NULL),
('451797157', 'W12017364', 'W12017364', 'UT01', 'Sleep Alternatives Salt Lake ', 'Rodolfo', '', 'Martinez-Ferrate', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 13606', 'South Jordan', 'Salt Lake', 'UT', '86284', '4804708336', '8665487855', 'PO Box 13606', 'South Jordan', 'Salt Lake', 'UT', '86284', '4804708336', '8665487855', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1598738270', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017365', 'W12017365', 'UT01', 'Wasatch Brain and Spine Surgery', 'David', 'J', 'Nathan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194731240', 0, 'N', 0, '2014-01-27', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12017366', 'W12017366', 'UT01', 'Wasatch Brain and Spine Surgery', 'David', 'J', 'Nathan', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194731240', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017367', 'W12017367', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Ericka', 'K', 'Tse', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', '4052 W Pioneer Pkwy Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-03', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750650586', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017368', 'W12017368', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Ericka', 'K', 'Tse', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-03', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750650586', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12017369', 'W12017369', 'ID02', 'Primary Health Medical Group', 'Terah', 'L', 'Young', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2088788011', NULL, '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2088788011', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508873050', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6191, -116.322, NULL, NULL),
('202630141', 'W12017370', 'W12017370', 'ID02', 'Primary Health Medical Group', 'Terah', 'L', 'Young', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508873050', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('820470661', 'W12017371', 'W12017371', 'ID01', 'Lifeline Chiropractic', 'Kjersten', 'J', 'Holt', 'DC', 'Chiropractic', '', '', NULL, 'O', '1627 S Orchard St Ste 1', 'Boise', 'Ada', 'ID', '83705', '2083367900', NULL, '1627 S Orchard St Ste 1', 'Boise', 'Ada', 'ID', '83705', '2083367900', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063782456', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017852', 'W12017852', 'UT01', 'MountainStar Jordan Family Health', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870630100', 'W12017372', 'W12017372', 'UT01', 'Debra Lynns Mastectomy Specialties', '', '', 'Debra Lynns Mastectomy Specialties', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1090 E 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013932885', NULL, '1090 E 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013932885', '          ', 'WCSTDLMS5', '', '', '0.00', '40.00', '0.00', 3, '2011-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834354', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12017373', 'W12017373', 'NM01', 'ABQ Health Partners', 'Leslie', '', 'OConnell', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627000', '5058968697', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627000', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-08-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851400188', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12017472', 'W12017472', 'NM01', 'ABQ Health Partners', 'Diane', '', 'Reisinger', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 27829  ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627636', 'PO Box 27829  ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627636', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003975699', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017845', 'W12017845', 'UT01', 'MountainStar Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12017474', 'W12017474', 'UTMH1', 'Northeastern Counseling Center', 'Keith', 'H', 'Evans', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', '', '', '', 'HCFA|UB|', '1033179049', 0, 'N', 1, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12017475', 'W12017475', 'UTMH1', 'Northeastern Counseling Center', 'Keith', 'H', 'Evans', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', '', '', '', 'HCFA|UB|', '1033179049', 0, 'N', 1, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12017478', 'W12017478', 'UT01', 'Tooele Clinic Corp', 'Katherine', 'E', 'Devries', 'NP', 'Family Practice', '', '', NULL, 'O', '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', NULL, '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1114244944', 0, 'N', 0, '2012-03-10', NULL, NULL, 40.5653, -112.298, NULL, NULL),
('870635889', 'W12017477', 'W12017477', 'UT01', 'Tooele Clinic Corp', 'Katherine', 'E', 'Devries', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358821644', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358821644', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1114244944', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12017476', 'W12017476', 'UT01', 'Tooele Clinic Corp', 'Katherine', 'E', 'Devries', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358821644', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358821644', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1114244944', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'W12017479', 'W12017479', 'UT01', 'U-U Otolaryngology - Pediatrics', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016621740', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016621740', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-09-17', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', 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
('870643697', 'W12017480', 'W12017480', 'UT01', 'University Health Care', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-09-17', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870543342', 'W12017483', 'W12017483', 'UT01', 'Moab Regional Hospital', 'John', 'M', 'Sanders', 'DO', 'Family Practice', '', '', NULL, 'O', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '', '', '', '0.00', '10.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1740444173', 0, 'N', 0, '2012-02-06', NULL, NULL, 38.5743, -109.56, NULL, NULL),
