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
('870618776', 'W12004731', 'W12004731', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', NULL, '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'W12004732', 'W12004732', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', NULL, '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('870618776', 'W12004733', 'W12004733', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', NULL, '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2011-11-07', 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004734', 'W12004734', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870618776', 'W12004735', 'W12004735', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', NULL, '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12004736', 'W12004736', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'W12004737', 'W12004737', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', NULL, 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004738', 'W12004738', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004739', 'W12004739', 'UT01', 'Gamma West Cancer Services', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004740', 'W12004740', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870618776', 'W12004741', 'W12004741', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', NULL, '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'W12004742', 'W12004742', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', NULL, '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('870618776', 'W12004743', 'W12004743', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', NULL, '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-07', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004744', 'W12004744', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', NULL, '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12004745', 'W12004745', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'W12004746', 'W12004746', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', NULL, 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004747', 'W12004747', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', NULL, 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004748', 'W12004748', 'UT01', 'Gamma West Cancer Services', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004749', 'W12004749', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', NULL, '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'W12004750', 'W12004750', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', NULL, '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('870618776', 'W12004751', 'W12004751', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', NULL, '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-07', 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004752', 'W12004752', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870618776', 'W12004753', 'W12004753', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', NULL, '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12004754', 'W12004754', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'W12004755', 'W12004755', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 30015 Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', NULL, 'PO Box 30015 Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004756', 'W12004756', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', NULL, 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004757', 'W12004757', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004758', 'W12004758', 'UT01', 'Gamma West Cancer Services', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004759', 'W12004759', 'UT01', 'Alta Internal Medicine', 'Robin', 'S', 'Poppen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1588698831', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.5523, -111.891, NULL, NULL),
('271477039', 'W12004760', 'W12004760', 'ID02', 'Advantage Walkin Chiropractic', 'JD', 'Tucker', 'Rohm', 'DC', 'Chiropractic', '', '', NULL, 'O', '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', NULL, '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-02-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356504443', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12004761', 'W12004761', 'UT01', 'Jordan Specialty Services', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004762', 'W12004762', 'UT01', 'Lone Peak Family Medicine', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004763', 'W12004763', 'UT01', 'Lone Peak Family Medicine', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'Y', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'W12004764', 'W12004764', 'UT01', 'Alpine Orthopaedic Specialists', 'Jared', 'C', 'Shippee', 'DPM', 'Podiatry', '', '', NULL, 'O', '267 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357872000', '4357871913', '267 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357872000', '4357871913', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871637033', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
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('870442129', 'W12004829', 'W12004829', 'UT01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', '', '', '1000', '54.91', '25.00', '0.00', 3, '2010-01-01', '2010-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
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('201332189', 'W12004847', 'W12004847', 'UT01', 'Physical Medicine Clinic', 'Patrick', '', 'Egbert', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '7669 S 1700 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', '7669 S 1700 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750388765', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('201332189', 'W12004848', 'W12004848', 'UT01', 'Egbert Chiropractic', 'Michael', '', 'Egbert', 'DC', 'Chiropractic', '', '', NULL, 'O', '7669 S 1700 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', '7669 S 1700 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578529921', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('263771889', 'W12004851', 'W12004851', 'UT01', 'Page Chiropractic & Wellness Center PC', 'Michael', '', 'Page', 'DC', 'Chiropractic', '', '', NULL, 'O', '7084 S 2300 E Ste 130', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017338300', '8017338301', '7084 S 2300 E Ste 130', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017338300', '8017338301', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205989431', 0, 'Y', 0, '2012-07-12', NULL, NULL, 0, 0, NULL, NULL),
('200930035', 'W12004852', 'W12004852', 'UT01', 'Rigby Chiropractic', 'Micah', 'L', 'Rigby', 'DC', 'Chiropractic', '', '', NULL, 'O', '25 N 570 E', 'Tremonton', 'Box Elder', 'UT', '84337', '4352572131', '4352572132', '25 N 570 E', 'Tremonton', 'Box Elder', 'UT', '84337', '4352572131', '4352572132', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760495808', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260860982', 'W12004853', 'W12004853', 'UT01', '', 'Rodney', 'R', 'Scuderi', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '8915 S 700 E Ste 201', 'Sandy', 'Salt Lake', 'UT', '84070', '8015236327', '8015539019', '8915 S 700 E Ste 201', 'Sandy', 'Salt Lake', 'UT', '84070', '8015236327', '8015539019', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548271950', 0, 'N', 0, '2010-11-01', NULL, NULL, 0, 0, NULL, NULL),
('272058546', 'W12004854', 'W12004854', 'UT01', 'Rocky Mountain Family Chiropractic ', 'William', 'Dalley', 'Green', 'DC', 'Chiropractic', '', '', NULL, 'O', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8019278972', '8013353209', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8019278972', '8013353209', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871730267', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12004857', 'W12004857', 'UTMH1', 'LDS Family Services', 'Roger', '', 'Hollingsworth', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'ma', '', '', '0.00', '35.00', '0.00', 8, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013234129', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12004858', 'W12004858', 'UT01', 'Granger Medical Clinic', 'Douglas', 'S', 'Mehr', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-28', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720070899', 0, 'N', 0, '2013-03-19', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12004859', 'W12004859', 'UT01', 'Granger Medical Clinic', 'Douglas', 'S', 'Mehr', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-28', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720070899', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12004861', 'W12004861', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014753701', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014753701', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'W12004865', 'W12004865', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84414', '8014753600', '8014753601', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84414', '8014753600', '8014753601', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.3068, -112.007, NULL, NULL),
('870286381', 'W12004863', 'W12004863', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.1689, -112.064, NULL, NULL),
