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
('621801973', 'W12029633', 'W12029633', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12029634', 'W12029634', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12029636', 'W12029636', 'TXHOUSTD', 'Houston Eye Associates', 'Allan', 'H', 'Fradkin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447258918', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.4951, -95.1089, NULL, NULL),
('760512625', 'W12029635', 'W12029635', 'TXHOUSTD', 'Houston Eye Associates', 'Allan', 'H', 'Fradkin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447258918', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.2921, -94.7893, NULL, NULL),
('363977608', 'W12030693', 'W12030693', 'ILCHIGSTD', 'Northwest Pediatric Services', 'Yesha', 'N', 'Modi', 'MD', 'Pediatrics', '', '', NULL, 'O', '1715 Algonquin Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8477258110', '8477258115', '1715 Algonquin Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8477258110', '8477258115', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053573972', 0, 'Y', 0, '2013-09-06', NULL, NULL, 42.0363, -87.9622, NULL, NULL),
('870286381', 'W12029638', 'W12029638', 'UT01', 'Ogden Clinic', 'Eric', 'F', 'Stakebake', 'PA-C', 'Neurology', '', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753202', '8014753209', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753202', '8014753209', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619215738', 0, 'N', 0, '2013-02-13', NULL, NULL, 41.1523, -111.94, NULL, NULL),
('870286381', 'W12029639', 'W12029639', 'UT01', 'Ogden Clinic', 'Eric', 'F', 'Stakebake', 'PA-C', 'Neurology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619215738', 0, 'N', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029640', 'W12029640', 'UT01', 'Central Utah Clinic PC', 'Randy', '', 'Clark', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '965 S Main St Ste A', 'Cedar City', 'Iron', 'UT', '84720', '4356289393', '4356289382', '965 S Main St Ste A', 'Cedar City', 'Iron', 'UT', '84720', '4356289393', '4356289382', 'WCUC', 'WUSTDHCPC', '', '0.00', '35.00', '0.00', 3, '2013-01-28', '2013-01-28', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679781140', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029641', 'W12029641', 'UT01', 'Central Utah Clinic PC', 'Randy', '', 'Clark', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4356289393', '4356289382', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4356289393', '4356289382', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-28', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679781140', 0, 'N', 0, '2013-10-24', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('760512625', 'W12029642', 'W12029642', 'TXHOUSTD', 'Houston Eye Associates', 'Da Thuy', '', 'Van', 'DO', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750375580', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.2921, -94.7893, NULL, NULL),
('760512625', 'W12029643', 'W12029643', 'TXHOUSTD', 'Houston Eye Associates', 'Da Thuy', '', 'Van', 'DO', 'Ophthalmology', '', '', NULL, 'O', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750375580', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.4951, -95.1089, NULL, NULL),
('760512625', 'W12029644', 'W12029644', 'TXHOUSTD', 'Houston Eye Associates', 'Da Thuy', '', 'Van', 'DO', 'Ophthalmology', '', '', NULL, 'O', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', '7111 Medical Center Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750375580', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.3964, -94.9775, NULL, NULL),
('760512625', 'W12029647', 'W12029647', 'TXHOUSTD', 'Houston Eye Associates', 'Stefan', 'D', 'Trocme', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', '2013-03-05', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1821157199', 0, 'N', 0, '2014-05-27', NULL, NULL, 29.3964, -94.9775, NULL, NULL),
('760512625', 'W12029645', 'W12029645', 'TXHOUSTD', 'Houston Eye Associates', 'Stefan', 'D', 'Trocme', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', '2013-03-05', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1821157199', 0, 'N', 0, '2014-05-27', NULL, NULL, 29.2921, -94.7893, NULL, NULL),
('760512625', 'W12029646', 'W12029646', 'TXHOUSTD', 'Houston Eye Associates', 'Stefan', 'D', 'Trocme', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', '2013-03-05', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1821157199', 0, 'N', 0, '2014-05-27', NULL, NULL, 29.4951, -95.1089, NULL, NULL),
('760512625', 'W12029649', 'W12029649', 'TXHOUSTD', 'Houston Eye Associates', 'Bernard', 'A', 'Milstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932107497', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.4951, -95.1089, NULL, NULL),
('760512625', 'W12029648', 'W12029648', 'TXHOUSTD', 'Houston Eye Associates', 'Bernard', 'A', 'Milstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932107497', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.2921, -94.7893, NULL, NULL),
('760512625', 'W12029650', 'W12029650', 'TXHOUSTD', 'Houston Eye Associates', 'Bernard', 'A', 'Milstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-05', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932107497', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.3964, -94.9775, NULL, NULL),
('952667855', 'W12029655', 'W12029655', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Prosthetics & Orthotics Inc', '', 'Durable Medical Equipment', '', '', NULL, 'O', '715 Martin Luther King Jr Blvd Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052249632', '5052242718', '715 Martin Luther King Jr Blvd Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052249632', '5052242718', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2012-10-17', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831229145', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'W12029668', 'W12029668', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', 'Durable Medical Equipment', '', '', NULL, 'O', '4824 McMahon Blvd Ste 112', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058986856', '5058996801', '4824 McMahon Blvd Ste 112', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058986856', '5058996801', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2012-10-17', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225102114', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12029657', 'W12029657', 'ILCHIGSTD', 'UroPartners', 'Neil', '', 'Mehta', 'MD', 'Radiology', '', '', NULL, 'M', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '3124772390', '3124772391', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '3124772390', '3124772391', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588605695', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12029656', 'W12029656', 'ILCHIGSTD', 'UroPartners', 'Neil', '', 'Mehta', 'MD', 'Radiology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3124772390', '3124772391', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3124772390', '3124772391', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588605695', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12029658', 'W12029658', 'ILCHIGSTD', 'UroPartners', 'Neil', '', 'Mehta', 'MD', 'Radiology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3124772390', '3124772391', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3124772390', '3124772391', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588605695', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'W12029669', 'W12029669', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', 'Durable Medical Equipment', '', '', NULL, 'O', '3917 West Rd Ste 150', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5059885526', '5059894464', '3917 West Rd Ste 150', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5059885526', '5059894464', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2012-10-17', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225102114', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('742047021', 'W12029659', 'W12029659', 'TXSATSTD', 'Central Texas Allergy and Asthma', 'Priyanka', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12414 Toepperwein Rd', 'San Antonio', 'Bexar', 'TX', '78233', '8306257612', '8306279357', '12414 Toepperwein Rd', 'San Antonio', 'Bexar', 'TX', '78233', '8306257612', '8306279357', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346281839', 0, 'N', 0, '2013-01-31', NULL, NULL, 29.552, -98.3461, NULL, NULL),
('201780406', 'W12029661', 'W12029661', 'ILCHIGSTD', 'UroPartners', 'Adam', '', 'Dickler', 'MD', 'Radiology', '', '', NULL, 'M', '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '          ', NULL, '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '          ', '          ', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387274', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12029660', 'W12029660', 'ILCHIGSTD', 'UroPartners', 'Adam', '', 'Dickler', 'MD', 'Radiology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3124772390', '3124772391', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3124772390', '3124772391', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387274', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12029662', 'W12029662', 'ILCHIGSTD', 'UroPartners', 'Adam', '', 'Dickler', 'MD', 'Radiology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-06', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387274', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12029663', 'W12029663', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Virginia', 'J', 'Homewood', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB', '1003072216', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12029664', 'W12029664', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Virginia', 'J', 'Homewood', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB', '1003072216', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W40016149', 'W40016149', 'UTMH1', 'Northeastern Counseling Center', 'Christi', 'M', 'Harris', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821173394', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12043352', 'W12043352', 'UT01', 'Central Utah Clinic PC', 'Benjamin', 'S', 'Crouch', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1336302546', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12043350', 'W12043350', 'UT01', 'Central Utah Clinic PC', 'Benjamin', 'S', 'Crouch', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8014659534', '8014658898', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8014659534', '8014658898', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1336302546', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12043351', 'W12043351', 'UT01', 'Central Utah Clinic PC', 'Benjamin', 'S', 'Crouch', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1336302546', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('800730902', 'W12043353', 'W12043353', 'UT01', '', 'Rodney', 'S', 'Merrill', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '434 E 5350 S Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014791641', '8014768538', '434 E 5350 S Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014791641', '8014768538', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-07', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265591697', 0, 'N', 0, '2014-01-16', NULL, NULL, 41.166, -111.97, NULL, NULL),
('300038860', 'W12043354', 'W12043354', 'TXHOUSTD', 'Lone Star Family Health Center', '', '', 'Lone Star Community Health Center Inc', '', 'Clinics', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326045774', 0, 'Y', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043355', 'W12043355', 'TXHOUSTD', 'Lone Star Family Health Center', 'Marwan', 'M', 'Al Khudhair', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1245466762', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043356', 'W12043356', 'TXHOUSTD', 'Lone Star Family Health Center', 'Kenneth', 'G', 'Davis', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1639265010', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043357', 'W12043357', 'TXHOUSTD', 'Lone Star Family Health Center', 'Yvette', 'F', 'Gordon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1326032897', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043358', 'W12043358', 'TXHOUSTD', 'Lone Star Family Health Center', 'Adel', 'A', 'Ibrahim', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1942466825', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043359', 'W12043359', 'TXHOUSTD', 'Lone Star Family Health Center', 'Lata', '', 'Joshi', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1629077045', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('800703995', 'W12029708', 'W12029708', 'ID01', 'Neurostimulation Services', '', '', 'Neurostimulation Services', 'Group', 'Mental Health Facility', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083913792', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('800703995', 'W12029707', 'W12029707', 'ID01', 'Neurostimulation Services', '', '', 'Neurostimulation Services', 'Group', 'Mental Health Facility', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083913792', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.757, -111.824, NULL, NULL),
('800147447', 'W12029706', 'W12029706', 'ID01', 'University Pediatric Allergy', '', '', 'University Pediatric Allergy', '', 'Pediatric Allergy and Immunology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009901', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('800147447', 'W12029705', 'W12029705', 'ID01', 'UUHC Greenwood Health Center', '', '', 'University Pediatric Allergy', '', 'Pediatric Allergy and Immunology', '', '', NULL, 'O', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009901', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.6152, -111.891, NULL, NULL),
('800147425', 'W12029704', 'W12029704', 'ID01', 'Pediatric Behavioral Health', '', '', 'Pediatric Behavioral Health', 'GROUP', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '8015853655', '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008106', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('260553931', 'W12029699', 'W12029699', 'IDBOISTD', '', '', '', 'Saint Alphonsus Specialty Services Inc', 'GROUP', '', '', '', NULL, 'O', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884600', '2083677092', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884600', '2083677092', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1093040479', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('260553931', 'W12029698', 'W12029698', 'IDBOISTD', '', '', '', 'Saint Alphonsus Specialty Services Inc', 'GROUP', '', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1093040479', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('260553931', 'W12029697', 'W12029697', 'IDBOISTD', '', '', '', 'Saint Alphonsus Specialty Services Inc', 'GROUP', '', '', '', NULL, 'O', '1603 E 12th Ave Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 E 12th Ave Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1093040479', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5531, -116.573, NULL, NULL),
('800765107', 'W12029709', 'W12029709', 'ID01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('800765107', 'W12029710', 'W12029710', 'ID01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('830458867', 'W12029711', 'W12029711', 'ID01', 'University Primary Care Sports Med', '', '', 'University Primary Care Sports Med', '', 'Sports Medicine', '', '', NULL, 'O', '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014130250', NULL, '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014130250', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699796706', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7233, -111.857, NULL, NULL),
('830458867', 'W12029712', 'W12029712', 'ID01', 'University Primary Care Sports Med', '', '', 'University Primary Care Sports Med', '', 'Sports Medicine', '', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699796706', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('861168471', 'W12029713', 'W12029713', 'ID01', 'U of U Palliative Care', '', '', 'U of U Palliative Care', 'GROUP', 'Internal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009244', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870442755', 'W12029714', 'W12029714', 'ID01', 'U-U Pulmonary Division', '', '', 'U-U Pulmonary Division', 'GROUP', 'Pulmonary', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009385', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870443046', 'W12029715', 'W12029715', 'ID01', 'U of U Medical Center - Psychiatry', '', '', 'U of U Medical Center - Psychiatry', 'GROUP', 'Mental Health', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009236', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870443152', 'W12029716', 'W12029716', 'ID01', 'U-U Endocrinology Division', '', '', 'U-U Endocrinology Division', 'GROUP', 'Endocrinology', NULL, NULL, NULL, 'O', '615 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817763', NULL, '615 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817763', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009376', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7552, -111.827, NULL, NULL),