('870543342', 'W12017482', 'W12017482', 'UT01', 'Moab Regional Family Medical Clinic', 'John', 'M', 'Sanders', 'DO', 'Family Practice', '', '', NULL, 'O', '476 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '476 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '', '', '', '0.00', '10.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1740444173', 0, 'N', 0, '2012-02-06', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('870543342', 'W12017481', 'W12017481', 'UT01', 'Moab Regional Family Medical Clinic', 'John', 'M', 'Sanders', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', 'PO Box 998', 'Moab', 'Grand', 'UT', '84532', '4357193508', '4357193509', '', '', '', '0.00', '10.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1740444173', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12017485', 'W12017485', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'M', '3340 N Ctr St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', '          ', '3340 N Ctr St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', '          ', '', '', '', '57.00', '25.00', '0.00', 3, '2012-02-01', '2014-06-30', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12017486', 'W12017486', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', '          ', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', '          ', '', '', '', '57.00', '25.00', '0.00', 3, '2012-02-01', '2014-06-30', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12017487', 'W12017487', 'UT01', 'Mountain West Anesthesia', 'David ', 'M', 'Chatwin', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322600', '8014322668', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322600', '8014322668', '', '', '', '57.00', '25.00', '0.00', 3, '2012-02-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1366535650', 0, 'Y', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12017490', 'W12017490', 'UTMH1', 'Valley Mental Health  Inc', 'Carol', 'A', 'Anglesey', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2012-01-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518271253', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12015727', 'W12015727', 'UTIHCPHY', 'Southridge Pediatrics', 'Shellie', 'J', 'Ring', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1316920770', 0, 'N', 0, '2014-05-02', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('820200895', 'W12017498', 'W12017498', 'ID01', 'Saint Alphonsus Medical Group Overland', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083675170', '2083677204', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083675170', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12017500', 'W12017500', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83708', '2083673131', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83708', '2083673131', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12017501', 'W12017501', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('460500210', 'W12017502', 'W12017502', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('953641024', 'W12017503', 'W12017503', 'ID02', 'Oliver Chiropractic', 'Herbert', 'W', 'Oliver', 'DC', 'Chiropractic', '', '', NULL, 'O', '4696 Overland Rd Ste 182', 'Boise', 'Ada', 'ID', '83705', '2083763111', '2083763175', '4696 Overland Rd Ste 182', 'Boise', 'Ada', 'ID', '83705', '2083763111', '2083763175', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700835428', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017504', 'W12017504', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Tanya', 'K', 'Powel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019843418', '8019848281', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019843418', '8019848281', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-18', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235265802', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12017505', 'W12017505', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Tanya', 'K', 'Powel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-18', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235265802', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('261900472', 'W12017506', 'W12017506', 'ID01', 'Idaho Skin Surgery Center', 'Jared', '', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', NULL, '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-02-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992808893', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('201312583', 'W12017507', 'W12017507', 'ID01', 'LIFE Counseling Center', 'Mitchell', '', 'Smith', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174754923', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12017508', 'W12017508', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Dale', '', 'Strawn', 'MD', 'General Surgery', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', '2083676849', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017509', 'W12017509', 'ID01', 'Idaho Emergency Physicians PA', 'Jessica', 'N', 'Wasielewski', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427126127', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('352332742', 'W12017510', 'W12017510', 'ID01', 'Healthy Habits Wellness Clinic', 'Bryce', '', 'Aitken', 'NPC', 'Family Practice', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', NULL, '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '          ', 'IDSTD', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730279407', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12017511', 'W12017511', 'UTMH1', 'Heber Valley Counseling', 'Mary', 'W', 'Bassis', 'NP', 'Mental Health', '', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-02-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215147046', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12017513', 'W12017513', 'UTMH1', 'Northeastern Counseling Center', 'Rochelle', 'L', 'Danley', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', NULL, '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114177318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12017512', 'W12017512', 'UTMH1', 'Northeastern Counseling Center', 'Rochelle', 'L', 'Danley', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114177318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12017515', 'W12017515', 'WY01', 'Rocky Mountain Oncology Center', 'Reim', '', 'Fehringer', 'PT', 'Physical Therapy', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072625992', NULL, '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072625992', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598825580', 0, 'N', 1, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12017520', 'W12017520', 'WYT2', 'Rocky Mountain Oncology Center', 'Reim', '', 'Fehringer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82500', '3078560254', NULL, '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82500', '3078560254', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598825580', 0, 'N', 1, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12017514', 'W12017514', 'WYT2', 'Rocky Mountain Oncology Center', 'Reim', '', 'Fehringer', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', NULL, 'PO Box 306142', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598825580', 0, 'N', 1, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12017522', 'W12017522', 'WY01', 'West Park Hospital District', 'Stephen', 'R', 'Mandler', 'DO', 'Psychiatry', 'Mental Health', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1659420099', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.517, -109.083, NULL, NULL),