('870286381', 'W12004862', 'W12004862', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '8014753301', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', '2011-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12004860', 'W12004860', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W12004864', 'W12004864', 'UT01', 'Ogden Clinic', 'Scott', 'C', 'Roberts', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '8014753801', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '8014753801', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083920672', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.1523, -111.94, NULL, NULL),
('204157017', 'W12004866', 'W12004866', 'ID01', 'Jensen Eye Associates', 'Justin', 'D', 'Sparhawk', 'OD', 'Optometry', '', '', NULL, 'O', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '2084674450', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '2084674450', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-12-01', NULL, 0, NULL, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1669552048', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.5528, -116.573, NULL, NULL),
('271670329', 'W12004867', 'W12004867', 'UT01', 'Alpine Center Medical Services', 'Stephen', '', 'Tucker', 'MD', 'Pediatric Internal Medicine', 'Family Practice', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538179247', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W12004868', 'W12004868', 'UTMH1', 'Resilient Solutions Inc', 'Max', 'C', 'Ward', 'LCSW', 'Mental Health', '', '', NULL, 'O', '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '8016628169', '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '8016628169', 'MA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2012-01-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902112295', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12004869', 'W12004869', 'UT01', 'Tooele Clinic Corp', 'Rebekah', '', 'Aldridge', 'PA', 'Family Practice', '', '', NULL, 'O', '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427386770', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870635889', 'W12004870', 'W12004870', 'UT01', 'Tooele Clinic Corp', 'Rebekah', '', 'Aldridge', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427386770', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12004871', 'W12004871', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004872', 'W12004872', 'UT01', 'Central Utah Clinic', 'John', 'A', 'Griffin', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-09-15', '2011-02-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821014903', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004873', 'W12004873', 'UT01', 'Snow Creek Medical', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '1600 Snow Creek Medical', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', '1600 Snow Creek Medical', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-16', '2011-10-17', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12004874', 'W12004874', 'UT01', 'Granger Medical Clinic', 'Michael', 'J', 'Sanderson', 'MD', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653479', '8019653717', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653479', '8019653717', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-05', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215134663', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870410605', 'W12004875', 'W12004875', 'UTMH1', 'Family Support & Treatment Center', 'Erin', 'E', 'Vasquez', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-04-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003875725', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('470905811', 'W12004876', 'W12004876', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Kay', 'B', 'Walker', 'MD', 'Allergy and Immunology', 'Asthma', '', NULL, 'O', '74 E Kimballs Ln Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012815973', '74 E Kimballs Ln Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012815973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-05', '2011-09-20', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083608095', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12004883', 'W12004883', 'UT01', 'University Health Care', 'Nicole', 'F', 'Langston', 'MD', 'Pediatrics', '', '', NULL, 'O', '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', NULL, '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-08-09', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669696241', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12004884', 'W12004884', 'UT01', 'Pediatric Inpatient Services Riverton', 'Nicole', 'F', 'Langston', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-08-09', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669696241', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12004881', 'W12004881', 'UT01', 'University Health Care', 'Nicole', 'F', 'Langston', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623446', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623446', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-08-09', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669696241', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12004882', 'W12004882', 'UT01', 'Pediatric Inpatient Services-Department of University of Uta', 'Nicole', 'F', 'Langston', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-08-09', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669696241', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12004885', 'W12004885', 'ID01', 'Pediatric Inpatient Services Riverton', 'Nicole', 'F', 'Langston', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-08-09', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669696241', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12004886', 'W12004886', 'ID01', 'Saint Alphonsus Medical Group Heart Care Eagle', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'W12004887', 'W12004887', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12004888', 'W12004888', 'ID01', 'Saint Alphonsus Medical Group EHP Family Medicine ', 'Judy', '', 'Kienzle', 'MD', 'Nurse Practitioner', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740224328', 0, 'N', 0, '2013-01-07', NULL, NULL, 43.6896, -116.35, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12004953', 'W12004953', 'UTPEHP', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', NULL, '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '', '', '', 'PRYPEHP', '0.00', '0.00', '0.00', 8, '2010-10-11', '2010-10-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004956', 'W12004956', 'UTIHC01', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '', '', 'IHC01', '0.00', '0.00', '0.00', 8, '2010-10-11', '2014-06-16', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004000', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004957', 'W12004957', 'UTIHC02', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '', '', 'IHC01', '0.00', '0.00', '0.00', 8, '2010-10-11', '2014-06-16', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004000', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004958', 'W12004958', 'UTIHC03', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '', '', 'IHC01', '0.00', '0.00', '0.00', 8, '2010-10-11', '2014-06-16', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004000', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12004960', 'W12004960', 'UTPEHP', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '', '', 'PRYPEHP', '0.00', '0.00', '0.00', 8, '2010-10-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004000', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004962', 'W12004962', 'UTIHC04', 'Occupational Therapy', 'Rhonda', 'E', 'Richardson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346442522', 0, 'N', 0, '2010-11-03', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12004963', 'W12004963', 'UTIHC04', 'Primary Childrens Medical Center', 'Louise', 'D', 'Elliott', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457544280', 0, 'N', 0, '2010-01-12', NULL, NULL, 40.6462, -111.934, NULL, NULL),
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('942854057', 'W12004967', 'W12004967', 'UTIHC01', 'EKG', 'Melanie', 'D', 'Everitt', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952480428', 0, 'Y', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004968', 'W12004968', 'UTIHC03', 'EKG', 'Melanie', 'D', 'Everitt', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952480428', 0, 'Y', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004969', 'W12004969', 'UTIHC04', 'EKG', 'Melanie', 'D', 'Everitt', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952480428', 0, 'Y', 0, '2011-11-08', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12004970', 'W12004970', 'UTIHC04', 'Primary Childrens Medical Center', 'Florence', NULL, 'Fairbanks', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154348993', 0, 'N', 0, '2010-01-12', NULL, NULL, 40.6462, -111.934, NULL, NULL),