('870446589', 'W12029717', 'W12029717', 'ID01', 'University Health Care', '', '', 'U-U Alcohol & Drug Clinic School of Medicine', 'Group', 'Clinics', '', '', NULL, 'O', '30 N 1900 E Ste 1B620 SoM', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816228', NULL, '30 N 1900 E Ste 1B620 SoM', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816228', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245371699', 0, 'N', 0, '2013-02-05', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870446589', 'W12029718', 'W12029718', 'ID01', 'U-U Alcohol & Drug Clinic School of Medicine', '', '', 'U-U Alcohol & Drug Clinic School of Medicine', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245371699', 0, 'N', 0, '2013-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12029719', 'W12029719', 'ID01', 'U-U Gastroenterology Division', '', '', 'U-U Gastroenterology Division', 'GROUP', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009377', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870453678', 'W12029720', 'W12029720', 'ID01', 'U-U Rheumatology Division', '', '', 'U-U Rheumatology Division', 'GROUP', 'Rheumatology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817724', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817724', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009387', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870460977', 'W12029721', 'W12029721', 'ID01', 'U-U Non-Invasive Vascular Lab', '', '', 'U-U Non-Invasive Vascular Lab', 'GROUP', 'Vascular Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812082', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812082', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009382', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('362476058', 'EDIN00064', 'EDIN00064', 'ILCHIGSTD', '', 'Michael', '', 'Flais', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', NULL, '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003899808', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362476058', 'EDIN00063', 'EDIN00063', 'ILCHIGSTD', 'Associated Allergists', 'Michael', '', 'Flais', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003899808', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5302, -87.6976, NULL, NULL),
('362660922', 'EDIN00143', 'EDIN00143', 'ILCHIGSTD', '', 'Bruce', 'A', 'Parisi', 'MD', 'Family Practice', '', '', NULL, 'B', '1851 Sibley Blvd', 'Calumet City', 'Cook', 'IL', '60409', '', NULL, '1851 Sibley Blvd', 'Calumet City', 'Cook', 'IL', '60409', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1003911009', 0, 'Y', 0, '2013-07-03', NULL, NULL, 41.6225, -87.5702, NULL, NULL),
('362660922', 'EDIN00142', 'EDIN00142', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Bruce', 'A', 'Parisi', 'MD', 'Family Practice', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7082063860', '7088681168', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7082063860', '7088681168', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1003911009', 0, 'N', 0, '2013-07-03', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('260010422', 'EDIN00021', 'EDIN00021', 'ILCHIGSTD', 'Midwest Internists of Illinois', 'Harish', '', 'Bhatia', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6300 W 159th St Ste C', 'Oak Forest', 'Cook', 'IL', '60452', '7085353300', '7083104393', '6300 W 159th St Ste C', 'Oak Forest', 'Cook', 'IL', '60452', '7085353300', '7083104393', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1003996794', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6027, -87.7736, NULL, NULL),
('260010422', 'EDIN00023', 'EDIN00023', 'ILCHIGSTD', '', 'Harish', '', 'Bhatia', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 327', 'Oak Forest', 'Cook', 'IL', '60452', '', NULL, 'PO Box 327', 'Oak Forest', 'Cook', 'IL', '60452', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1003996794', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364385192', 'EDIN00130', 'EDIN00130', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Paul', '', 'Ngumi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013185693', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('363028121', 'EDIN00090', 'EDIN00090', 'ILCHIGSTD', 'JT Iwanetz MD SC', 'Bohdan', 'Askold', 'Iwanetz', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 167th St Ste 150', 'Calumet City', 'Cook', 'IL', '60409', '7089336578', '7089336577', '1600 167th St Ste 150', 'Calumet City', 'Cook', 'IL', '60409', '7089336578', '7089336577', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013916089', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5954, -87.5609, NULL, NULL),
('363028121', 'EDIN00091', 'EDIN00091', 'ILCHIGSTD', '', 'Bohdan', 'Askold', 'Iwanetz', 'MD', 'General Surgery', '', '', NULL, 'B', '713 E 142nd St', 'Dolton', 'Cook', 'IL', '60419', '', NULL, '713 E 142nd St', 'Dolton', 'Cook', 'IL', '60419', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013916089', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363746106', 'EDIN00048', 'EDIN00048', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Carl', 'P', 'Di Lella', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1033201058', 0, 'N', 0, '2013-03-30', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('362970624', 'EDIN00136', 'EDIN00136', 'ILCHIGSTD', 'Illinois Retina Associates', 'David', '', 'Orth', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043210750', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363769553', 'EDIN00165', 'EDIN00165', 'ILCHIGSTD', 'Surgical Care Associates', 'Michael', '', 'Romberg', 'MD', 'General Surgery', '', '', NULL, 'O', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7083315987', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7083315987', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043217078', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364295605', 'EDIN00126', 'EDIN00126', 'ILCHIGSTD', 'Asad Zaman MD SC', 'Sandhya', '', 'Nagubadi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6700 W 167th St Ste 4', 'Tinley Park', 'Cook', 'IL', '60477', '7084293700', '7084294460', '6700 W 167th St Ste 4', 'Tinley Park', 'Cook', 'IL', '60477', '7084293700', '7084294460', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043262207', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5879, -87.7828, NULL, NULL),
('364295605', 'EDIN00127', 'EDIN00127', 'ILCHIGSTD', '', 'Sandhya', '', 'Nagubadi', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 880', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '7084294460', 'PO Box 880', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '7084294460', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043262207', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363739422', 'EDIN00068', 'EDIN00068', 'ILCHIGSTD', 'Neurology Associates', 'Tonya', '', 'Fuller', 'MD', 'Neurology', '', '', NULL, 'O', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043304611', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364364574', 'EDIN00097', 'EDIN00097', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Vivek', '', 'Kaistha', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6703 W 159th St Ste 103', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423060', '6703 W 159th St Ste 103', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053311407', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('363104024', 'EDIN00194', 'EDIN00194', 'ILCHIGSTD', 'Agop Tepeli MD', 'Agop', '', 'Tepeli', 'MD', 'Pulmonary', '', '', NULL, 'O', '17850 S Kedzie Ave Ste 3300', 'Hazel Crest', 'Cook', 'IL', '60429', '7087996055', '7087999931', '17850 S Kedzie Ave Ste 3300', 'Hazel Crest', 'Cook', 'IL', '60429', '7087996055', '7087999931', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1053397513', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5654, -87.6944, NULL, NULL),
('362939074', 'EDIN00115', 'EDIN00115', 'ILCHIGSTD', 'David C Lee MD', 'David', '', 'Lee', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5320 W 159th St Ste 302', 'Oak Forest', 'Cook', 'IL', '60452', '7086876440', '7086879311', '5320 W 159th St Ste 302', 'Oak Forest', 'Cook', 'IL', '60452', '7086876440', '7086879311', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1083641849', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6031, -87.7493, NULL, NULL),
('364385192', 'EDIN00082', 'EDIN00082', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Ernest', '', 'Hayes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083776678', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('200310589', 'EDIN00028', 'EDIN00028', 'ILCHIGSTD', 'Performance Foot and Ankle Center', 'Dale', '', 'Brink', 'DPM', 'Podiatry', '', '', NULL, 'O', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093722365', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6008, -87.6073, NULL, NULL),
('364346917', 'EDIN00179', 'EDIN00179', 'ILCHIGSTD', 'Family Christian Health Center', 'Sharonda', '', 'Shaw Berrocal', 'DO', 'Family Practice', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093855736', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('362476058', 'EDIN00062', 'EDIN00062', 'ILCHIGSTD', 'Associated Allergists', 'Richard', '', 'Fitzsimmons', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1104809227', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5302, -87.6976, NULL, NULL),
('362970624', 'EDIN00123', 'EDIN00123', 'ILCHIGSTD', 'Illinois Retina Associates', 'Pauline', '', 'Merrill', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1104826841', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('200310589', 'EDIN00112', 'EDIN00112', 'ILCHIGSTD', 'Performance Foot and Ankle Center', 'Timothy', '', 'Krygsheld', 'DPM', 'Podiatry', '', '', NULL, 'O', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104833292', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6008, -87.6073, NULL, NULL),
('364346917', 'EDIN00049', 'EDIN00049', 'ILCHIGSTD', 'Family Christian Health Center', 'Shelly', '', 'Dixon', 'MD', 'Pediatrics', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104863380', 0, 'N', 0, '2013-11-15', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('364346917', 'EDIN00050', 'EDIN00050', 'ILCHIGSTD', '', 'Shelly', '', 'Dixon', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 789', 'Matteson', 'Cook', 'IL', '60443', '', NULL, 'PO Box 789', 'Matteson', 'Cook', 'IL', '60443', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104863380', 0, 'Y', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('363746106', 'EDIN00197', 'EDIN00197', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Joseph', '', 'Thometz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1114915063', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, 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
('364132865', 'EDIN00098', 'EDIN00098', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Mary', '', 'Kanashiro', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16532 S Oak Park Ave Ste 200', 'Tinley Park', 'Cook', 'IL', '60477', '7085321104', '7085325539', '16532 S Oak Park Ave Ste 200', 'Tinley Park', 'Cook', 'IL', '60477', '7085321104', '7085325539', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114949211', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.7849, NULL, NULL),
('364132865', 'EDIN00099', 'EDIN00099', 'ILCHIGSTD', '', 'Mary', '', 'Kanashiro', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 430', 'Flossmoor', 'Cook', 'IL', '60422', '7085326132', NULL, 'PO Box 430', 'Flossmoor', 'Cook', 'IL', '60422', '7085326132', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114949211', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364346917', 'EDIN00076', 'EDIN00076', 'ILCHIGSTD', 'Family Christian Health Center', 'Lisa', '', 'Green', 'DO', 'Family Practice', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085965177', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085965177', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114973062', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('362660922', 'EDIN00227', 'EDIN00227', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Daniel', '', 'Yohay', 'MD', 'Nephrology', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1124123302', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00229', 'EDIN00229', 'ILCHIGSTD', '', 'Daniel', '', 'Yohay', 'MD', 'Nephrology', '', '', NULL, 'B', '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1124123302', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('362878285', 'EDIN00105', 'EDIN00105', 'ILCHIGSTD', 'Monroe Medical Associates', 'Mark', '', 'Kozloff', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '7083394814', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '7083394814', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134166879', 0, 'N', 0, '2013-02-01', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('362878285', 'EDIN00106', 'EDIN00106', 'ILCHIGSTD', '', 'Mark', '', 'Kozloff', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 3419', 'Munster', 'Lake', 'IN', '46321', '', NULL, 'PO Box 3419', 'Munster', 'Lake', 'IN', '46321', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134166879', 0, 'Y', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('363191463', 'EDIN00022', 'EDIN00022', 'ILCHIGSTD', 'Motilal A Bhatia MD SC', 'Motilal', 'Asanand', 'Bhatia', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17850 S Kedzie Ave Ste 2100', 'Hazel Crest', 'Cook', 'IL', '60429', '7089574011', '7089574013', '17850 S Kedzie Ave Ste 2100', 'Hazel Crest', 'Cook', 'IL', '60429', '7089574011', '7089574013', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1134211956', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5654, -87.6944, NULL, NULL),
('036104523', 'EDIN00149', 'EDIN00149', 'ILCHIGSTD', 'Surgical Care Associates', 'Gary', '', 'Peplinski', 'MD', 'General Surgery', '', '', NULL, 'O', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7083315987', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7083315987', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134280134', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363010536', 'EDIN00238', 'EDIN00238', 'ILCHIGSTD', 'Midwest Eye Center', 'Burton', '', 'Zeiger', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174516199', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('363594874', 'EDIN00002', 'EDIN00002', 'ILCHIGSTD', 'Abayomi Adeyemi MD', 'Abayomi', '', 'Adeyemi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9501 171st St', 'Tinley Park', 'Cook', 'IL', '60478', '7084034898', NULL, '9501 171st St', 'Tinley Park', 'Cook', 'IL', '60478', '7084034898', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1174523518', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5715, -87.838, NULL, NULL),
('363594874', 'EDIN00003', 'EDIN00003', 'ILCHIGSTD', '', 'Abayomi', '', 'Adeyemi', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'Dept 77 52157', 'Chicago', 'Cook', 'IL', '60678', '7087475850', NULL, 'Dept 77 52157', 'Chicago', 'Cook', 'IL', '60678', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1174523518', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('200310589', 'EDIN00221', 'EDIN00221', 'ILCHIGSTD', 'Performance Foot and Ankle Center', 'Brian', 'C', 'Wittmayer', 'DPM', 'Podiatry', '', '', NULL, 'O', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', '401 E 162nd St Ste 101', 'South Holland', 'Cook', 'IL', '60473', '7085963757', '7085963779', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174671333', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6008, -87.6073, NULL, NULL),
('208929101', 'EDIN00108', 'EDIN00108', 'ILCHIGSTD', 'Daniel T Weber MD SC', 'James', '', 'Krcik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6850 Centennial Dr', 'Tinley Park', 'Cook', 'IL', '60477', '7084293455', '7084293422', '6850 Centennial Dr', 'Tinley Park', 'Cook', 'IL', '60477', '7084293455', '7084293422', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1174790463', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5977, -87.7866, NULL, NULL),
('208929101', 'EDIN00109', 'EDIN00109', 'ILCHIGSTD', '', 'James', '', 'Krcik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 690', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 690', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1174790463', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364336908', 'EDIN00075', 'EDIN00075', 'ILCHIGSTD', 'Foot and Ankle Associates', 'John', '', 'Grady', 'DPM', 'Podiatry', '', '', NULL, 'O', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194707059', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.7247, -87.7375, NULL, NULL),
('342038120', 'EDIN00207', 'EDIN00207', 'ILCHIGSTD', 'Bhupinder K Valia MD', 'Bhupinder', '', 'Valia', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16115 LaSalle St', 'South Holland', 'Cook', 'IL', '60473', '7083318830', '7083318860', '16115 LaSalle St', 'South Holland', 'Cook', 'IL', '60473', '7083318830', '7083318860', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194724872', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6024, -87.6194, NULL, NULL),
('342038120', 'EDIN00208', 'EDIN00208', 'ILCHIGSTD', '', 'Bhupinder', '', 'Valia', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1179', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1179', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194724872', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363010536', 'EDIN00218', 'EDIN00218', 'ILCHIGSTD', 'Midwest Eye Center', 'Michael', 'R', 'Weisberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205097607', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('362970624', 'EDIN00043', 'EDIN00043', 'ILCHIGSTD', 'Illinois Retina Associates', 'Jack', 'Albert', 'Cohen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205836947', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('362715317', 'EDIN00174', 'EDIN00174', 'ILCHIGSTD', 'South Suburban Cardiology', 'Dilip', '', 'Shah', 'MD', 'Cardiology', '', '', NULL, 'O', '17901 Governors Hwy Ste 203', 'Homewood', 'Cook', 'IL', '60430', '7087990180', '7085325539', '17901 Governors Hwy Ste 203', 'Homewood', 'Cook', 'IL', '60430', '7087990180', '7085325539', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1215928676', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364132865', 'EDIN00137', 'EDIN00137', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Eyas', '', 'Othman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '71 W 156th St Ste 107', 'Harvey', 'Cook', 'IL', '60426', '7083330730', '7087980205', '71 W 156th St Ste 107', 'Harvey', 'Cook', 'IL', '60426', '7083330730', '7087980205', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215937636', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364132865', 'EDIN00138', 'EDIN00138', 'ILCHIGSTD', '', 'Eyas', '', 'Othman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215937636', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363504430', 'EDIN00188', 'EDIN00188', 'ILCHIGSTD', 'Dixie Medical Associates', 'Madhupa', '', 'Sud', 'MD', 'Pediatrics', '', '', NULL, 'O', '10743 W 159th St', 'Orland Park', 'Cook', 'IL', '60467', '7086339000', '7739953207', '10743 W 159th St', 'Orland Park', 'Cook', 'IL', '60467', '7086339000', '7739953207', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1215979729', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6008, -87.8802, NULL, NULL),