('830207671', 'W12017523', 'W12017523', 'WY01', 'West Park Hospital District', 'Stephen', 'R', 'Mandler', 'DO', 'Psychiatry', 'Mental Health', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1659420099', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.526, -109.074, NULL, NULL),
('830207671', 'W12017525', 'W12017525', 'WYT1', 'West Park Hospital District', 'Stephen', 'R', 'Mandler', 'DO', 'Psychiatry', 'Mental Health', '', NULL, 'O', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1659420099', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12017524', 'W12017524', 'WYT1', 'West Park Hospital District', 'Stephen', 'R', 'Mandler', 'DO', 'Psychiatry', 'Mental Health', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1659420099', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('200348433', 'W12017528', 'W12017528', 'UT01', 'Cedar Ridge Family Medicine', 'Drew', '', 'Polson', 'MD', 'Family Practice', '', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700084829', 0, 'N', 0, '2012-03-10', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('820529971', 'W12016400', 'W12016400', 'ID02', 'Childrens Therapy Place Inc', 'Anthony', 'A', 'Richitella', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073770947', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('453625227', 'W12017530', 'W12017530', 'UT01', '', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358827644', '4358822284', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358827644', '4358822284', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('942854057', 'W12017532', 'W12017532', 'UTIHCPHY', 'Heber Valley Clinic', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', '2013-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578889465', 0, 'Y', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017533', 'W12017533', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Diedre', 'D', 'Bacon', 'APRN', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700020369', 0, 'N', 0, '2013-03-11', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12017534', 'W12017534', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Craig', 'L', 'Booth', 'MD', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225146392', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12017536', 'W12017536', 'UTIHCPHY', 'Cardiovascular & Thoracic Surgery - St. George', 'Stephen', 'P', 'Craig', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679843965', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12017537', 'W12017537', 'UTIHCPHY', 'Holladay Pediatrics', 'Neal', 'R', 'Davis', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760691166', 0, 'N', 0, '2012-01-24', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('942854057', 'W12017540', 'W12017540', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Joan', 'V', 'Eggert', 'MD', 'Obstetrics and Gynecology', 'Gynecology', 'Hyperbaric Medicine', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1093715542', 0, 'N', 0, '2014-06-16', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12017543', 'W12017543', 'UTIHCPHY', 'Heber Valley Clinic', 'Ron', '', 'Ellsworth', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Highway 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1245556141', 0, 'Y', 0, '2012-08-17', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12017544', 'W12017544', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Michelle', 'H', 'Gilbert', 'MD', 'Hematology and Oncology', 'Internal Medicine', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992876452', 0, 'N', 0, '2012-07-31', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12017545', 'W12017545', 'UTIHCPHY', 'Budge Surgical Spec-North Ogden', 'Nathan', 'William', 'Hanson', 'MD', 'Dermatology', '', '', NULL, 'O', '2400 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84414', '4357921770', '4357921727', '2400 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84414', '4357921770', '4357921727', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407048515', 0, 'N', 0, '2012-01-24', NULL, NULL, 41.2228, -111.97, NULL, NULL),
('942854057', 'W12017547', 'W12017547', 'UTIHCPHY', 'Heber Valley Clinic', 'Samuel', '', 'Inouye', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1700102696', 0, 'Y', 0, '2012-08-17', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12017549', 'W12017549', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Jana', 'M', 'Leany', 'APRN', 'Mental Health', 'Family Practice', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861488900', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12017551', 'W12017551', 'UTIHCPHY', 'Dixie Plastic & Reconstructive Surgery', 'Kristina', '', 'McMahon', 'APRN', 'Family Practice', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', '652 S Medical Ctr Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053600171', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12017553', 'W12017553', 'UTIHCPHY', 'Heber Valley Clinic', 'Nathan', '', 'Nielson', 'DO', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Fillmore Community Medical Center', 'Delta Community Medical Center', '', 'HCFA|UB|', '1659697555', 0, 'Y', 0, '2012-08-17', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12017555', 'W12017555', 'UTIHCPHY', 'Heber Valley Clinic', 'Isaac', 'R', 'Rasmussen', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1548586431', 0, 'Y', 0, '2012-08-17', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12017557', 'W12017557', 'UTIHCPHY', 'Heber Valley Clinic', 'Alexis', '', 'Somers', 'DO', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346566171', 0, 'Y', 0, '2012-01-25', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12017558', 'W12017558', 'UTIHCPHY', 'Holladay Pediatrics', 'Mark', 'C', 'Templeman', 'MD', 'Pediatrics', '', '', NULL, 'O', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922120468', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('942854057', 'W12017559', 'W12017559', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Steven', 'A', 'VanNorman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780671107', 0, 'N', 0, '2013-03-05', NULL, NULL, 37.0989, -113.575, NULL, NULL),
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('942854057', 'W12017562', 'W12017562', 'UTIHCPHY', 'Logan Hyperbaric and Wound Care', '', '', 'Logan Hyperbaric and Wound Care', 'Group', 'Clinic', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033489505', 0, 'N', 0, '2012-01-25', NULL, NULL, 0, 0, NULL, NULL),
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