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('942854057', 'W12005061', 'W12005061', 'UTIHC04', 'Primary Childrens Medical Center', 'Claire', 'R', 'Stoecker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W Ste G', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093735565', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005065', 'W12005065', 'UTIHC01', 'EKG', 'Lloyd', 'Y', 'Tani', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326127994', 0, 'Y', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005068', 'W12005068', 'UTIHC04', 'Primary Childrens Medical Center', 'Katherine', 'M', 'Tolsma', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417155227', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005072', 'W12005072', 'UTIHC01', 'Maternal Fetal Medicine', 'Michael', 'W', 'Varner', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', NULL, NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396783486', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005081', 'W12005081', 'UTIHC03', 'EKG', 'Angela', 'T', 'Yetman', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', '2012-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891885471', 0, 'Y', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005082', 'W12005082', 'UTIHC04', 'EKG', 'Angela', 'T', 'Yetman', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', '2012-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891885471', 0, 'Y', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005083', 'W12005083', 'UTIHC04', 'Primary Childrens Medical Center', 'Jennifer', 'Lyn', 'Young', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'O', '5770 S 1500 W Ste G', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '5770 S 1500 W Ste G', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871517094', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.6462, -111.934, NULL, NULL),
('742842145', 'W12005084', 'W12005084', 'TX01', 'Neurology Center of San Antonio PA', 'Ann', 'D', 'Bass', 'MD', 'Neurology', '', '', NULL, 'O', '1314 E Sonterra Blvd Ste 604', 'San Antonio', 'Bexar', 'TX', '78258', '2104900016', NULL, '1314 E Sonterra Blvd Ste 604', 'San Antonio', 'Bexar', 'TX', '78258', '2104900016', '          ', 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-10-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104925171', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.613, -98.4731, NULL, NULL),
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('870681797', 'W12005087', 'W12005087', 'SINCLAIRDEN', '', 'Stephen', NULL, 'Johansen', 'DDS', 'Dentist', '', '', NULL, 'O', '7370 S Creek Rd Ste 202', 'Sandy', 'Salt Lake', 'UT', '84093', '8016761234', NULL, '7370 S Creek Rd Ste 202', 'Sandy', 'Salt Lake', 'UT', '84093', '8016761234', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2006-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006953', 0, 'N', 0, '2008-08-25', NULL, NULL, 0, 0, NULL, NULL),
('272616703', 'W12005089', 'W12005089', 'UTDT01', 'Farr West Family Dental', 'Brad', '', 'Butterfield', 'DDS', 'Dentist', '', '', NULL, 'O', '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017319058', NULL, '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017319058', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '0000004001', 0, 'N', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W12005091', 'W12005091', 'UTDT01', 'Utah Navajo Health System', 'Brian', '', 'Olsen', 'DDS', 'Dentist', '', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004002', 0, 'N', 0, '2010-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('261665351', 'W12005170', 'W12005170', 'UTDT01', 'Springville Dentistry', 'Richard ', '', 'Francis ', 'DDS', 'Dentist', '', '', NULL, 'O', '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', NULL, '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004024', 0, 'N', 0, '2010-10-12', NULL, NULL, 0, 0, NULL, NULL),
('272039296', 'W12005171', 'W12005171', 'UTDT01', 'Genesis Dental of Riverton', 'Terry', '', 'Sorensen', 'DMD', 'Dentist', '', '', NULL, 'O', '12569 S 2700 W Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8012547272', NULL, '12569 S 2700 W Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8012547272', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008815', 0, 'N', 0, '2010-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('261665351', 'W12005174', 'W12005174', 'UTDT01', 'Springville Dentistry', 'Dale', '', 'Hadley', 'DDS', 'Dentist', '', '', NULL, 'O', '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', NULL, '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006524', 0, 'N', 0, '2010-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('261665351', 'W12005176', 'W12005176', 'UTDT01', 'Springville Dentistry', 'Kyle R', '', 'Marshall', 'DDS', 'Dentist', '', '', NULL, 'O', '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', NULL, '378 E 400 S Ste 1', 'Springville', 'Utah', 'UT', '84663', '8014899456', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007444', 0, 'N', 0, '2013-05-02', NULL, NULL, 0, 0, NULL, NULL),
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('470940673', 'W12005191', 'W12005191', 'SINCLAIRDEN', 'Great Divide Dental Associates', 'Stephen', '', 'Hays', 'DDS', 'Dentist', '', '', NULL, 'O', '212 S 1st St', 'Saratoga', 'Carbon', 'WY', '82331', '3073268895', NULL, '212 S 1st St', 'Saratoga', 'Carbon', 'WY', '82331', '3073268895', '          ', '', '', '', '0.00', '5.00', '0.00', 8, '2006-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006625', 0, 'Y', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
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('830332962', 'W12005195', 'W12005195', 'Sinclair', '(Sinclair Health Services\rProvider) Wyoming Spine & Neurosurgery Assoc', 'Steven', '', 'Beer', '', 'Neurosurgery', '', '', NULL, 'O', '1950 Bluegrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', NULL, '1950 Bluegrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', '82009     ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588633291', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830332962', 'W12005196', 'W12005196', 'Sinclair', '(Sinclair Health Services\rProvider) Wyoming Spine & Neurosurgery Assoc', 'Andrew ', '', 'Beguin', '', 'Neurosurgery', '', '', NULL, 'O', '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', NULL, '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622809', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830332962', 'W12005197', 'W12005197', 'Sinclair', '(Sinclair Health Services\rProvider) Wyoming Spine & Neurosurgery Assoc', 'Judson ', '', 'Cook', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', NULL, '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386603553', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12005198', 'W12005198', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'Gail ', '', 'Enyert', 'NP', 'Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', NULL, '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-10-27', '2013-06-01', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1306813647', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12005199', 'W12005199', 'Sinclair', 'Rocky Mountain Oncology Center', 'Diane ', '', 'Henshaw', 'MD', 'Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', NULL, '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-10-27', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912939182', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12005200', 'W12005200', 'Sinclair', '(Sinclair Health Services\rProvider) 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, '2010-10-27', 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', 'W12005201', 'W12005201', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'Joseph ', '', 'Rosen', 'MD', 'Oncology', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', NULL, '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1225002413', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12005202', 'W12005202', 'Sinclair', '(Sinclair Health Services\rProvider) 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, '2010-10-27', 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),
('830332962', 'W12005203', 'W12005203', 'Sinclair', '(Sinclair Health Services\rProvider) Wyoming Spine & Neurosurgery Assoc', 'Kelli ', 'R', 'McKee', 'PAC', 'Neurosurgery', '', '', NULL, 'O', '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', NULL, '1950 Blugrass Cir Ste 170', 'Cheyenne', 'Laramie', 'WY', '82009', '3077782860', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558344812', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830266658', 'W12005204', 'W12005204', 'Sinclair', '(Sinclair Health Services\rProvider) Central Wyoming Eye Clinic', 'Ronald', 'E', 'Gibson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1705 E 12th St', 'Casper', 'Natrona', 'WY', '82601', '3072354185', NULL, '1705 E 12th St', 'Casper', 'Natrona', 'WY', '82601', '3072354185', '          ', 'GIBSON', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2010-11-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629129739', 0, 'Y', 0, '2012-12-17', NULL, NULL, 0, 0, NULL, NULL),
('830253656', 'W12005205', 'W12005205', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Donald ', '', 'Smith', 'MD', 'Internal Medicine', '', '', NULL, 'O', '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3075770477', NULL, '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '          ', 'WYSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457338485', 0, 'N', 0, '2012-08-30', 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