('363504430', 'EDIN00189', 'EDIN00189', 'ILCHIGSTD', '', 'Madhupa', '', 'Sud', 'MD', 'Pediatrics', '', '', NULL, 'B', '16750 S 80th Ave Ste E', 'Tinley Park', 'Cook', 'IL', '60477', '7086339000', NULL, '16750 S 80th Ave Ste E', 'Tinley Park', 'Cook', 'IL', '60477', '7086339000', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1215979729', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('050540914', 'EDIN00164', 'EDIN00164', 'ILCHIGSTD', 'Wellgroup Health Partners', 'Leonard', '', 'Robinson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225078264', 0, 'N', 0, '2013-05-17', NULL, NULL, 41.5088, -87.7317, NULL, NULL),
('061378794', 'EDIN00074', 'EDIN00074', 'ILCHIGSTD', 'Ram Gopi MD', 'Ram', '', 'Gopi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17901 Governors Hwy Ste 207', 'Homewood', 'Cook', 'IL', '60430', '7087998787', '7087998870', '17901 Governors Hwy Ste 207', 'Homewood', 'Cook', 'IL', '60430', '7087998787', '7087998870', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225109044', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364138353', 'EDIN00167', 'EDIN00167', 'ILCHIGSTD', '', 'Vibha', '', 'Sabharwal', 'MD', 'Urology', '', '', NULL, 'B', '1000 Remington Blvd Ste 200', 'Bolingbrook', 'Will', 'IL', '60440', '7087475850', NULL, '1000 Remington Blvd Ste 200', 'Bolingbrook', 'Will', 'IL', '60440', '7087475850', '          ', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1235171943', 0, 'Y', 0, '2013-05-29', NULL, NULL, 0, 0, NULL, NULL),
('364138353', 'EDIN00166', 'EDIN00166', 'ILCHIGSTD', 'Adventist Health Partners Inc', 'Vibha', '', 'Sabharwal', 'MD', 'Urology', '', '', NULL, 'O', '6703 W 159th St Ste 107', 'Tinley Park', 'Cook', 'IL', '60477', '6302261436', '6302266938', '6703 W 159th St Ste 107', 'Tinley Park', 'Cook', 'IL', '60477', '6302261436', '6302266938', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1235171943', 0, 'N', 0, '2013-05-29', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('364346917', 'EDIN00148', 'EDIN00148', 'ILCHIGSTD', 'Family Christian Health Center', 'Lisa', '', 'Peng', 'MD', 'Family Practice', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235206897', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('363739422', 'EDIN00226', 'EDIN00226', 'ILCHIGSTD', 'Neurology Associates', 'Engin', '', 'Yilmaz', 'MD', 'Neurology', '', '', NULL, 'O', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245324821', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363746106', 'EDIN00083', 'EDIN00083', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Kevin', 'M', 'Hilton', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1245348184', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('364431300', 'EDIN00092', 'EDIN00092', 'ILCHIGSTD', 'Dinesh Jain MD SC', 'Dinesh', '', 'Jain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16532 S Oak Park Ave Ste 101', 'Tinley Park', 'Cook', 'IL', '60477', '7084292220', '7083421521', '16532 S Oak Park Ave Ste 101', 'Tinley Park', 'Cook', 'IL', '60477', '7084292220', '7083421521', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1255330361', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.7849, NULL, NULL),
('363460234', 'EDIN00224', 'EDIN00224', 'ILCHIGSTD', 'Ingalls Cancer Care Center', 'Sulochana', '', 'Yalavarthi', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1 Ingalls Dr Cancer Care Ctr', 'Harvey', 'Cook', 'IL', '60426', '7089156620', '7089153782', '1 Ingalls Dr Cancer Care Ctr', 'Harvey', 'Cook', 'IL', '60426', '7089156620', '7089153782', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255331658', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6068, -87.6594, NULL, NULL),
('363460234', 'EDIN00225', 'EDIN00225', 'ILCHIGSTD', '', 'Sulochana', '', 'Yalavarthi', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255331658', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.5061, -87.774, NULL, NULL),
('362988677', 'EDIN00096', 'EDIN00096', 'ILCHIGSTD', 'South Suburban Gastroenterology', 'Robert', '', 'Kaiser', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255362000', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('363673204', 'EDIN00001', 'EDIN00001', 'ILCHIGSTD', 'Parikh and Abbasi MD SC', 'Tahir', '', 'Abbasi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17680 S Kedzie Ave Ste 206', 'Hazel Crest', 'Cook', 'IL', '60429', '7082061090', '7082061055', '17680 S Kedzie Ave Ste 206', 'Hazel Crest', 'Cook', 'IL', '60429', '7082061090', '7082061055', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1255495701', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5683, -87.6944, NULL, NULL),
('363010536', 'EDIN00209', 'EDIN00209', 'ILCHIGSTD', 'Midwest Eye Center', 'Srigurunat', '', 'Vangipuram', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265425284', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('363449544', 'EDIN00011', 'EDIN00011', 'ILCHIGSTD', 'Bharti Amin MD', 'Bharti', '', 'Amin', 'MD', 'Pediatrics', '', '', NULL, 'O', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087485910', '7087485984', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087485910', '7087485984', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265458343', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5061, -87.7288, NULL, NULL),
('364364574', 'EDIN00077', 'EDIN00077', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Anjum', '', 'Hameeduddin', 'MD', 'Family Practice', '', '', NULL, 'O', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087477720', '7089157239', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087477720', '7089157239', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285633461', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5061, -87.7288, NULL, NULL),
('364364574', 'EDIN00078', 'EDIN00078', 'ILCHIGSTD', '', 'Anjum', '', 'Hameeduddin', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 250', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 250', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285633461', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('208929101', 'EDIN00216', 'EDIN00216', 'ILCHIGSTD', 'Daniel T Weber MD SC', 'Daniel', '', 'Weber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6850 Centennial Dr', 'Tinley Park', 'Cook', 'IL', '60477', '7084293455', '7084293422', '6850 Centennial Dr', 'Tinley Park', 'Cook', 'IL', '60477', '7084293455', '7084293422', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316051956', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5977, -87.7866, NULL, NULL),
('208929101', 'EDIN00217', 'EDIN00217', 'ILCHIGSTD', '', 'Daniel', '', 'Weber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 609', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 609', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316051956', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364351282', 'EDIN00051', 'EDIN00051', 'ILCHIGSTD', 'Advanced Heart Group', 'Ripple', 'R', 'Doshi', 'MD', 'Cardiology', '', '', NULL, 'O', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316122237', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('264408856', 'EDIN00118', 'EDIN00118', 'ILCHIGSTD', 'Martin G Luken III MD SC', 'Martin', '', 'Luken', 'MD', 'Neurosurgery', '', '', NULL, 'O', '71 W 156th St Ste 205', 'Harvey', 'Cook', 'IL', '60426', '7085963344', '7085963432', '71 W 156th St Ste 205', 'Harvey', 'Cook', 'IL', '60426', '7085963344', '7085963432', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326013392', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('264408856', 'EDIN00119', 'EDIN00119', 'ILCHIGSTD', '', 'Martin', '', 'Luken', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 429', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 429', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326013392', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362970624', 'EDIN00039', 'EDIN00039', 'ILCHIGSTD', 'Illinois Retina Associates', 'Joseph', '', 'Civantos', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1336149053', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364238357', 'EDIN00032', 'EDIN00032', 'ILCHIGSTD', 'Chandra Diagnostic Cardiology', 'Lokesh', '', 'Chandra', 'MD', 'Cardiology', '', '', NULL, 'O', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1336162783', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('364238357', 'EDIN00033', 'EDIN00033', 'ILCHIGSTD', '', 'Lokesh', '', 'Chandra', 'MD', 'Cardiology', '', '', NULL, 'B', '4250 N Maine Dr Ste 236', 'Chicago', 'Cook', 'IL', '60613', '', NULL, '4250 N Maine Dr Ste 236', 'Chicago', 'Cook', 'IL', '60613', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1336162783', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364359125', 'EDIN00094', 'EDIN00094', 'ILCHIGSTD', 'Dorothy M Jones MD Chartered', 'Dorothy', '', 'Jones', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 167th St Ste 750', 'Calumet City', 'Cook', 'IL', '60409', '7088628852', '7088628847', '1600 167th St Ste 750', 'Calumet City', 'Cook', 'IL', '60409', '7088628852', '7088628847', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1336189869', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5954, -87.5609, NULL, NULL),
('364359125', 'EDIN00095', 'EDIN00095', 'ILCHIGSTD', '', 'Dorothy', '', 'Jones', 'MD', 'Internal Medicine', '', '', NULL, 'B', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '', NULL, '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1336189869', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.588, -87.5596, NULL, NULL),
('364351282', 'EDIN00116', 'EDIN00116', 'ILCHIGSTD', 'Advanced Heart Group', 'Andy', '', 'Lin', 'MD', 'Cardiology', '', '', NULL, 'O', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336204031', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('261368474', 'EDIN00204', 'EDIN00204', 'ILCHIGSTD', 'Angelo G Tsakopoulos MD', 'Angelo', '', 'Tsakopoulous', 'MD', 'Family Practice', '', '', NULL, 'O', '19550 Governors Hwy Ste 2700', 'Flossmoor', 'Cook', 'IL', '60422', '7087989170', '7087989173', '19550 Governors Hwy Ste 2700', 'Flossmoor', 'Cook', 'IL', '60422', '7087989170', '7087989173', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356320774', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('261368474', 'EDIN00205', 'EDIN00205', 'ILCHIGSTD', '', 'Angelo', '', 'Tsakopoulous', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1149', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1149', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356320774', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363010536', 'EDIN00183', 'EDIN00183', 'ILCHIGSTD', 'Midwest Eye Center', 'Sriram', '', 'Sonty', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356334379', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('362970624', 'EDIN00160', 'EDIN00160', 'ILCHIGSTD', 'Illinois Retina Associates', 'Kourous', '', 'Rezaei', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366428070', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('362878285', 'EDIN00161', 'EDIN00161', 'ILCHIGSTD', 'Monroe Medical Associates', 'Erwin', '', 'Robin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '2198363070', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '2198363070', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366484313', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.6067, -87.6601, NULL, NULL),
('362878285', 'EDIN00162', 'EDIN00162', 'ILCHIGSTD', '', 'Erwin', '', 'Robin', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 3419', 'Munster', 'Lake', 'IN', '46321', '', NULL, 'PO Box 3419', 'Munster', 'Lake', 'IN', '46321', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366484313', 0, 'Y', 0, '2013-04-02', NULL, NULL, 0, 0, NULL, NULL),
('363673204', 'EDIN00141', 'EDIN00141', 'ILCHIGSTD', 'Parikh and Abbasi MD SC', 'Dilipkumar', '', 'Parikh', 'MD', 'Cardiology', '', '', NULL, 'O', '17680 S Kedzie Ave Ste 206', 'Hazel Crest', 'Cook', 'IL', '60429', '7082061090', '7082061055', '17680 S Kedzie Ave Ste 206', 'Hazel Crest', 'Cook', 'IL', '60429', '7082061090', '7082061055', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1376527044', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5683, -87.6944, NULL, NULL),
('364142062', 'EDIN00128', 'EDIN00128', 'ILCHIGSTD', 'Southland Rheumatology Center', 'Veena', '', 'Nayak', 'MD', 'Rheumatology', '', '', NULL, 'O', '20060 Governors Hwy Ste 300', 'Olympia Fields', 'Cook', 'IL', '60461', '7082832600', '7082831250', '20060 Governors Hwy Ste 300', 'Olympia Fields', 'Cook', 'IL', '60461', '7082832600', '7082831250', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1376539106', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5256, -87.7021, NULL, NULL),
('364142062', 'EDIN00129', 'EDIN00129', 'ILCHIGSTD', '', 'Veena', '', 'Nayak', 'MD', 'Rheumatology', '', '', NULL, 'B', 'PO Box 848', 'Aurora', 'Kane', 'IL', '60507', '', NULL, 'PO Box 848', 'Aurora', 'Kane', 'IL', '60507', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1376539106', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364346917', 'EDIN00173', 'EDIN00173', 'ILCHIGSTD', 'Family Christian Health Center', 'Shana', 'J', 'Sewell', 'DO', 'Pediatrics', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386611663', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('362660922', 'EDIN00146', 'EDIN00146', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Michael', '', 'Peck', 'MD', 'Nephrology', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1386749521', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00147', 'EDIN00147', 'ILCHIGSTD', '', 'Michael', '', 'Peck', 'MD', 'Nephrology', '', '', NULL, 'B', '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1386749521', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363900178', 'EDIN00089', 'EDIN00089', 'ILCHIGSTD', 'Jerry Itkonen MD SC', 'Jerry', '', 'Itkonen', 'MD', 'Pulmonary', '', '', NULL, 'O', '18141 Dixie Hwy Ste 107', 'Homewood', 'Cook', 'IL', '60430', '7083310405', '7083318164', '18141 Dixie Hwy Ste 107', 'Homewood', 'Cook', 'IL', '60430', '7083310405', '7083318164', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407832967', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5597, -87.6654, NULL, NULL),
('363589895', 'EDIN00107', 'EDIN00107', 'ILCHIGSTD', 'Homewood Flossmoor Medical Associates', 'Mitchell', '', 'Krawczyk', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407847106', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364238357', 'EDIN00044', 'EDIN00044', 'ILCHIGSTD', 'Chandra Diagnostic Cardiology', 'Frederman', '', 'Concepcion', 'MD', 'Cardiology', '', '', NULL, 'O', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1417181116', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('363739422', 'EDIN00058', 'EDIN00058', 'ILCHIGSTD', 'Neurology Associates', 'Kevin', '', 'Fagan', 'MD', 'Neurology', '', '', NULL, 'O', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', '71 W 156th St Ste 308', 'Harvey', 'Cook', 'IL', '60426', '7083316617', '7083317957', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427061068', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363739422', 'EDIN00059', 'EDIN00059', 'ILCHIGSTD', '', 'Kevin', '', 'Fagan', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 1187', 'Harvey', 'Cook', 'IL', '60426', '', NULL, 'PO Box 1187', 'Harvey', 'Cook', 'IL', '60426', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427061068', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363769553', 'EDIN00047', 'EDIN00047', 'ILCHIGSTD', 'Surgical Care Associates', 'Ravi', '', 'Deshmukh', 'MD', 'General Surgery', '', '', NULL, 'O', '12800 S Ridgeland Ste F', 'Palos Heights', 'Cook', 'IL', '60463', '7082726606', NULL, '12800 S Ridgeland Ste F', 'Palos Heights', 'Cook', 'IL', '60463', '7082726606', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427107697', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6588, -87.7776, NULL, NULL),
('364330223', 'EDIN00192', 'EDIN00192', 'ILCHIGSTD', 'Comprehensive Pediatric Care', 'Shahida', '', 'Tanveer', 'MD', 'Pediatrics', '', '', NULL, 'O', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7088910089', '7088910681', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7088910089', '7088910681', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Ingalls Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1427120849', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.5589, NULL, NULL),