('600262662', 'W12005208', 'W12005208', 'ID01', 'Family Counseling Services', 'Jared', 'A', 'Belsher', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '870 N Linder Rd Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088885905', NULL, '870 N Linder Rd Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088885905', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174717870', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12005218', 'W12005218', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-11', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W12005219', 'W12005219', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-11', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('460500210', 'W12005220', 'W12005220', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', '2083673174', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-11', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12005224', 'W12005224', 'ID01', 'Saint Alphonsus Medical Group MPH Family Medicine', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-11', '2012-11-20', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12005226', 'W12005226', 'ID01', 'Saint Alphonsus  Medical Group Family Medicine Dominican', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-11', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.025, -116.928, NULL, NULL),
('272927297', 'W12005229', 'W12005229', 'UT01', 'RLC Physical Therapy & Rehab LLC', 'Roger', 'L', 'Colvin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '990 S Medical Dr Ste U 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', '990 S Medical Dr Ste U 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-07-05', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1740390988', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
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('860735726', 'W12005393', 'W12005393', 'Sinclair', 'Flagstaff Bone and Joint', 'Dave ', '', 'Brown', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1578535464', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('721311350', 'W12005341', 'W12005341', 'Sinclair', '(Sinclair Health Services\rProvider) Aesthetics of Plastic Surgery', 'Thomas ', 'F', 'Crais', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 2741', 'Hailey', 'Blaine', 'ID', '83333', '2087887700', NULL, 'PO Box 2741', 'Hailey', 'Blaine', 'ID', '83333', '2087887700', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073668042', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('820527849', 'W12005344', 'W12005344', 'Sinclair', '(Sinclair Health Services\rProvider) Physical Therapy Plus of Idaho', 'Gloria ', 'G', 'Gunter', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', NULL, 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275512246', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('820396055', 'W12005347', 'W12005347', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Randall ', '', 'Hermann', 'MD', 'General Practice', 'Internal Medicine', '', NULL, 'O', '208 Spruce Ave', 'Ketchum', 'Blaine', 'ID', '83340', '2087269781', NULL, '208 Spruce Ave', 'Ketchum', 'Blaine', 'ID', '83340', '2087269781', '          ', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619034188', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820396055', 'W12005348', 'W12005348', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Randall ', '', 'Hermann', 'MD', 'General Practice', 'Internal Medicine', '', NULL, 'B', 'PO Box 1204', 'Ketchum', 'Blaine', 'ID', '83340', '2087269781', NULL, 'PO Box 1204', 'Ketchum', 'Blaine', 'ID', '83340', '2087269781', '          ', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619034188', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005350', 'W12005350', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Ron ', '', 'Earhart', 'PT', 'Physical Therapy', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', '9282142837', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', '9282142837', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104080118', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005351', 'W12005351', 'Sinclair', 'Flagstaff Bone and Joint', 'Kevin ', '', 'ODonnell', 'DO', 'Sports Medicine', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114911492', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005352', 'W12005352', 'Sinclair', 'Flagstaff Bone and Joint', 'Frank ', '', 'Maher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467436659', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('743108768', 'W12005353', 'W12005353', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Physical Therapy', 'Mary ', 'A.', 'Hogan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '21 E Maple Ste D', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', NULL, '21 E Maple Ste D', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376602136', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('743108768', 'W12005354', 'W12005354', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Physical Therapy', 'Mary ', 'A.', 'Hogan', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 3113', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', NULL, 'PO Box 3113', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376602136', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820497115', 'W12005356', 'W12005356', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Steven ', 'L', 'Karassik', 'MD', 'Dermatology', '', '', NULL, 'O', '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2087252171', NULL, '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2087252171', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891748117', 0, 'N', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('582669520', 'W12005357', 'W12005357', 'Sinclair', '(Sinclair Health Services\rProvider) Koth Sports Physical Therapy', 'John ', '', 'Koth', 'PT', 'Physical Therapy', '', '', NULL, 'O', '101 Saddle Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087269222', NULL, '101 Saddle Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087269222', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124110002', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('582669520', 'W12005358', 'W12005358', 'Sinclair', '(Sinclair Health Services\rProvider) Koth Sports Physical Therapy', 'John ', '', 'Koth', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1510', 'Ketchum', 'Blaine', 'ID', '83340', '2087269222', NULL, 'PO Box 1510', 'Ketchum', 'Blaine', 'ID', '83340', '2087269222', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124110002', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('742152396', 'W12005360', 'W12005360', 'UTPEHP', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'M', '8023 Vantage Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8002754524', NULL, '8023 Vantage Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2010-08-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12005361', 'W12005361', 'UTPEHP', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 203084', 'Houston', 'Harris', 'TX', '77215', '8002754524', NULL, 'PO Box 203084', 'Houston', 'Harris', 'TX', '77215', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2010-08-01', '2013-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('753183580', 'W12005366', 'W12005366', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Sport & Spine Physical Therapy Clinic', 'Kim', '', 'Mazik', 'PT', 'Physical Therapy', '', '', NULL, 'O', '810 S Main St Ste 7A', 'Hailey', 'Blaine', 'ID', '83333', '2087886312', NULL, '810 S Main St Ste 7A', 'Hailey', 'Blaine', 'ID', '83333', '2087886312', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801884499', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('753183580', 'W12005367', 'W12005367', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Sport & Spine Physical Therapy Clinic', 'Kim', '', 'Mazik', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1693', 'Hailey', 'Blaine', 'ID', '83333', '2087886312', NULL, 'PO Box 1693', 'Hailey', 'Blaine', 'ID', '83333', '2087886312', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801884499', 0, 'N', 0, '2012-08-30', 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
('860735726', 'W12005368', 'W12005368', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Torrey ', '', 'Botti', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1952348237', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005369', 'W12005369', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Darius ', '', 'Moezzi', 'MD', 'Sports Medicine', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1700860996', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005370', 'W12005370', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Amber ', '', 'Randall', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1063496255', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('204508629', 'W12005363', 'W12005363', 'Sinclair', '(Sinclair Health Services\rProvider) Family Practice Associates', 'Donald ', '', 'Levin', 'DO', 'Family Practice', '', '', NULL, 'O', '21 E Maple St Ste A', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '2087883386', '21 E Maple St Ste A', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '2087883386', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841258621', 0, 'N', 0, '2012-12-28', NULL, NULL, 43.5143, -114.31, NULL, NULL),
('204508629', 'W12005364', 'W12005364', 'Sinclair', '(Sinclair Health Services\rProvider) Camas Family Health Services', 'Donald ', '', 'Levin', 'DO', 'Family Practice', '', '', NULL, 'O', '401 Camas Ave W', 'Fairfield', 'Camas', 'ID', '83327', '2087642611', NULL, '401 Camas Ave W', 'Fairfield', 'Camas', 'ID', '83327', '2087642611', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841258621', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005372', 'W12005372', 'Sinclair', '(Sinclair Health Services\rProvider) Physical Therapy Plus of Idaho', 'Sydney ', 'L', 'Praeger', 'PT', 'Physical Therapy', '', '', NULL, 'O', '180 W 1st St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', NULL, '180 W 1st St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821077223', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005373', 'W12005373', 'Sinclair', '(Sinclair Health Services\rProvider) Physical Therapy Plus of Idaho', 'Sydney ', 'L', 'Praeger', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', NULL, 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821077223', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005374', 'W12005374', 'Sinclair', 'Physical Therapy Plus of Idaho', 'Nancy ', 'M', 'Penrose', 'PT', 'Physical Therapy', '', '', NULL, 'O', '180 W 1st St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', NULL, '180 W 1st St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801875604', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005377', 'W12005377', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Physical Therapy', 'Nancy ', 'M', 'Penrose', 'PT', 'Physical Therapy', '', '', NULL, 'O', '21 E Maple Ste D', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', NULL, '21 E Maple Ste D', 'Hailey', 'Blaine', 'ID', '83333', '2084810275', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801875604', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005376', 'W12005376', 'Sinclair', '(Sinclair Health Services\rProvider) Physical Therapy Plus of Idaho', 'Nancy ', 'M', 'Penrose', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 1544', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', NULL, 'PO Box 1544', 'Ketchum', 'Blaine', 'ID', '83340', '2087255185', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801875604', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820527849', 'W12005375', 'W12005375', 'Sinclair', '(Sinclair Health Services\rProvider) Physical Therapy Plus of Idaho', 'Nancy ', 'M', 'Penrose', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', NULL, 'PO Box 2182', 'Ketchum', 'Blaine', 'ID', '83340', '2087255785', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801875604', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('800480964', 'W12005391', 'W12005391', 'UT01', 'Ogden Imaging', '', '', 'West Valley Imaging', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'O', '5322 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014750800', NULL, '5322 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014750800', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598763294', 0, 'N', 0, '2011-01-27', NULL, NULL, 41.1654, -111.959, NULL, NULL),
('800480964', 'W12005392', 'W12005392', 'UT01', 'Ogden Imaging', '', '', 'West Valley Imaging', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'B', 'PO Box 404894', 'Atlanta', 'Fulton', 'GA', '30384', '8014750800', NULL, 'PO Box 404894', 'Atlanta', 'Fulton', 'GA', '30384', '8014750800', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598763294', 0, 'N', 0, '2011-01-27', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005394', 'W12005394', 'Sinclair', 'Flagstaff Bone and Joint', 'John ', '', 'Hall', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', '2011-07-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1174533723', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005395', 'W12005395', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Sherry ', '', 'Mace', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033237904', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12005397', 'W12005397', 'Sinclair', '(Sinclair Health Services\rProvider) St Lukes Internal Medicine', 'Royal', '', 'McClure', 'MD', 'Internal Medicine', '', '', NULL, 'O', '100 Hospital Dr Ste 201', 'Ketchum', 'Blaine', 'ID', '83340', '2087278888', NULL, '100 Hospital Dr Ste 201', 'Ketchum', 'Blaine', 'ID', '83340', '2087278888', '          ', 'IDSINCLAIRC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2012-10-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1093768368', 0, 'N', 0, '2012-12-27', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('841421665', 'W12005398', 'W12005398', 'Sinclair', '(Sinclair Health Services\rProvider) St Lukes Internal Medicine', 'A', 'Patrick', 'Mclaughlin III', 'MD', 'Urology', '', '', NULL, 'O', '100 Hospital Dr Ste 201', 'Ketchum', 'Blaine', 'ID', '83340', '2087278888', NULL, '100 Hospital Dr Ste 201', 'Ketchum', 'Blaine', 'ID', '83340', '2087278888', '          ', 'IDSINCLAIRC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2012-10-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1720028004', 0, 'N', 0, '2013-07-11', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('820531151', 'W12005401', 'W12005401', 'Sinclair', '(Sinclair Health Services\rProvider) Boulder Mountain PT & Sports Rehab', 'Mark ', 'E', 'Morgan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '507 S Main St', 'Hailey', 'Blaine', 'ID', '83333', '2087880061', NULL, '507 S Main St', 'Hailey', 'Blaine', 'ID', '83333', '2087880061', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013137850', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820531151', 'W12005402', 'W12005402', 'Sinclair', '(Sinclair Health Services\rProvider) Boulder Mountain PT & Sports Rehab', 'Mark ', 'E', 'Morgan', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1191', 'Hailey', 'Blaine', 'ID', '83333', '2087880061', NULL, 'PO Box 1191', 'Hailey', 'Blaine', 'ID', '83333', '2087880061', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013137850', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860679535', 'W12005404', 'W12005404', 'Sinclair', '(Sinclair Health Services\rProvider) DeRosa Physical Therapy ', 'Carriee ', '', 'Thompsen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1485 N Turquoise Dr Ste 220', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287746626', NULL, '1485 N Turquoise Dr Ste 220', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287746626', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225149974', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12005461', 'W12005461', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005463', 'W12005463', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', NULL, '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005459', 'W12005459', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005458', 'W12005458', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005455', 'W12005455', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005460', 'W12005460', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005462', 'W12005462', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005456', 'W12005456', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005453', 'W12005453', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005464', 'W12005464', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Debra ', 'L', 'Griner', 'FNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1861460289', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005465', 'W12005465', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Debra ', 'L', 'Griner', 'FNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1861460289', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005472', 'W12005472', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', NULL, '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005469', 'W12005469', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', NULL, '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005468', 'W12005468', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005476', 'W12005476', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005478', 'W12005478', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', NULL, '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005474', 'W12005474', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005473', 'W12005473', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005470', 'W12005470', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005475', 'W12005475', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005477', 'W12005477', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005471', 'W12005471', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005480', 'W12005480', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005481', 'W12005481', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005487', 'W12005487', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', NULL, '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005493', 'W12005493', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', NULL, '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005483', 'W12005483', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005484', 'W12005484', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005491', 'W12005491', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005489', 'W12005489', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005488', 'W12005488', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005485', 'W12005485', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005490', 'W12005490', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005492', 'W12005492', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005486', 'W12005486', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005482', 'W12005482', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005553', 'W12005553', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', NULL, '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', 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