('364330223', 'EDIN00193', 'EDIN00193', 'ILCHIGSTD', '', 'Shahida', '', 'Tanveer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 7388', 'Villa Park', 'Dupage', 'IL', '60181', '', NULL, 'PO Box 7388', 'Villa Park', 'Dupage', 'IL', '60181', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Ingalls Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1427120849', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363129115', 'EDIN00145', 'EDIN00145', 'ILCHIGSTD', 'Rao Uppuluri MD SC', 'Rajesh', '', 'Patel', 'MD', 'Urology', '', '', NULL, 'O', '17901 Governors Hwy Ste 205', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', '17901 Governors Hwy Ste 205', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1427145440', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('362660922', 'EDIN00214', 'EDIN00214', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Romauld', '', 'Warakomski', 'DO', 'Internal Medicine', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1427153618', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00215', 'EDIN00215', 'ILCHIGSTD', '', 'Romauld', '', 'Warakomski', 'DO', 'Internal Medicine', '', '', NULL, 'B', '2065 Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2065 Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1427153618', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364351282', 'EDIN00190', 'EDIN00190', 'ILCHIGSTD', 'Advanced Heart Group', 'Ponnambalam', 'Sandy', 'Sundram', 'MD', 'Cardiology', '', '', NULL, 'O', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437137478', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363198178', 'EDIN00031', 'EDIN00031', 'ILCHIGSTD', 'A Step Ahead Foot Care', 'Michael', '', 'Buck', 'DPM', 'Podiatry', '', '', NULL, 'B', '15531 127th St', 'Lemont', 'Cook', 'IL', '60439', '8477970528', NULL, '15531 127th St', 'Lemont', 'Cook', 'IL', '60439', '8477970528', '          ', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1437166212', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('363198178', 'EDIN00030', 'EDIN00030', 'ILCHIGSTD', 'A Step Ahead Foot Care', 'Michael', '', 'Buck', 'DPM', 'Podiatry', '', '', NULL, 'O', '16735 S Oak Park Ave', 'Tinley Park', 'Cook', 'IL', '60477', '7085327439', '7085321243', '16735 S Oak Park Ave', 'Tinley Park', 'Cook', 'IL', '60477', '7085327439', '7085321243', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1437166212', 0, 'N', 0, '2014-01-15', NULL, NULL, 41.5873, -87.7847, NULL, NULL),
('270177970', 'EDIN00072', 'EDIN00072', 'ILCHIGSTD', 'Cynthia Goldman MD', 'Cynthia', '', 'Goldman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 167th St Ste 700', 'Calumet City', 'Cook', 'IL', '60409', '7088320947', '7088628613', '1600 167th St Ste 700', 'Calumet City', 'Cook', 'IL', '60409', '7088320947', '7088628613', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447246111', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5954, -87.5609, NULL, NULL),
('270177970', 'EDIN00073', 'EDIN00073', 'ILCHIGSTD', '', 'Cynthia', '', 'Goldman', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447246111', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364385192', 'EDIN00158', 'EDIN00158', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Lima', '', 'Redhead', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447283445', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('364385192', 'EDIN00159', 'EDIN00159', 'ILCHIGSTD', '', 'Lima', '', 'Redhead', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', NULL, 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447283445', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('431963293', 'EDIN00102', 'EDIN00102', 'ILCHIGSTD', 'PriMed Medical Center', 'Shirin', '', 'Khan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10715 W 159th St', 'Orland Park', 'Cook', 'IL', '60467', '7083649300', '7083649301', '10715 W 159th St', 'Orland Park', 'Cook', 'IL', '60467', '7083649300', '7083649301', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1447327606', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6009, -87.8796, NULL, NULL),
('363746106', 'EDIN00131', 'EDIN00131', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Phillip', 'T', 'Nigro', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447474283', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('363769553', 'EDIN00093', 'EDIN00093', 'ILCHIGSTD', 'Surgical Care Associates', 'Carl', '', 'Johnson', 'MD', 'General Surgery', '', '', NULL, 'O', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7087475020', '71 W 156th St Ste 309', 'Harvey', 'Cook', 'IL', '60426', '7083311122', '7087475020', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467450122', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363198178', 'EDIN00019', 'EDIN00019', 'ILCHIGSTD', 'A Step Ahead Foot Care', 'Bart', '', 'Beaver', 'DPM', 'Podiatry', '', '', NULL, 'B', '15531 127th St', 'Lemont', 'Cook', 'IL', '60439', '8477970528', NULL, '15531 127th St', 'Lemont', 'Cook', 'IL', '60439', '8477970528', '          ', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1467468207', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('363198178', 'EDIN00018', 'EDIN00018', 'ILCHIGSTD', 'A Step Ahead Foot Care', 'Bart', '', 'Beaver', 'DPM', 'Podiatry', '', '', NULL, 'O', '16735 S Oak Park Ave', 'Tinley Park', 'Cook', 'IL', '60477', '7085327439', '7085321243', '16735 S Oak Park Ave', 'Tinley Park', 'Cook', 'IL', '60477', '7085327439', '7085321243', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1467468207', 0, 'N', 0, '2014-01-15', NULL, NULL, 41.5873, -87.7847, NULL, NULL),
('362988677', 'EDIN00086', 'EDIN00086', 'ILCHIGSTD', 'South Suburban Gastroenterology', 'Matthew', '', 'Horowitz', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467484410', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('362879528', 'EDIN00177', 'EDIN00177', 'ILCHIGSTD', 'BD Sharma MD SC', 'Bansi', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17577 S Kedzie Ave Ste 109', 'Hazel Crest', 'Cook', 'IL', '60429', '7087991780', '7087994914', '17577 S Kedzie Ave Ste 109', 'Hazel Crest', 'Cook', 'IL', '60429', '7087991780', '7087994914', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477507291', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5695, -87.6943, NULL, NULL),
('363799281', 'EDIN00045', 'EDIN00045', 'ILCHIGSTD', 'William Crevier MD', 'William', '', 'Crevier', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16450 S 104th Ave Ste 101', 'Orland Park', 'Cook', 'IL', '60462', '7083490070', '7083490077', '16450 S 104th Ave Ste 101', 'Orland Park', 'Cook', 'IL', '60462', '7083490070', '7083490077', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477509347', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5909, -87.8718, NULL, NULL),
('362988677', 'EDIN00070', 'EDIN00070', 'ILCHIGSTD', 'South Suburban Gastroenterology', 'Shibban', '', 'Ganju', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477583532', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, 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
('362988677', 'EDIN00071', 'EDIN00071', 'ILCHIGSTD', '', 'Shibban', '', 'Ganju', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 370', 'Chicago Heights', 'Cook', 'IL', '60412', '', NULL, 'PO Box 370', 'Chicago Heights', 'Cook', 'IL', '60412', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477583532', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364325987', 'EDIN00066', 'EDIN00066', 'ILCHIGSTD', 'Adrienne Fregia MD', 'Adrienne', '', 'Fregia', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7084819912', '7084819914', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7084819912', '7084819914', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1477653111', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5061, -87.7288, NULL, NULL),
('364385192', 'EDIN00026', 'EDIN00026', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Audrey', '', 'Brewer', 'MD', 'Pediatrics', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1477835544', 0, 'N', 0, '2014-06-02', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('364385192', 'EDIN00027', 'EDIN00027', 'ILCHIGSTD', '', 'Audrey', '', 'Brewer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', NULL, 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1477835544', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('362715317', 'EDIN00079', 'EDIN00079', 'ILCHIGSTD', 'South Suburban Cardiology', 'Imtiaz', '', 'Hamid', 'MD', 'Cardiology', '', '', NULL, 'O', '17901 Governors Hwy Ste 101', 'Homewood', 'Cook', 'IL', '60430', '7087990180', '7085325539', '17901 Governors Hwy Ste 101', 'Homewood', 'Cook', 'IL', '60430', '7087990180', '7085325539', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1508857061', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('362660922', 'EDIN00041', 'EDIN00041', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Kenneth', '', 'Cline', 'MD', 'Nephrology', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1508961517', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00042', 'EDIN00042', 'ILCHIGSTD', '', 'Kenneth', '', 'Cline', 'MD', 'Nephrology', '', '', NULL, 'B', '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1508961517', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('362970624', 'EDIN00065', 'EDIN00065', 'ILCHIGSTD', 'Illinois Retina Associates', 'Timothy', '', 'Flood', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1518967223', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364320032', 'EDIN00233', 'EDIN00233', 'ILCHIGSTD', '', 'Shahla', '', 'Zaidi', 'MD', 'Family Practice', '', '', NULL, 'B', '17850 S Kedzie Ave Ste 3100', 'Hazel Crest', 'Cook', 'IL', '60429', '', NULL, '17850 S Kedzie Ave Ste 3100', 'Hazel Crest', 'Cook', 'IL', '60429', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528013026', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.5654, -87.6967, NULL, NULL),
('364320032', 'EDIN00232', 'EDIN00232', 'ILCHIGSTD', 'SFZ Corporation', 'Shahla', '', 'Zaidi', 'MD', 'Family Practice', '', '', NULL, 'O', '3330 W 177th St Ste 3D', 'Hazel Crest', 'Cook', 'IL', '60429', '7089574278', '7087994177', '3330 W 177th St Ste 3D', 'Hazel Crest', 'Cook', 'IL', '60429', '7089574278', '7087994177', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528013026', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('363025060', 'EDIN00156', 'EDIN00156', 'ILCHIGSTD', 'Baroukh Radfar MD SC', 'Baroukh', '', 'Radfar', 'MD', 'Pediatrics', '', '', NULL, 'O', '16264 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083312040', '7083319755', '16264 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083312040', '7083319755', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528131018', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6002, -87.5865, NULL, NULL),
('050540914', 'EDIN00211', 'EDIN00211', 'ILCHIGSTD', 'Wellgroup Health Partners', 'Lance', '', 'Wallace', 'MD', 'Internal Medicine', '', '', NULL, 'O', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1538100128', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5091, -87.7324, NULL, NULL),
('050540914', 'EDIN00213', 'EDIN00213', 'ILCHIGSTD', '', 'Lance', '', 'Wallace', 'MD', 'Internal Medicine', '', '', NULL, 'B', '333 Dixie Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '', NULL, '333 Dixie Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1538100128', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364346917', 'EDIN00084', 'EDIN00084', 'ILCHIGSTD', 'Family Christian Health Center', 'Lester', '', 'Hockenberry', 'MD', 'Internal Medicine', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538114715', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('362970624', 'EDIN00139', 'EDIN00139', 'ILCHIGSTD', 'Illinois Retina Associates', 'Kirk', '', 'Packo', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538169248', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('721595655', 'EDIN00056', 'EDIN00056', 'ILCHIGSTD', 'Fabi and Associates SC', 'Nanette', '', 'Fabi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18127 Williams St', 'Lansing', 'Cook', 'IL', '60438', '7084748844', '7084746135', '18127 Williams St', 'Lansing', 'Cook', 'IL', '60438', '7084748844', '7084746135', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548269228', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5653, -87.5322, NULL, NULL),
('721595655', 'EDIN00057', 'EDIN00057', 'ILCHIGSTD', '', 'Nanette', '', 'Fabi', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1419', 'Matteston', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1419', 'Matteston', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548269228', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363129115', 'EDIN00035', 'EDIN00035', 'ILCHIGSTD', 'Rao Uppuluri MD SC', 'Grant', '', 'Chavin', 'MD', 'Urology', '', '', NULL, 'O', '17901 Governors Hwy Ste 205A', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', '17901 Governors Hwy Ste 205A', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548284730', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('362996035', 'EDIN00006', 'EDIN00006', 'ILCHIGSTD', 'Yahya Ahmadian MD', 'Yahya', '', 'Ahmadian', 'MD', 'Pediatrics', '', '', NULL, 'O', '17901 Governors Hwy Ste 104', 'Homewood', 'Cook', 'IL', '60430', '7087990960', '7087993326', '17901 Governors Hwy Ste 104', 'Homewood', 'Cook', 'IL', '60430', '7087990960', '7087993326', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548335680', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364349969', 'EDIN00037', 'EDIN00037', 'ILCHIGSTD', '', 'Mathew', '', 'Chelich', 'DO', 'Family Practice', '', '', NULL, 'B', '1600 Torrence Ave Ste B', 'Calumet City', 'Cook', 'IL', '60409', '7089152099', NULL, '1600 Torrence Ave Ste B', 'Calumet City', 'Cook', 'IL', '60409', '7089152099', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1558349514', 0, 'Y', 0, '2014-05-16', NULL, NULL, 41.588, -87.5596, NULL, NULL),
('364349969', 'EDIN00036', 'EDIN00036', 'ILCHIGSTD', 'Mathew Chelich MD', 'Mathew', '', 'Chelich', 'DO', 'Family Practice', '', '', NULL, 'O', '16240 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083310011', '7083310008', '16240 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083310011', '7083310008', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1558349514', 0, 'N', 0, '2014-05-16', NULL, NULL, 41.6002, -87.5865, NULL, NULL),
('363839184', 'EDIN00172', 'EDIN00172', 'ILCHIGSTD', 'Natan Scher MD', 'Natan', '', 'Scher', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16532 S Oak Park Ave Ste 202', 'Tinley Park', 'Cook', 'IL', '60477', '7084447995', '7084447760', '16532 S Oak Park Ave Ste 202', 'Tinley Park', 'Cook', 'IL', '60477', '7084447995', '7084447760', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558370569', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.7849, NULL, NULL),
('364364574', 'EDIN00061', 'EDIN00061', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Sherry', '', 'Fishkin', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '19550 Governors Hwy Ste 2350', 'Flossmoor', 'Cook', 'IL', '60422', '7087980200', '7087980205', '19550 Governors Hwy Ste 2350', 'Flossmoor', 'Cook', 'IL', '60422', '7087980200', '7087980205', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568647196', 0, 'N', 0, '2013-04-05', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('363947964', 'EDIN00015', 'EDIN00015', 'ILCHIGSTD', 'Abdol H Azaran MD SC', 'Abdol', '', 'Azaran', 'MD', 'Nephrology', '', '', NULL, 'O', '15614 S Harlem Ave Ste C', 'Orland Park', 'Cook', 'IL', '60462', '7084814200', '7083423040', '15614 S Harlem Ave Ste C', 'Orland Park', 'Cook', 'IL', '60462', '7084814200', '7083423040', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1578563912', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6071, -87.7944, NULL, NULL),
('363947964', 'EDIN00016', 'EDIN00016', 'ILCHIGSTD', '', 'Abdol', '', 'Azaran', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 219', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 219', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1578563912', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363900178', 'EDIN00203', 'EDIN00203', 'ILCHIGSTD', '', 'Bsher', '', 'Touleimat', 'MD', 'Pulmonary', '', '', NULL, 'B', '18141 Dixie Hwy Ste 107', 'Homewood', 'Cook', 'IL', '60430', '', NULL, '18141 Dixie Hwy Ste 107', 'Homewood', 'Cook', 'IL', '60430', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588640049', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.5598, -87.6649, NULL, NULL),
('363900178', 'EDIN00202', 'EDIN00202', 'ILCHIGSTD', 'Jerry Itkonen MD SC', 'Bsher', '', 'Touleimat', 'MD', 'Pulmonary', '', '', NULL, 'O', '71 W 156th St Ste 203', 'Harvey', 'Cook', 'IL', '60426', '7083310405', '7083318166', '71 W 156th St Ste 203', 'Harvey', 'Cook', 'IL', '60426', '7083310405', '7083318166', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588640049', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('203216363', 'EDIN00103', 'EDIN00103', 'ILCHIGSTD', 'Peace Medical Center', 'Eugene', '', 'Kim', 'MD', 'Internal Medicine', '', '', NULL, 'O', '14618 Lincoln Ave', 'Harvey', 'Cook', 'IL', '60426', '7083397000', '7083397026', '14618 Lincoln Ave', 'Harvey', 'Cook', 'IL', '60426', '7083397000', '7083397026', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598894891', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6241, -87.6633, NULL, NULL),
('203497717', 'EDIN00178', 'EDIN00178', 'ILCHIGSTD', 'GeriMed Service', 'Rekha', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3330 W 177th St Ste 2E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087995455', '7087995925', '3330 W 177th St Ste 2E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087995455', '7087995925', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1619054228', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('363746106', 'EDIN00182', 'EDIN00182', 'ILCHIGSTD', 'Bone and Joint Physicians', 'David', '', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1619966561', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('363010536', 'EDIN00004', 'EDIN00004', 'ILCHIGSTD', 'Midwest Eye Center', 'Afzal', '', 'Ahmad', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088622964', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088622964', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629061684', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('363138225', 'EDIN00013', 'EDIN00013', 'ILCHIGSTD', 'Jerome Antony MD', 'Jerome', '', 'Antony', 'MD', 'Internal Medicine', '', '', NULL, 'O', '327 W 76th St', 'Chicago', 'Cook', 'IL', '60620', '7732246837', '7732246841', '327 W 76th St', 'Chicago', 'Cook', 'IL', '60620', '7732246837', '7732246841', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639122583', 0, 'N', 0, '2013-12-02', NULL, NULL, 41.7563, -87.6329, NULL, NULL),
('331941672', 'EDIN00101', 'EDIN00101', 'ILCHIGSTD', 'Tanjeev Kaur MD', 'Tanjeev', '', 'Kaur', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17577 S Kedzie Ave Ste 109', 'Hazel Crest', 'Cook', 'IL', '60429', '7087991780', '7089575150', '17577 S Kedzie Ave Ste 109', 'Hazel Crest', 'Cook', 'IL', '60429', '7087991780', '7089575150', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639123458', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5695, -87.6943, NULL, NULL),
('363705401', 'EDIN00235', 'EDIN00235', 'ILCHIGSTD', '', 'Benham', '', 'Zakhireh', 'MD', 'Infectious Disease', '', '', NULL, 'B', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639178924', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.5061, -87.774, NULL, NULL),
('363705401', 'EDIN00234', 'EDIN00234', 'ILCHIGSTD', 'Infectious Disease Specialists', 'Benham', '', 'Zakhireh', 'MD', 'Infectious Disease', '', '', NULL, 'O', '71 W 156th St Ste 304', 'Harvey', 'Cook', 'IL', '60426', '7083333113', '7083338991', '71 W 156th St Ste 304', 'Harvey', 'Cook', 'IL', '60426', '7083333113', '7083338991', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639178924', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('362660922', 'EDIN00195', 'EDIN00195', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Lourdes', '', 'Terrado', 'MD', 'Nephrology', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1639274624', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00196', 'EDIN00196', 'ILCHIGSTD', '', 'Lourdes', '', 'Terrado', 'MD', 'Nephrology', '', '', NULL, 'B', '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1639274624', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363589895', 'EDIN00201', 'EDIN00201', 'ILCHIGSTD', 'Homewood Flossmoor Medical Associates', 'Carmelita', '', 'Torres', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649251414', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364336908', 'EDIN00231', 'EDIN00231', 'ILCHIGSTD', 'Foot and Ankle Associates', 'Emil', '', 'Zager', 'DPM', 'Podiatry', '', '', NULL, 'O', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649252099', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.7247, -87.7375, NULL, NULL),
('364336908', 'EDIN00168', 'EDIN00168', 'ILCHIGSTD', 'Foot and Ankle Associates', 'Tara', '', 'Sakevich', 'DPM', 'Podiatry', '', '', NULL, 'O', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649253097', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.7247, -87.7375, NULL, NULL),
('362970624', 'EDIN00120', 'EDIN00120', 'ILCHIGSTD', 'Illinois Retina Associates', 'Matthew', '', 'Maccumber', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Hospital Chicago', NULL, NULL, 'HCFA|UB|', '1649270224', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363184772', 'EDIN00025', 'EDIN00025', 'ILCHIGSTD', 'Shyamal Bose MD SC', 'Shyamal', '', 'Bose', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3030 Chicago Rd', 'Steger', 'Cook', 'IL', '60475', '7087563037', '7087563065', '3030 Chicago Rd', 'Steger', 'Cook', 'IL', '60475', '7087563037', '7087563065', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1649362443', 0, 'N', 0, '2013-04-09', NULL, NULL, 41.4758, -87.6373, NULL, NULL),
('364385192', 'EDIN00186', 'EDIN00186', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Sharon', '', 'Stirgus James', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659385128', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('364385192', 'EDIN00187', 'EDIN00187', 'ILCHIGSTD', '', 'Sharon', '', 'Stirgus James', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '71 W 156th St  Ste 108', 'Harvey', 'Cook', 'IL', '60426', '', NULL, '71 W 156th St  Ste 108', 'Harvey', 'Cook', 'IL', '60426', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659385128', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.6067, -87.6601, NULL, NULL),
('362660922', 'EDIN00228', 'EDIN00228', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Ilene', '', 'Yohay', 'MD', 'Endocrinology', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089574585', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1669486262', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362660922', 'EDIN00230', 'EDIN00230', 'ILCHIGSTD', '', 'Ilene', '', 'Yohay', 'MD', 'Endocrinology', '', '', NULL, 'B', '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', NULL, '2605 W Lincoln Hwy', 'Olympia Fields', 'Cook', 'IL', '60461', '7087479780', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1669486262', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('362878285', 'EDIN00212', 'EDIN00212', 'ILCHIGSTD', '', 'James', '', 'Wallace', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '1400 S Lake Park Ave Ste 205', 'Hobart', 'Lake', 'IN', '46342', '2198367763', NULL, '1400 S Lake Park Ave Ste 205', 'Hobart', 'Lake', 'IN', '46342', '2198367763', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669687307', 0, 'Y', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('362878285', 'EDIN00210', 'EDIN00210', 'ILCHIGSTD', 'Monroe Medical Associates', 'James', '', 'Wallace', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '6701 W 159th St Ste 1', 'Tinley Park', 'Cook', 'IL', '60477', '7084442226', '7084442224', '6701 W 159th St Ste 1', 'Tinley Park', 'Cook', 'IL', '60477', '7084442226', '7084442224', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669687307', 0, 'N', 0, '2013-02-01', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('363746106', 'EDIN00034', 'EDIN00034', 'ILCHIGSTD', 'Bone and Joint Physicians', 'George', '', 'Charuk', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679547079', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('362988677', 'EDIN00163', 'EDIN00163', 'ILCHIGSTD', 'South Suburban Gastroenterology', 'Carl', '', 'Robinson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17901 Governors Hwy Ste 106', 'Homewood', 'Cook', 'IL', '60430', '7087993305', NULL, '17901 Governors Hwy Ste 106', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689787889', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364385192', 'EDIN00052', 'EDIN00052', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'Joy', 'M', 'Elion', 'MD', 'Pediatrics', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1689840704', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('364385192', 'EDIN00053', 'EDIN00053', 'ILCHIGSTD', '', 'Joy', 'M', 'Elion', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', NULL, 'PO Box 4685', 'Chicago', 'Cook', 'IL', '60680', '7083333030', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1689840704', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('363746106', 'EDIN00132', 'EDIN00132', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Mark', '', 'Nikkel', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1699762336', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('320154495', 'EDIN00154', 'EDIN00154', 'ILCHIGSTD', 'Bella T Prospero MD SC', 'Bella', '', 'Prospero', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17901 Governors Hwy Ste 101', 'Homewood', 'Cook', 'IL', '60430', '7087997193', '7087993839', '17901 Governors Hwy Ste 101', 'Homewood', 'Cook', 'IL', '60430', '7087997193', '7087993839', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699775916', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('320154495', 'EDIN00155', 'EDIN00155', 'ILCHIGSTD', '', 'Bella', '', 'Prospero', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1329', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1329', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699775916', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364351282', 'EDIN00010', 'EDIN00010', 'ILCHIGSTD', '', 'Francis', '', 'Almeda', 'MD', 'Cardiology', '', '', NULL, 'B', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700864550', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.5061, -87.774, NULL, NULL),
('364351282', 'EDIN00009', 'EDIN00009', 'ILCHIGSTD', 'Advanced Heart Group', 'Francis', '', 'Almeda', 'MD', 'Cardiology', '', '', NULL, 'O', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', '71 W 156th St Ste 305', 'Harvey', 'Cook', 'IL', '60426', '7083312200', '7083318015', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700864550', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('362970624', 'EDIN00080', 'EDIN00080', 'ILCHIGSTD', 'Illinois Retina Associates', 'Sohail', '', 'Hasan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700886439', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363583464', 'EDIN00104', 'EDIN00104', 'ILCHIGSTD', 'Alexander Kmicikewycz MD', 'Alexander', '', 'Kmicikewycz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12622 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7089239610', '7089239613', '12622 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7089239610', '7089239613', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710097779', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6622, -87.7964, NULL, NULL),
('363746106', 'EDIN00121', 'EDIN00121', 'ILCHIGSTD', 'Bone and Joint Physicians', 'John', '', 'McClellan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1710974472', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('363142574', 'EDIN00239', 'EDIN00239', 'ILCHIGSTD', 'South Suburban Neurology', 'Marvin', '', 'Zelkowitz', 'MD', 'Neurology', '', '', NULL, 'O', '3235 Vollmer Rd Ste 110', 'Flossmoor', 'Cook', 'IL', '60422', '7089573737', '7089572516', '3235 Vollmer Rd Ste 110', 'Flossmoor', 'Cook', 'IL', '60422', '7089573737', '7089572516', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1730189259', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.528, -87.6897, NULL, NULL),
('363142574', 'EDIN00014', 'EDIN00014', 'ILCHIGSTD', 'South Suburban Neurology', 'Bridgette', '', 'Arnett', 'MD', 'Neurology', '', '', NULL, 'O', '3235 Vollmer Rd Ste 110', 'Flossmoor', 'Cook', 'IL', '60422', '7089573737', '7089572516', '3235 Vollmer Rd Ste 110', 'Flossmoor', 'Cook', 'IL', '60422', '7089573737', '7089572516', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1730189291', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.528, -87.6897, NULL, NULL),
('363129115', 'EDIN00206', 'EDIN00206', 'ILCHIGSTD', 'Rao Uppuluri MD SC', 'Venkata', 'S Rao', 'Uppuluri', 'MD', 'Urology', '', '', NULL, 'O', '17901 Governors Hwy Ste 205A', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', '17901 Governors Hwy Ste 205A', 'Homewood', 'Cook', 'IL', '60430', '7089570220', '7089574519', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730276742', 0, 'N', 0, '2013-04-09', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('205252669', 'EDIN00151', 'EDIN00151', 'ILCHIGSTD', 'Cressa Perish MD', 'Cressa', '', 'Perish', 'MD', 'Family Practice', '', '', NULL, 'O', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087477720', '7089157238', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087477720', '7089157238', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740289933', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5061, -87.7288, NULL, NULL),
('205252669', 'EDIN00152', 'EDIN00152', 'ILCHIGSTD', '', 'Cressa', '', 'Perish', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1269', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1269', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740289933', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364132865', 'EDIN00170', 'EDIN00170', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Vasantha', '', 'Sastry', 'MD', 'Gynecology', '', '', NULL, 'O', '19550 Governors Hwy', 'Flossmoor', 'Cook', 'IL', '60422', '7087982600', '7087984745', '19550 Governors Hwy', 'Flossmoor', 'Cook', 'IL', '60422', '7087982600', '7087984745', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760481287', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('364132865', 'EDIN00171', 'EDIN00171', 'ILCHIGSTD', '', 'Vasantha', '', 'Sastry', 'MD', 'Gynecology', '', '', NULL, 'B', 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760481287', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363460234', 'EDIN00169', 'EDIN00169', 'ILCHIGSTD', 'Ingalls Cancer Care Center', 'Shankar', '', 'Sanwalani', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1 Ingalls Dr Cancer Care Ctr', 'Harvey', 'Cook', 'IL', '60426', '7089156620', '7089153782', '1 Ingalls Dr Cancer Care Ctr', 'Harvey', 'Cook', 'IL', '60426', '7089156620', '7089153782', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760482160', 0, 'N', 0, '2013-03-30', NULL, NULL, 41.6068, -87.6594, NULL, NULL),
('263281554', 'EDIN00113', 'EDIN00113', 'ILCHIGSTD', 'Premier Orthopaedic and Hand Center', 'John', '', 'Kung', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '19801 Governors Hwy Ste 160', 'Flossmoor', 'Cook', 'IL', '60422', '7089570505', '7089570506', '19801 Governors Hwy Ste 160', 'Flossmoor', 'Cook', 'IL', '60422', '7089570505', '7089570506', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760483390', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5304, -87.6975, NULL, NULL),
('263281554', 'EDIN00114', 'EDIN00114', 'ILCHIGSTD', '', 'John', '', 'Kung', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 661194', 'Chicago', 'Cook', 'IL', '60666', '', NULL, 'PO Box 661194', 'Chicago', 'Cook', 'IL', '60666', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760483390', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363746106', 'EDIN00124', 'EDIN00124', 'ILCHIGSTD', 'Bone and Joint Physicians', 'George', '', 'Miz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1770570699', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('364295605', 'EDIN00236', 'EDIN00236', 'ILCHIGSTD', 'Asad Zaman MD SC', 'Asad', '', 'Zaman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6700 W 167th St Ste 4', 'Tinley Park', 'Cook', 'IL', '60477', '7084293700', '7084294460', '6700 W 167th St Ste 4', 'Tinley Park', 'Cook', 'IL', '60477', '7084293700', '7084294460', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780636944', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5879, -87.7828, NULL, NULL),
('364295605', 'EDIN00237', 'EDIN00237', 'ILCHIGSTD', '', 'Asad', '', 'Zaman', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 880', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '7084294460', 'PO Box 880', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '7084294460', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780636944', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362476058', 'EDIN00088', 'EDIN00088', 'ILCHIGSTD', '', 'James', '', 'Hunter', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', NULL, '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1780667592', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362476058', 'EDIN00087', 'EDIN00087', 'ILCHIGSTD', 'Associated Allergists', 'James', '', 'Hunter', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1780667592', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5302, -87.6976, NULL, NULL),
('364493543', 'EDIN00020', 'EDIN00020', 'ILCHIGSTD', 'Nader Beshay MD SC', 'Nader', '', 'Beshay', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3330 W 177th St Ste 3H', 'Hazel Crest', 'Cook', 'IL', '60429', '7089221866', '7089223803', '3330 W 177th St Ste 3H', 'Hazel Crest', 'Cook', 'IL', '60429', '7089221866', '7089223803', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1780673897', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('481285893', 'EDIN00038', 'EDIN00038', 'ILCHIGSTD', 'Nirav P Chudgar MD SC', 'Nirav', '', 'Chudgar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 Torrence Ave 2nd Fl', 'Calumet City', 'Cook', 'IL', '60409', '7088320244', '7088321008', '1600 Torrence Ave 2nd Fl', 'Calumet City', 'Cook', 'IL', '60409', '7088320244', '7088321008', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780763805', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.5589, NULL, NULL),
('030387834', 'EDIN00055', 'EDIN00055', 'ILCHIGSTD', '', 'David', '', 'Ellens', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6703 W 159th St Ste 115', 'Tinley Park', 'Cook', 'IL', '60477', '7083421573', NULL, '6703 W 159th St Ste 115', 'Tinley Park', 'Cook', 'IL', '60477', '7083421573', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1780785402', 0, 'Y', 0, '2013-01-31', NULL, NULL, 41.6024, -87.7821, NULL, NULL),
('030387834', 'EDIN00054', 'EDIN00054', 'ILCHIGSTD', 'David Ellens MD FACP', 'David', '', 'Ellens', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6800 Centennial Dr Ste C', 'Tinley Park', 'Cook', 'IL', '60477', '7083421573', '7083420750', '6800 Centennial Dr Ste C', 'Tinley Park', 'Cook', 'IL', '60477', '7083421573', '7083420750', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1780785402', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5978, -87.7852, NULL, NULL),
('362878285', 'EDIN00185', 'EDIN00185', 'ILCHIGSTD', 'Monroe Medical Associates', 'Alexander', '', 'Starr', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '7083394814', '71 W 156th St Ste 401', 'Harvey', 'Cook', 'IL', '60426', '7083394800', '7083394814', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790722619', 0, 'N', 0, '2013-02-01', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('364346917', 'EDIN00085', 'EDIN00085', 'ILCHIGSTD', 'Family Christian Health Center', 'Jamie', '', 'Horn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790735595', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('364347582', 'EDIN00125', 'EDIN00125', 'ILCHIGSTD', 'Foot and Ankle Care', 'Carol', '', 'Moore', 'DPM', 'Podiatry', '', '', NULL, 'O', '11308 Distinctive Dr', 'Orland Park', 'Cook', 'IL', '60467', '7084796460', '7084796462', '11308 Distinctive Dr', 'Orland Park', 'Cook', 'IL', '60467', '7084796460', '7084796462', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801856927', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5559, -87.8927, NULL, NULL),