('830238247', 'W12005554', 'W12005554', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', NULL, '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005496', 'W12005496', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005497', 'W12005497', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005557', 'W12005557', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005559', 'W12005559', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', NULL, '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005555', 'W12005555', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005551', 'W12005551', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005556', 'W12005556', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005558', 'W12005558', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005552', 'W12005552', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005495', 'W12005495', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005565', 'W12005565', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', NULL, '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005571', 'W12005571', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', NULL, '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005561', 'W12005561', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005562', 'W12005562', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-11-01', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005569', 'W12005569', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005567', 'W12005567', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005566', 'W12005566', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005563', 'W12005563', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005568', 'W12005568', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005570', 'W12005570', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12042351', 'W12042351', 'WY01', 'Community Health Center of Central Wyoming', 'Travis', '', 'Scoresby', 'PA', 'Internal Medicine', '', '', NULL, 'O', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003067594', 0, 'N', 1, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005564', 'W12005564', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005560', 'W12005560', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005575', 'W12005575', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Arianne ', 'E', 'Staffileno', 'FNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1184677023', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005573', 'W12005573', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Arianne ', 'E', 'Staffileno', 'FNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1184677023', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005581', 'W12005581', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', NULL, '111 S Fifth St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005583', 'W12005583', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', NULL, '1124 Washington Blvd', 'Newcastle', 'Weston', 'WY', '82701', '3077462793', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005577', 'W12005577', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005578', 'W12005578', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', NULL, '1233 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2010-10-27', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005586', 'W12005586', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005588', 'W12005588', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', NULL, '150 E Arapahoe', 'Meeteetse', 'Park', 'WY', '82433', '3078643121', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005584', 'W12005584', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005582', 'W12005582', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573400', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005579', 'W12005579', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', NULL, '2221 E Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005585', 'W12005585', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', NULL, '400 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073473221', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005587', 'W12005587', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076845521', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005580', 'W12005580', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076828811', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12005576', 'W12005576', 'Sinclair', 'Wyoming Cardiopulmonary Services', 'Allan ', 'B', 'Wicks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', NULL, 'PO Box 51230', 'Casper', 'Natrona', 'WY', '82605', '3075772222', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1497792402', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('860744315', 'W12005589', 'W12005589', 'Sinclair', 'A Womans Place', 'Cherrie ', '', 'Andersen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', NULL, '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672089', 0, 'N', 0, '2010-11-02', NULL, NULL, 0, 0, NULL, NULL),
('860744315', 'W12005590', 'W12005590', 'Sinclair', '(Sinclair Health Services\rProvider) A Womans Place', 'Linda ', '', 'Nassif', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', NULL, '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672006', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860744315', 'W12005591', 'W12005591', 'Sinclair', 'A Womans Place', 'Mike ', '', 'Nowak', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', NULL, '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558360131', 0, 'N', 1, '2013-02-05', NULL, NULL, 0, 0, NULL, NULL),
('860979580', 'W12005592', 'W12005592', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Pediatric Care', 'Glen ', '', 'Austin', 'DO', 'Pediatrics', '', '', NULL, 'O', '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', NULL, '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528155082', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860979580', 'W12005593', 'W12005593', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Pediatric Care', 'Karl ', '', 'Baumgartner', 'MD', 'Pediatrics', '', '', NULL, 'O', '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', NULL, '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174522890', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860979580', 'W12005594', 'W12005594', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Pediatric Care', 'Lauren ', '', 'Stuart', 'MD', 'Pediatrics', '', '', NULL, 'O', '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', NULL, '107 E Oak Ave Ste 101', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741811', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578555843', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12005598', 'W12005598', 'Sinclair', 'Wyoming Surgical Associates', 'James', '', 'Anderson', 'MD', 'Colon and Rectal Surgery', 'General Surgery', 'Vascular Surgery', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', NULL, '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2012-06-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1205822442', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12005596', 'W12005596', 'Sinclair', 'Wyoming Surgical Associates', 'Lane ', '', 'Smothers', 'MD', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', NULL, '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-06-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1043206485', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12005597', 'W12005597', 'Sinclair', 'Wyoming Surgical Associates', 'Todd', '', 'Beckstead', 'MD', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', NULL, '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-06-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1336135763', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005599', 'W12005599', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Mary ', 'A', 'Berger', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356333165', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005600', 'W12005600', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Barbara ', '', 'Bosch', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053303321', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005601', 'W12005601', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Amy ', '', 'DeLava', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912976879', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005602', 'W12005602', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Sheila ', '', 'Mackell', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629060439', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005603', 