('200587924', 'EDIN00135', 'EDIN00135', 'ILCHIGSTD', 'Wojciech Ornowski MD', 'Wojciech', '', 'Ornowski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7087301750', '7089154897', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7087301750', '7089154897', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1801887369', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.5589, NULL, NULL),
('364132865', 'EDIN00175', 'EDIN00175', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Mohammad', '', 'Shamshuddin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6703 W 159th St', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423050', '6703 W 159th St', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423050', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801896261', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('364132865', 'EDIN00176', 'EDIN00176', 'ILCHIGSTD', '', 'Mohammad', '', 'Shamshuddin', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 1119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801896261', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363746106', 'EDIN00191', 'EDIN00191', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Joseph', 'P', 'Tansey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Little Company of Mary Hospital', NULL, NULL, 'HCFA|UB|', '1821023987', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, NULL, NULL),
('364346917', 'EDIN00222', 'EDIN00222', 'ILCHIGSTD', 'Family Christian Health Center', 'Lisa', 'K', 'Wright', 'MD', 'Pediatrics', '', '', NULL, 'O', '31 W 155th St Ste E', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St Ste E', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199124', 0, 'N', 0, '2013-05-01', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('364346917', 'EDIN00223', 'EDIN00223', 'ILCHIGSTD', '', 'Lisa', 'K', 'Wright', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 789', 'Matteson', 'Cook', 'IL', '60443', '', NULL, 'PO Box 789', 'Matteson', 'Cook', 'IL', '60443', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199124', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('364238357', 'EDIN00180', 'EDIN00180', 'ILCHIGSTD', 'Chandra Diagnostic Cardiology', 'Pranavkumar', '', 'Shroff', 'MD', 'Family Practice', '', '', NULL, 'O', '10718 S Ewing Ave', 'Chicago', 'Cook', 'IL', '60617', '7737315456', '7733164755', '10718 S Ewing Ave', 'Chicago', 'Cook', 'IL', '60617', '7737315456', '7733164755', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1831330877', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.7006, -87.5353, NULL, NULL),
('364238357', 'EDIN00181', 'EDIN00181', 'ILCHIGSTD', 'Chandra Diagnostic Cardiology', 'Pranavkumar', '', 'Shroff', 'MD', 'Family Practice', '', '', NULL, 'O', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', '3330 W 177th St Ste 3E', 'Hazel Crest', 'Cook', 'IL', '60429', '7087984500', '7087994093', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1831330877', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('363746106', 'EDIN00024', 'EDIN00024', 'ILCHIGSTD', 'Bone and Joint Physicians', 'Phyllis', 'N', 'Bonaminio', 'MD', 'Rheumatology', '', '', NULL, 'O', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', '5540 W 111th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084238440', '7084234024', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841289527', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6906, -87.7576, 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
('362660922', 'EDIN00029', 'EDIN00029', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Dwayne', '', 'Buchanan', 'MD', 'Family Practice', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1841437936', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('481285893', 'EDIN00140', 'EDIN00140', 'ILCHIGSTD', 'Nirav P Chudgar MD SC', 'Sonal', '', 'Parikh', 'MD', 'Family Practice', '', '', NULL, 'O', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7088320244', '7088321008', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7088320244', '7088321008', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851458202', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.5589, NULL, NULL),
('364132865', 'EDIN00017', 'EDIN00017', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Kavitha', '', 'Bathala', 'MD', 'Family Practice', '', '', NULL, 'O', '6703 W 159th St Ste 110', 'Tinley Park', 'Cook', 'IL', '60477', '7084448282', '7084444904', '6703 W 159th St Ste 110', 'Tinley Park', 'Cook', 'IL', '60477', '7084448282', '7084444904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1861415747', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('364346917', 'EDIN00040', 'EDIN00040', 'ILCHIGSTD', 'Family Christian Health Center', 'Cordia', '', 'Clark White', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', NULL, '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1861676538', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('203872755', 'EDIN00133', 'EDIN00133', 'ILCHIGSTD', 'Olympia Foot and Ankle Care', 'Kevin', 'James', 'O Connor', 'DPM', 'Podiatry', '', '', NULL, 'O', '3347 Vollmer Rd', 'Flossmoor', 'Cook', 'IL', '60422', '7087992900', '7087992919', '3347 Vollmer Rd', 'Flossmoor', 'Cook', 'IL', '60422', '7087992900', '7087992919', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1871521286', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5281, -87.6969, NULL, NULL),
('203872755', 'EDIN00134', 'EDIN00134', 'ILCHIGSTD', '', 'Kevin', 'James', 'O Connor', 'DPM', 'Podiatry', '', '', NULL, 'B', '3428 Vollmer Rd', 'Olympia Fields', 'Cook', 'IL', '60461', '7087992900', NULL, '3428 Vollmer Rd', 'Olympia Fields', 'Cook', 'IL', '60461', '7087992900', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1871521286', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364346917', 'EDIN00081', 'EDIN00081', 'ILCHIGSTD', 'Family Christian Health Center', 'Wanda', '', 'Hatter Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7085892091', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881649069', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('364132865', 'EDIN00007', 'EDIN00007', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Cyrus', '', 'Akrami', 'MD', 'Family Practice', '', '', NULL, 'O', '6703 W 159th St', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423038', '6703 W 159th St', 'Tinley Park', 'Cook', 'IL', '60477', '7083423000', '7083423038', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881694222', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6024, -87.7838, NULL, NULL),
('364132865', 'EDIN00008', 'EDIN00008', 'ILCHIGSTD', '', 'Cyrus', '', 'Akrami', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, 'PO Box 119', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881694222', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362970624', 'EDIN00153', 'EDIN00153', 'ILCHIGSTD', 'Illinois Retina Associates', 'John', '', 'Pollack', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '2198368780', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '2198368780', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1881694933', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.6067, -87.6601, NULL, NULL),
('363705401', 'EDIN00111', 'EDIN00111', 'ILCHIGSTD', '', 'Dorota', '', 'Krezolek', 'MD', 'Infectious Disease', '', '', NULL, 'B', '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', NULL, '4647 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7087475850', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881728509', 0, 'Y', 0, '2013-09-17', NULL, NULL, 41.5061, -87.774, NULL, NULL),
('363705401', 'EDIN00110', 'EDIN00110', 'ILCHIGSTD', 'Infectious Disease Specialists', 'Dorota', '', 'Krezolek', 'MD', 'Infectious Disease', '', '', NULL, 'O', '71 W 156th St Ste 304', 'Harvey', 'Cook', 'IL', '60426', '7083333113', '7083338991', '71 W 156th St Ste 304', 'Harvey', 'Cook', 'IL', '60426', '7083333113', '7083338991', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881728509', 0, 'N', 0, '2013-09-20', NULL, NULL, 41.6067, -87.6601, NULL, NULL),
('263281554', 'EDIN00100', 'EDIN00100', 'ILCHIGSTD', 'Premier Orthopaedic and Hand Center', 'Samera', '', 'Kasim', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '19801 Governors Hwy Ste 160', 'Flossmoor', 'Cook', 'IL', '60422', '7089570505', '7089570506', '19801 Governors Hwy Ste 160', 'Flossmoor', 'Cook', 'IL', '60422', '7089570505', '7089570506', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902113483', 0, 'N', 0, '2014-04-02', NULL, NULL, 41.5304, -87.6975, NULL, NULL),
('362476058', 'EDIN00199', 'EDIN00199', 'ILCHIGSTD', '', 'James', '', 'Thompson', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', NULL, '1300 Reliable Pkwy', 'Chicago', 'Cook', 'IL', '60686', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1932182748', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('362476058', 'EDIN00198', 'EDIN00198', 'ILCHIGSTD', 'Associated Allergists', 'James', '', 'Thompson', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', '19815 Governors Hwy Ste 2', 'Flossmoor', 'Cook', 'IL', '60422', '7087982950', '7089577471', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1932182748', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5302, -87.6976, NULL, NULL),
('363589895', 'EDIN00219', 'EDIN00219', 'ILCHIGSTD', 'Homewood Flossmoor Medical Associates', 'Jacqueline', '', 'White', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', '17901 Governors Hwy Ste 102', 'Homewood', 'Cook', 'IL', '60430', '7087998880', '7087998991', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932190634', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('363123669', 'EDIN00012', 'EDIN00012', 'ILCHIGSTD', 'Pramod K Anand MD', 'Pramod', '', 'Anand', 'MD', 'Internal Medicine', '', '', NULL, 'O', '71 W 156th St Ste 212', 'Harvey', 'Cook', 'IL', '60426', '7083398044', '7084292242', '71 W 156th St Ste 212', 'Harvey', 'Cook', 'IL', '60426', '7083398044', '7084292242', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942294251', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('363010536', 'EDIN00005', 'EDIN00005', 'ILCHIGSTD', 'Midwest Eye Center', 'Amjad', '', 'Ahmad', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Edward Hospital', 'Ingalls Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1952375800', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('364408868', 'EDIN00122', 'EDIN00122', 'ILCHIGSTD', 'Southwest Eye Center', 'Bhagvanji', '', 'Meghpara', 'DO', 'Ophthalmology', '', '', NULL, 'O', '3330 W 177th St Ste 1B', 'Hazel Crest', 'Cook', 'IL', '60429', '7087999490', '7087999773', '3330 W 177th St Ste 1B', 'Hazel Crest', 'Cook', 'IL', '60429', '7087999490', '7087999773', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1952439200', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('362970624', 'EDIN00046', 'EDIN00046', 'ILCHIGSTD', 'Illinois Retina Associates', 'Serge', '', 'DeBustros', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '7085969820', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962402685', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.6067, -87.6601, NULL, NULL),
('362988677', 'EDIN00060', 'EDIN00060', 'ILCHIGSTD', 'South Suburban Gastroenterology', 'Abraham', '', 'Fallah', 'MD', 'Gastroenterology', '', '', NULL, 'O', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', '17901 Governors Hwy Ste 208', 'Homewood', 'Cook', 'IL', '60430', '7087993305', '7087997220', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962436378', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5649, -87.681, NULL, NULL),
('364417153', 'EDIN00184', 'EDIN00184', 'ILCHIGSTD', 'Administer Medical Associates', 'Olaekan', '', 'Sowade', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17850 S Kedzie Ave Ste 3000', 'Hazel Crest', 'Cook', 'IL', '60429', '7087981200', '7087988141', '17850 S Kedzie Ave Ste 3000', 'Hazel Crest', 'Cook', 'IL', '60429', '7087981200', '7087988141', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1962486274', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5654, -87.6944, NULL, NULL),
('364336908', 'EDIN00117', 'EDIN00117', 'ILCHIGSTD', 'Foot and Ankle Associates', 'Laura', 'E', 'Linde', 'DPM', 'Podiatry', '', '', NULL, 'O', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', '4650 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962625681', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.7247, -87.7375, NULL, NULL),
('362660922', 'EDIN00220', 'EDIN00220', 'ILCHIGSTD', 'Horizon Healthcare Associates', 'Karen', '', 'Whitehorn', 'MD', 'Internal Medicine', '', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7089578750', '7089578602', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1972535102', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('364346917', 'EDIN00144', 'EDIN00144', 'ILCHIGSTD', 'Family Christian Health Center', 'Bari', '', 'Parks Ballard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7083393583', '31 W 155th St', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7083393583', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972545358', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('362878285', 'EDIN00067', 'EDIN00067', 'ILCHIGSTD', 'Monroe Medical Associates', 'Barbara', '', 'Fuller', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1600 S Lake Park Ste 1101', 'Hobart', 'Lake', 'IN', '46342', '2199471795', '2198363070', '1600 S Lake Park Ste 1101', 'Hobart', 'Lake', 'IN', '46342', '2199471795', '2198363070', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972545804', 0, 'Y', 0, '2013-05-02', NULL, NULL, 41.5121, -87.2589, NULL, NULL),
('362878285', 'EDIN00069', 'EDIN00069', 'ILCHIGSTD', '', 'Barbara', '', 'Fuller', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '801 MacArthur Blvd Ste 401', 'Munster', 'Lake', 'IN', '46321', '', NULL, '801 MacArthur Blvd Ste 401', 'Munster', 'Lake', 'IN', '46321', '', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972545804', 0, 'Y', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('363010536', 'EDIN00150', 'EDIN00150', 'ILCHIGSTD', 'Midwest Eye Center', 'Muhammed', '', 'Peracha', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', '1700 E West Rd', 'Calumet City', 'Cook', 'IL', '60409', '7088913330', '7088910904', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982606950', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5995, -87.5638, NULL, NULL),
('364385192', 'EDIN00200', 'EDIN00200', 'ILCHIGSTD', 'Chicago Metropolitan OB-GYN', 'James', '', 'Threatte', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', '15620 S Wood St', 'Harvey', 'Cook', 'IL', '60426', '7083333030', '7083336060', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1992712145', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6059, -87.6608, NULL, NULL),
('362970624', 'EDIN00157', 'EDIN00157', 'ILCHIGSTD', 'Illinois Retina Associates', 'Zac', '', 'Ravage', 'MD', 'Ophthalmology', '', '', NULL, 'O', '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', NULL, '71 W 156th St Ste 400', 'Harvey', 'Cook', 'IL', '60426', '7085968710', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992871248', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('752254247', 'W12029728', 'W12029728', 'TXDALSTD', 'HeartPlace', 'Michael', '', 'Donsky', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', '16980 Dallas Pkwy', 'Dallas', 'Dallas', 'TX', '75248', '2148412000', '2148412015', '16980 Dallas Pkwy', 'Dallas', 'Dallas', 'TX', '75248', '2148412000', '2148412015', 'HEARTPLACE', 'TXHCPC13', '', '0.00', '45.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245207992', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('752254247', 'W12029729', 'W12029729', 'TXDALSTD', 'HeartPlace', 'Michael', '', 'Donsky', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148412000', '2148412015', '621 N Hall St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148412000', '2148412015', 'HEARTPLACE', 'TXHCPC13', '', '0.00', '45.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245207992', 0, 'N', 0, '2013-11-04', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752254247', 'W12029727', 'W12029727', 'TXDALSTD', 'HeartPlace', 'Michael', '', 'Donsky', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 842471', 'Dallas', 'Dallas', 'TX', '75284', '2148412000', '2148412015', 'PO Box 842471', 'Dallas', 'Dallas', 'TX', '75284', '2148412000', '2148412015', 'HEARTPLACE', 'TXHCPC13', '', '0.00', '45.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245207992', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'W12029730', 'W12029730', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Chaim', '', 'Sigler', 'PA', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831174077', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'W12029731', 'W12029731', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Chaim', '', 'Sigler', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831174077', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'W12029732', 'W12029732', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Ronald', '', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528043221', 0, 'N', 0, '2013-07-24', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'W12029733', 'W12029733', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Ronald', '', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528043221', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'W12029734', 'W12029734', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Milton', '', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437134137', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'W12029735', 'W12029735', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Milton', '', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437134137', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12029736', 'W12029736', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', 'R', 'Luna', 'MD', 'Family Practice', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-12-24', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023127255', 0, 'N', 0, '2013-02-01', NULL, NULL, 29.5207, -98.5727, NULL, NULL),
('202148889', 'W12029737', 'W12029737', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', 'R', 'Luna', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-12-24', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023127255', 0, 'N', 0, '2013-02-01', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12029738', 'W12029738', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', 'R', 'Luna', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-12-24', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023127255', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12029739', 'W12029739', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Claudia', '', 'Santos', 'MD', 'Hospitalist', '', '', NULL, 'O', '215 E Quincy St Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '2102713434', '215 E Quincy St Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '2102713434', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1013192970', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('202148889', 'W12029740', 'W12029740', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Claudia', '', 'Santos', 'MD', 'Hospitalist', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102231600', '2102713434', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102231600', '2102713434', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013192970', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12029741', 'W12029741', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Claudia', '', 'Santos', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102231600', '2102713434', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102231600', '2102713434', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1013192970', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029742', 'W12029742', 'UTIHCPHY', 'Canyon View', 'Robert', 'D', 'Corry', 'MD', 'Family Practice', '', '', NULL, 'O', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-09-26', '2013-12-31', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1952324410', 0, 'N', 0, '2014-05-12', NULL, NULL, 37.8411, -112.83, NULL, NULL),
('942854057', 'W12029745', 'W12029745', 'UTIHCPHY', 'Southern Utah Neurosciences Institute', 'Jon', '', 'Wheiler', 'APRN', 'Neurology', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Center Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-13', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134156565', 0, 'N', 0, '2013-02-01', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12029744', 'W12029744', 'UTIHCPHY', 'Utah Valley Pulmonary - Critical Care', 'Raed', 'A', 'Wahab', '', 'Pulmonary', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285841437', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870467746', 'W12029746', 'W12029746', 'ID01', 'U-U Human Development Division', '', '', 'U-U Human Development Division', 'GROUP', 'Geriatrics', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812628', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812628', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009380', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870468377', 'W12029747', 'W12029747', 'ID01', 'University Health Care', '', '', 'U-U Dermatology Division', 'GROUP', 'Dermatology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812955', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812955', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009375', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870473288', 'W12029748', 'W12029748', 'ID01', 'U-U Infectious Disease Division', '', '', 'U-U Infectious Disease Division', 'GROUP', 'Infectious Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015852031', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015852031', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009381', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870478993', 'W12029749', 'W12029749', 'ID01', 'U-U General Medicine Division', '', '', 'U-U General Medicine Division', 'GROUP', 'Internal Medicine', 'General Practice', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009378', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870480520', 'W12029750', 'W12029750', 'ID01', 'Dept of Neurology School of Medicine U of U', '', '', 'Dept of Neurology School of Medicine U of U', 'GROUP', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005954', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870483582', 'W12029751', 'W12029751', 'ID01', 'University of Utah Orthopedic Consultants', '', '', 'University of Utah Orthopedic Consultants', '', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8015877028', NULL, '5848 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8015877028', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487680609', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.6447, -111.883, NULL, NULL),
('870483582', 'W12029752', 'W12029752', 'ID01', 'University of Utah Orthopedic Consultants', '', '', 'University of Utah Orthopedic Consultants', '', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487680609', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7558, -111.833, NULL, NULL),
('870483582', 'W12029753', 'W12029753', 'ID01', 'University of Utah Orthopedic Consultants', '', '', 'University of Utah Orthopedic Consultants', '', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', NULL, 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487680609', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W12029754', 'W12029754', 'ID01', 'University of Utah Surgical Associates', '', '', 'University of Utah Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009322', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870515631', 'W12029755', 'W12029755', 'ID01', 'U-U Rehabilitation Medicine', '', '', 'U-U Rehabilitation Medicine', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812268', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812268', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009386', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870516127', 'W12029756', 'W12029756', 'UT01', 'University of Utah Pediatric Surgeons', '', '', 'University of Utah Pediatric Surgeons', 'GROUP', 'Pediatric Surgery', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883350', NULL, '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883350', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009318', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870542578', 'W12029757', 'W12029757', 'ID01', 'University of Utah Dialysis - Physicians', '', '', 'U Of U Dialysis Program', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', NULL, '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689770356', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.77, -111.839, NULL, NULL),
('870542578', 'W12029758', 'W12029758', 'ID01', 'University of Utah Dialysis - Physicians', '', '', 'U Of U Dialysis Program', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689770356', 0, 'Y', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W12029759', 'W12029759', 'ID01', 'U-U Division of Nephrology', '', '', 'Division of Nephrology University of Utah', 'GROUP', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '0000000000', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005984', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870551044', 'W12029760', 'W12029760', 'ID01', 'University Radiation Oncologists', '', '', 'University Radiation Oncologists', 'GROUP', 'Radiation Oncology', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818793', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818793', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009331', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('870564069', 'W12029762', 'W12029762', 'ID01', 'U Dept of Family & Preventative Medicine', '', '', 'U Dept of Family & Preventative Medicine', 'GROUP', 'Family Practice', 'Internal Medicine', 'Geriatrics', NULL, 'O', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015855382', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015855382', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009216', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7575, -111.836, NULL, NULL),
('870567427', 'W12029763', 'W12029763', 'ID01', 'University of Utah Emergency Physicians', '', '', 'University of Utah Emergency Physicians', 'GROUP', 'Emergency Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009310', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870619420', 'W12029764', 'W12029764', 'ID01', 'College of Nursing, University of Utah', '', '', 'College of Nursing, University of Utah', 'GROUP', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '4535 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019637335', NULL, '4535 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019637335', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005767', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870619552', 'W12029765', 'W12029765', 'ID01', 'University Andrology Associates', '', '', 'University Andrology Associates', '', 'none', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813740', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813740', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205998259', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870619552', 'W12029766', 'W12029766', 'ID01', 'University Andrology Associates', '', '', 'University Andrology Associates', '', 'none', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205998259', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W12029767', 'W12029767', 'ID01', 'U of U Hospitals and Clinics - FPO', '', '', 'U of U Hospitals and Clinics - FPO', 'GROUP', 'Cardiovascular Disease', 'Gastroenterology', 'Internal Medicine', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009234', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7259, -111.934, NULL, NULL),
('870648457', 'W12029768', 'W12029768', 'ID01', 'U of U OB Care Now', '', '', 'U of U OB Care Now', 'GROUP', 'Maternal Fetal Medicine', '', '', 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, '2012-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009239', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870659348', 'W12029769', 'W12029769', 'ID01', 'University Pathology Associates', '', '', 'University Pathology Associates', 'GROUP', 'Pathology', 'Clinical Pathology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUPATH', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009330', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870584427', 'W12029770', 'W12029770', 'ID01', 'University of Utah Vascular Surgeons', '', '', 'University of Utah Vascular Surgeons', 'GROUP', 'Vascular Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015815311', '0000000000', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015815311', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009325', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870663870', 'W12029771', 'W12029771', 'ID01', 'UNI-OutReach Services', '', '', 'UNI-OutReach Services', 'Group', 'Pediatric Psychiatry', '', '', NULL, 'O', '650 S Komas Dr Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', NULL, '650 S Komas Dr Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', '          ', 'WUUPEDS', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720140114', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7553, -111.83, NULL, NULL),
('870663870', 'W12029772', 'W12029772', 'ID01', 'UNI-OutReach Services', '', '', 'UNI-OutReach Services', 'Group', 'Pediatric Psychiatry', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720140114', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'W12029773', 'W12029773', 'ID01', 'University of Utah Cardiothoracic Surgeons', '', '', 'University of Utah Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015815311', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015815311', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009282', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870675415', 'W12029774', 'W12029774', 'ID01', 'U of U Rehabilitation & Wellness Program', '', '', 'U of U Rehabilitation & Wellness Program', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', NULL, '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009256', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12029777', 'W12029777', 'ID01', 'UNI Home Project', '', '', 'UNI Home Project', 'GROUP', 'Mental Health', '', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009270', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12029776', 'W12029776', 'ID01', 'UNI Home Project', '', '', 'UNI Home Project', 'GROUP', 'Mental Health', '', '', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009270', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W12029778', 'W12029778', 'ID01', 'University of Utah Dept of Ophthalmology', '', '', 'University of Utah Dept of Ophthalmology', 'GROUP', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009291', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W12029779', 'W12029779', 'ID01', 'University Ear, Nose, and Throat Associates', '', '', 'University Ear, Nose, and Throat Associates', 'CCCA', 'Ear, Nose and Throat', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015818915', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015818915', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003005', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('460711441', 'W12029780', 'W12029780', 'ID01', 'University of Utah Neuromuscular', '', '', 'University of Utah Neuromuscular', '', 'Neurology', '', '', NULL, 'O', '175 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857575', NULL, '175 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857575', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336496074', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('460711441', 'W12029781', 'W12029781', 'ID01', 'University of Utah Neuromuscular', '', '', 'University of Utah Neuromuscular', '', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336496074', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('460711941', 'W12029782', 'W12029782', 'ID01', 'University of Utah Nero Critical Care', '', '', 'University of Utah Nero Critical Care', '', 'Neurology', '', '', NULL, 'O', '175 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857575', NULL, '175 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857575', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659628394', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('460711941', 'W12029783', 'W12029783', 'ID01', 'University of Utah Nero Critical Care', '', '', 'University of Utah Nero Critical Care', '', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659628394', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('383881130', 'W12029784', 'W12029784', 'ID01', 'Internal Med Hepatology Department of University of Utah', '', '', 'Internal Med Hepatology Department of University of Utah', '', 'Internal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427300177', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('383881130', 'W12029785', 'W12029785', 'ID01', 'Internal Med Hepatology Department of University of Utah', '', '', 'Internal Med Hepatology Department of University of Utah', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427300177', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('455511410', 'W12029787', 'W12029787', 'UTDT01', 'Basin Dental', 'Michael', '', 'Crookstone', 'DDS', 'Dentist', '', '', NULL, 'O', '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', NULL, '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1326136490', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('455511410', 'W12029789', 'W12029789', 'UTDT01', 'Basin Dental', 'Jared', '', 'Flitton', 'DMD', 'Dentist', '', '', NULL, 'O', '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', NULL, '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770878241', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12029790', 'W12029790', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jeffrey', 'V', 'Ball', 'PA-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1598790560', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820200895', 'W12029791', 'W12029791', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Julie', 'M', 'Clark', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649214131', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5903, -116.31, NULL, NULL),
('742743906', 'W12029794', 'W12029794', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Gerardo', 'A', 'Chica', 'MD', 'Nephrology', '', '', NULL, 'O', '2391 NE Loop 410 Ste 405', 'San Antonio', 'Bexar', 'TX', '78217', '2106547326', NULL, '2391 NE Loop 410 Ste 405', 'San Antonio', 'Bexar', 'TX', '78217', '2106547326', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790760940', 0, 'N', 0, '2013-02-06', NULL, NULL, 29.5163, -98.4204, NULL, NULL),