'W12005603', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Lee ', '', 'McGarey', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1093707804', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005604', 'W12005604', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Paula ', '', 'Rand', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912999582', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005605', 'W12005605', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Ron ', '', 'Tuckman', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184616997', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860718949', 'W12005606', 'W12005606', 'Sinclair', '(Sinclair Health Services\rProvider) Mountain View Pediatrics', 'Laurie ', '', 'Brown', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', NULL, '77 W Forest Ave Ste 304', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282143600', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932191509', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005607', 'W12005607', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Don ', '', 'Berlyn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', NULL, '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124029541', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005608', 'W12005608', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Don ', '', 'Berlyn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285560776', NULL, '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285560776', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124029541', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005609', 'W12005609', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Dan ', '', 'Chitwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', NULL, '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144413667', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860961347', 'W12005610', 'W12005610', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Perry ', 'Y', 'Lin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 W Forest Ave Ste 203', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282136303', NULL, '77 W Forest Ave Ste 203', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282136303', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356342943', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005612', 'W12005612', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Beverly ', '', 'Pishkur', 'PT', 'Physical Therapy', '', '', NULL, 'B', '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', NULL, '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972665016', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005611', 'W12005611', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Beverly ', '', 'Pishkur', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285271556', NULL, '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285271556', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972665016', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005614', 'W12005614', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Judy ', '', 'Stratton', 'PT', 'Physical Therapy', '', '', NULL, 'B', '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', NULL, '1200 W Route 66', 'Flagstaff', 'Coconino', 'AZ', '86001', '9285560776', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457417552', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860691792', 'W12005613', 'W12005613', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Judy ', '', 'Stratton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285271556', NULL, '3200 N Country Club Dr', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285271556', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457417552', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860686125', 'W12005615', 'W12005615', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Orthopedic Physical Therapy', 'Candy ', '', 'Boyle', 'PT', 'Physical Therapy', '', '', NULL, 'O', '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', NULL, '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740466721', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860686125', 'W12005616', 'W12005616', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Orthopedic Physical Therapy', 'Laurie ', '', 'Majestic', 'PT', 'Physical Therapy', '', '', NULL, 'O', '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', NULL, '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184898678', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860484857', 'W12005617', 'W12005617', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Podiatry', 'Kelly ', '', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962403311', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860484857', 'W12005618', 'W12005618', 'Sinclair', 'Northern Arizona Podiatry', 'Travis ', '', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952436446', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860686125', 'W12005619', 'W12005619', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Orthopedic Physical Therapy', 'Mari ', '', 'Dieckman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', NULL, '940 N Switzer Canyon Dr Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225185366', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12005620', 'W12005620', 'Sinclair', 'Central Wyoming Urological Assoc', 'James', '', 'Haden', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', NULL, '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2011-07-31', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1578679809', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12005621', 'W12005621', 'Sinclair', 'Central Wyoming Urological Assoc', 'Todd ', '', 'Hansen', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', NULL, '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2011-07-31', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1245293455', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12005622', 'W12005622', 'Sinclair', 'Central Wyoming Urological Assoc', 'J Paul', '', 'Jones', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', NULL, '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2011-07-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1275592024', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12005623', 'W12005623', 'Sinclair', 'Central Wyoming Urological Assoc (Sinclair Health Services Provider)', 'G David', '', 'Munday', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', NULL, '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108432', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12005624', 'W12005624', 'Sinclair', 'Central Wyoming Urological Assoc (Sinclair Health Services Provider)', 'Chad ', '', 'Sundquist', 'PA-C', 'Urology', '', '', NULL, 'O', '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', NULL, '1416 E A St', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2011-07-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1023199221', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('200545191', 'W12005625', 'W12005625', 'Sinclair', '(Sinclair Health Services\rProvider) Alpha & Omega Physical Therapy', 'Paul ', 'M', 'Larsen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', NULL, '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477525681', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('200545191', 'W12005626', 'W12005626', 'Sinclair', '(Sinclair Health Services\rProvider) Alpha & Omega Physical Therapy', 'Rachelle ', '', 'Plumb', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', NULL, '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063726370', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('200545191', 'W12005627', 'W12005627', 'Sinclair', '(Sinclair Health Services\rProvider) Alpha & Omega Physical Therapy', 'Michael ', '', 'Simon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', NULL, '2510 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9285220364', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811128614', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('201171314', 'W12005628', 'W12005628', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Marcelyn ', 'Ann', 'LePique', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '513 N Beaver St Ste 2', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282269292', NULL, '513 N Beaver St Ste 2', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282269292', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114929783', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830320797', 'W12005629', 'W12005629', 'Sinclair', 'Rock Springs IV Center (Sinclair Health Services Provider)', '', '', 'Rock Springs IV Center', 'Group', 'Infusion Agency', '', '', NULL, 'O', '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', NULL, '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332970', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('201080063', 'W12005631', 'W12005631', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Howard ', '', 'Schneider', 'MD', 'Rheumatology', 'Internal Medicine', '', NULL, 'O', '1331 Prairie Ave Ste 2', 'Cheyenne', 'Laramie', 'WY', '82009', '3076321957', NULL, '1331 Prairie Ave Ste 2', 'Cheyenne', 'Laramie', 'WY', '82009', '3076321957', '          ', 'WYSINCLAIR1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629188552', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12005633', 'W12005633', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone & Joint', 'Ariel ', '', 'Coffey', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', '9282142837', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', '9282142837', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225341118', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005637', 'W12005637', 'WYBILLINGS', 'Billings Clinic- Cardiology', 'Fredrick', 'J.', 'Barry', '', 'Cardiovascular Disease', '', '', NULL, '', 'Change', 'Billings', 'Yellowstone', 'MT', '59101', '          ', '          ', 'Change', 'Billings', 'Yellowstone', 'MT', '59101', '          ', '          ', '', '', '', '0.00', '17.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1285601740', 0, 'N', 1, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005661', 'W12005661', 'WYBILLINGS', 'Billings Clinic - Orthopedics & Sports Medicine', 'Laura', '', 'Cahill', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066573782', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066573782', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235442666', 0, 'N', 0, '2010-10-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005662', 'W12005662', 'WYBILLINGS', 'Billings Clinic - West End', 'Jessica', '', 'Cozzens', 'MD', 'Family Practice', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2010-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164633327', 0, 'N', 0, '2010-10-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12038598', 'W12038598', 'WYBILLINGS', 'Billings Clinic - Cancer Center', 'Marshall', '', 'Dressel', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-09-27', '2013-09-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629176680', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005663', 'W12005663', 'WYBILLINGS', 'Billings Clinic  - Hospitalist', 'Mary', 'M', 'Foote', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073826988', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12038376', 'W12038376', 'WYBILLINGS', 'Billings Clinic ', 'Robert', 'B.', 'Geller', '', 'Oncology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-10-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1861673121', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005664', 'W12005664', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Donald', '', 'Jenny', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-05', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568402097', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005665', 'W12005665', 'WYBILLINGS', 'Billings Clinic - ENT', 'Donald', 'L', 'Roberts', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1558493239', 0, 'N', 0, '2010-10-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005666', 'W12005666', 'WYBILLINGS', 'Billings Clinic Onc/Hem', 'Donald', '', 'Twito', 'MD', 'Oncology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '', '', '', '0.00', '17.00', '0.00', 3, '2010-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356499792', 0, 'N', 0, '2010-10-25', NULL, NULL, 0, 0, NULL, NULL),
('264696078', 'W12005667', 'W12005667', 'UT01', 'Mt Springs Family Medicine', 'Randy', 'R', 'Lundell', 'DO', 'Family Practice', '', '', NULL, 'O', '468 S Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', NULL, '468 S Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, NULL, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1336239888', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.1032, -111.655, 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
('870648457', 'W12005750', 'W12005750', 'UT01', 'University Health Care', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12005669', 'W12005669', 'UT01', 'Standard Optical', 'David', 'K', 'Morrill', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8015729280', NULL, '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8015729280', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528085016', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12005668', 'W12005668', 'UT01', 'Standard Optical', 'David', 'K', 'Morrill', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', NULL, '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528085016', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.5806, -111.868, NULL, NULL),
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('208759533', 'W12005640', 'W12005640', 'SINCLAIRDEN', 'Horizon Dental Group', 'Mark', '', 'Costes', '', 'Dentist', '', '', NULL, 'O', '518 N Beaver Ste 12', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', '9282139665', '518 N Beaver Ste 12', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', '9282139665', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004025', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('860881657', 'W12005642', 'W12005642', 'SINCLAIRDEN', 'Mountain Dental Center', 'Jefrey', '', 'Abramowitz', '', 'Dentist', '', '', NULL, 'O', '3013 N W St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287745266', '9287745845', '3013 N W St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287745266', '9287745845', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004026', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('272556490', 'W12005647', 'W12005647', 'SINCLAIRDEN', 'Timberline Dental', 'Brandon', '', 'Tilts', '', 'Dentist', '', '', NULL, 'O', '518 N Beaver St Ste N', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', NULL, '518 N Beaver St Ste N', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', '          ', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2009-03-24', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004028', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('272556490', 'W12005644', 'W12005644', 'SINCLAIRDEN', 'Timberline Dental', 'Dawn', '', 'Tilts', '', 'Dentist', '', '', NULL, 'O', '518 N Beaver St Ste N', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', NULL, '518 N Beaver St Ste N', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744705', '          ', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2009-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004027', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('861009608', 'W12005649', 'W12005649', 'SINCLAIRDEN', '', 'Scott', '', 'Darlington', '', 'Dentist', '', '', NULL, 'O', '710 N Beaver St Ste 5', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744726', '9282149204', '710 N Beaver St Ste 5', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744726', '9282149204', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2008-10-27', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004029', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('727543146', 'W12005651', 'W12005651', 'SINCLAIRDEN', '', 'Douglas', '', 'Law', '', 'Dentist', '', '', NULL, 'O', '1100 N San Francisco St Ste D', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287745050', '9287741339', '1100 N San Francisco St Ste D', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287745050', '9287741339', 'AZ000E', '', '', '0.00', '100.00', '0.00', 8, '2009-07-27', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '0000004030', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('061831308', 'W12005655', 'W12005655', 'SINCLAIRDEN', 'Flagstaff Family Dental Center', 'Ralph', '', 'Umali', '', 'Dentist', '', '', NULL, 'O', '2615 N 4th S Ste 6', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287744761', NULL, '2615 N 4th S Ste 6', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287744761', '          ', 'AZ000A', '', '', '0.00', '100.00', '0.00', 8, '1955-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004032', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('202024769', 'W12005657', 'W12005657', 'SINCLAIRDEN', '', 'David', '', 'Oldroyd', '', 'Dentist', '', '', NULL, 'O', '2532 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287149019', '9285264918', '2532 E 7th Ave', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287149019', '9285264918', 'AZ000B', '', '', '0.00', '100.00', '0.00', 8, '1955-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004033', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('205921864', 'W12005659', 'W12005659', 'SINCLAIRDEN', 'Aesthetic Dentistry', 'D Dennis', '', 'Moshos', '', 'Dentist', '', '', NULL, 'O', '1415 N Beaver St', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741170', '9287741169', '1415 N Beaver St', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287741170', '9287741169', 'AZ000C', '', '', '0.00', '20.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004034', 0, 'Y', 0, '2010-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W12005749', 'W12005749', 'UT01', 'University Health Care', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('870410144', 'W12005748', 'W12005748', 'UT01', 'University Health Care', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870410144', 'W12005747', 'W12005747', 'UT01', 'University Health Care', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012132995', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012132995', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870410144', 'W12005746', 'W12005746', 'UT01', 'University of Utah Hospital Dept of Ob/Gyn', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL);