('506968511', 'W12029796', 'W12029796', 'WY01', 'Susanne S Levene MD', 'Susanne', 'S', 'Levene', 'MD', 'General Surgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1760581276', 0, 'N', 1, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('506968511', 'W12029798', 'W12029798', 'WY01', 'Susanne S Levene MD', 'Susanne', 'S', 'Levene', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 15385', 'Durham', 'Durham', 'NC', '27704', '3072346554', '3072346557', 'PO Box 15385', 'Durham', 'Durham', 'NC', '27704', '3072346554', '3072346557', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1760581276', 0, 'N', 1, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('506968511', 'W12029797', 'W12029797', 'WYT1', 'Susanne S Levene MD', 'Susanne', 'S', 'Levene', 'MD', 'General Surgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072346554', '3072346557', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1760581276', 0, 'N', 1, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('506968511', 'W12029799', 'W12029799', 'WYT1', 'Susanne S Levene MD', 'Susanne', 'S', 'Levene', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 15385', 'Durham', 'Durham', 'NC', '27704', '3072346554', '3072346557', 'PO Box 15385', 'Durham', 'Durham', 'NC', '27704', '3072346554', '3072346557', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1760581276', 0, 'N', 1, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870280366', 'W12029800', 'W12029800', 'UT01', 'Obstetrics and Gynecology Clinic', 'Margaret', 'Margaret', 'Batson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221214', '2013223613', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221214', '2013223613', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1437127735', 0, 'N', 0, '2013-03-08', NULL, NULL, 40.7628, -111.867, NULL, NULL),
('742743906', 'W12029801', 'W12029801', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Christopher', 'W', 'Glanton', 'MD', 'Nephrology', '', '', NULL, 'O', '222 Sidney Baker S Ste 208', 'Kerrville', 'Kerr', 'TX', '78028', '8308967607', NULL, '222 Sidney Baker S Ste 208', 'Kerrville', 'Kerr', 'TX', '78028', '8308967607', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1609840222', 0, 'Y', 0, '2013-04-23', NULL, NULL, 30.0436, -99.1449, NULL, NULL),
('742743906', 'W12029802', 'W12029802', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'John', 'E', 'Kobert', 'DO', 'Nephrology', '', '', NULL, 'O', '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '2103374911', NULL, '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', '2013-04-04', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376528810', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.1596, -98.1743, NULL, NULL),
('742743906', 'W12029803', 'W12029803', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Rodolfo', 'O', 'Garza', 'MD', 'Nephrology', '', '', NULL, 'O', '731 Carnoustie Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78258', '0000000000', NULL, '731 Carnoustie Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78258', '0000000000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', '2013-04-04', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184609349', 0, 'N', 0, '2013-06-05', NULL, NULL, 29.6177, -98.4824, NULL, NULL),
('742743906', 'W12029804', 'W12029804', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Carl', 'J', 'Blond', 'MD', 'Nephrology', '', '', NULL, 'O', '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', NULL, '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174507776', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742743906', 'W12029805', 'W12029805', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Caridad', 'M', 'Rebollar', 'MD', 'Nephrology', '', '', NULL, 'O', '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', NULL, '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-02-01', '2013-04-24', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073598520', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'W12029811', 'W12029811', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Toby', 'C', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750541991', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'W12029810', 'W12029810', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Toby', 'C', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750541991', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'W12029812', 'W12029812', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'John', 'D', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073598777', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'W12029813', 'W12029813', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'John', 'D', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073598777', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12029814', 'W12029814', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6191, -116.322, NULL, NULL),
('202630141', 'W12029816', 'W12029816', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.61, -116.201, NULL, NULL),
('201417984', 'W12029819', 'W12029819', 'WY01', 'Poplar Living Center', '', '', 'Poplar Living Center', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '4305 S Poplar', 'Casper', 'Natrona', 'WY', '82601', '3072372561', '3072349937', '4305 S Poplar', 'Casper', 'Natrona', 'WY', '82601', '3072372561', '3072349937', '', '', '5007', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700907029', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.8066, -106.345, NULL, NULL),
('201417984', 'W12029820', 'W12029820', 'WYT1', 'Poplar Living Center', '', '', 'Poplar Living Center', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '4305 S Poplar', 'Casper', 'Natrona', 'WY', '82601', '3072372561', '3072349937', '4305 S Poplar', 'Casper', 'Natrona', 'WY', '82601', '3072372561', '3072349937', '', '', '5007', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700907029', 0, 'N', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('271326738', 'W12029831', 'W12029831', 'ID01', 'Strickland Ear Clinic', 'Tosha', 'K', 'Strickland', 'AUD', 'Audiology', '', '', NULL, 'O', '10112 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083754327', '2089658227', '10112 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083754327', '2089658227', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992958565', 0, 'N', 0, '2013-07-11', NULL, NULL, 43.5903, -116.308, NULL, NULL),
('204043287', 'W12029834', 'W12029834', 'NM01', 'ABQ Health Partners', 'Jeremiah', '', 'Francis', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE ', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', '2121 Juan Tabo Blvd NE ', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699000752', 0, 'N', 0, '2013-02-06', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12029835', 'W12029835', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-25', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12029836', 'W12029836', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-25', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12029837', 'W12029837', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-25', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12029838', 'W12029838', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-25', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029842', 'W12029842', 'UTIHC01', '', 'Taj', 'N', 'Becker', 'MD', 'Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497976864', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12029841', 'W12029841', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-01-25', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029843', 'W12029843', 'UTIHC02', '', 'Taj', 'N', 'Becker', 'MD', 'Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497976864', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029844', 'W12029844', 'UTIHC04', '', 'Taj', 'N', 'Becker', 'MD', 'Neurology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356887000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497976864', 0, 'Y', 0, '2014-02-04', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12029845', 'W12029845', 'UTIHC01', '', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-11-01', '2013-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029846', 'W12029846', 'UTIHC02', '', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-11-01', '2013-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029847', 'W12029847', 'UTIHC03', '', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-11-01', '2013-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029848', 'W12029848', 'UTIHC04', '', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-11-01', '2013-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12029849', 'W12029849', 'UTIHC04', '', 'Wayne', 'Richard', 'Graham', 'DO', 'Family Practice', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781054', 0, 'N', 0, '2013-02-06', NULL, NULL, 40.489, -111.409, NULL, NULL),
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('201508140', 'W12029926', 'W12029926', 'TXDALSTD', 'North Central Surgical Center', '', '', 'North Central Surgical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '9301 N Central Expy Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2142652810', NULL, '9301 N Central Expy Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2142652810', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1548236524', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.8748, -96.7706, 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
('201508140', 'W12029927', 'W12029927', 'TXDALSTD', 'North Central Surgical Center', '', '', 'North Central Surgical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 840494', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', NULL, 'PO Box 840494', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1548236524', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('481260190', 'W12029929', 'W12029929', 'TXDALSTD', 'Baylor Medical Center at Trophy Club', '', '', 'Baylor Medical Center at Trophy Club', '', 'Hospital', NULL, NULL, NULL, 'O', '2850 E State Hwy 114', 'Roanoke', 'Denton', 'TX', '76262', '8178374600', NULL, '2850 E State Hwy 114', 'Roanoke', 'Denton', 'TX', '76262', '8178374600', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982609558', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.9805, -97.1758, NULL, NULL),
('261578178', 'W12029931', 'W12029931', 'TXDALSTD', 'Baylor Orthopedic and Spine Hospital at Arlington', '', '', 'Baylor Orthopedic and Spine Hospital at Arlington', '', 'Hospital', NULL, NULL, NULL, 'O', '707 Highlander Blvd', 'Arlington', 'Tarrant', 'TX', '76017', '8175837100', NULL, '707 Highlander Blvd', 'Arlington', 'Tarrant', 'TX', '76017', '8175837100', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346570710', 0, 'N', 0, '2013-04-23', NULL, NULL, 32.6829, -97.1169, NULL, NULL),
('731697736', 'W12029934', 'W12029934', 'TXDALSTD', 'Baylor Ambulatory Endoscopy Center', '', '', 'Baylor Ambulatory Endoscopy Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '4708 Alliance Blvd Ste 210', 'Plano', 'Collin', 'TX', '75093', '9727584950', NULL, '4708 Alliance Blvd Ste 210', 'Plano', 'Collin', 'TX', '75093', '9727584950', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346203528', 0, 'N', 0, '2013-02-08', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('731697736', 'W12029935', 'W12029935', 'TXDALSTD', 'Baylor Ambulatory Endoscopy Center', '', '', 'Baylor Ambulatory Endoscopy Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 840320', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', NULL, 'PO Box 840320', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346203528', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('752813815', 'W12029937', 'W12029937', 'TXDALSTD', 'Baylor SurgiCare', '', '', 'Baylor SurgiCare', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '3920 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148202581', NULL, '3920 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148202581', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811995913', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.7903, -96.7769, NULL, NULL),
('562297308', 'W12029939', 'W12029939', 'TXDALSTD', 'Baylor Surgicare at Oakmont', '', '', 'Baylor Surgicare at Oakmont', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7200 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177323300', NULL, '7200 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177323300', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275536328', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.6637, -97.4178, NULL, NULL),
('752708579', 'W12029941', 'W12029941', 'TXDALSTD', 'Baylor Surgicare at Denton', '', '', 'Baylor Surgicare at Denton', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '350 S I35 E', 'Denton', 'Denton', 'TX', '76205', '9403200407', NULL, '350 S I35 E', 'Denton', 'Denton', 'TX', '76205', '9403200407', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548238140', 0, 'N', 0, '2013-02-08', NULL, NULL, 33.1945, -97.1301, NULL, NULL),
('752854711', 'W12029943', 'W12029943', 'TXDALSTD', 'Baylor Surgicare at Grapevine', '', '', 'Baylor Surgicare at Grapevine', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2040 SW Hwy 114', 'Grapevine', 'Tarrant', 'TX', '76051', '8174104300', NULL, '2040 SW Hwy 114', 'Grapevine', 'Tarrant', 'TX', '76051', '8174104300', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295702942', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.9366, -97.0978, NULL, NULL),
('752567179', 'W12029945', 'W12029945', 'TXDALSTD', 'Baylor Surgicare at Bedford', '', '', 'Baylor Surgicare at Bedford', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1600 Central Dr Ste 180', 'Bedford', 'Tarrant', 'TX', '76022', '8175711999', NULL, '1600 Central Dr Ste 180', 'Bedford', 'Tarrant', 'TX', '76022', '8175711999', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467458513', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.8319, -97.1334, NULL, NULL),
('562399993', 'W12029947', 'W12029947', 'TXDALSTD', 'Baylor Surgicare at North Garland', '', '', 'Baylor Surgicare at North Garland', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7150 N George Bush Fwy Ste 101', 'Garland', 'Dallas', 'TX', '75044', '2147031800', NULL, '7150 N George Bush Fwy Ste 101', 'Garland', 'Dallas', 'TX', '75044', '2147031800', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124083076', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.9814, -96.6634, NULL, NULL),
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('208303422', 'W12029968', 'W12029968', 'TXDALSTD', 'Baylor Surgicare at Fort Worth I', '', '', 'Baylor Surgicare at Fort Worth I', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '975 Haskell St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8175700200', NULL, '975 Haskell St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8175700200', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1578530226', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7501, -97.3715, NULL, NULL),
('208303422', 'W12029970', 'W12029970', 'TXDALSTD', ' Baylor Surgicare at Fort Worth II', '', '', 'Baylor Surgicare at Fort Worth II', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2001 Cooper St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178771291', NULL, '2001 Cooper St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178771291', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992901847', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.7365, -97.3474, NULL, NULL),
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('274202856', 'W12029984', 'W12029984', 'TXDALSTD', 'Baylor Surgicare at Ennis', '', '', 'Baylor Surgicare at Ennis', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2200 Physicians Blvd Ste A', 'Ennis', 'Ellis', 'TX', '75119', '9728755538', NULL, '2200 Physicians Blvd Ste A', 'Ennis', 'Ellis', 'TX', '75119', '9728755538', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992008965', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.3032, -96.6352, NULL, NULL),
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('621801360', 'W12030206', 'W12030206', 'TXHOUSTD', 'HCA Patient Account Services', '', '', 'Clear Lake Regional Medical Center', '', 'Hospital', NULL, NULL, NULL, 'M', '8101 W Sam Houston Pkwy Ste 100', 'Houston', 'Harris', 'TX', '77072', '7134482000', '0000000000', '8101 W Sam Houston Pkwy Ste 100', 'Houston', 'Harris', 'TX', '77072', '7134482000', '0000000000', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063466035', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
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('621801360', 'W12028382', 'W12028382', 'TXHOUSTD', 'Patient Account Payment', '', '', 'Clear Lake Regional Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406795', 'Atlanta', 'Fulton', 'GA', '30384', '2813322511', '2813383352', 'PO Box 406795', 'Atlanta', 'Fulton', 'GA', '30384', '2813322511', '2813383352', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063466035', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('274478152', 'W12029994', 'W12029994', 'ILCHIGSTD', 'Metro Chicago Surgical Oncology dba Consultants in Gynecology SC', 'Balakrishna', '', 'Sundar', 'MD', 'Urology', '', '', NULL, 'O', '2400 N Ashland Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7738681800', '7738684072', '2400 N Ashland Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7738681800', '7738684072', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1316049166', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9252, -87.6682, NULL, NULL),
('274478152', 'W12029995', 'W12029995', 'ILCHIGSTD', 'Metro Chicago Surgical Oncology dba Consultants in Gynecology SC', 'Balakrishna', '', 'Sundar', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7738681800', '7738684072', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7738681800', '7738684072', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1316049166', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'W12029996', 'W12029996', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '944 S Hwy 123', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '8303791992', '944 S Hwy 123', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '8303791992', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5611, -97.9435, NULL, NULL),
('030380493', 'W12030000', 'W12030000', 'TXDALSTD', 'Baylor Surgicare at Carrollton', '', '', 'Baylor Surgicare at Carrollton', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '4780 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9723950440', NULL, '4780 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9723950440', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780683490', 0, 'N', 0, '2013-02-08', NULL, NULL, 33.0432, -96.8799, NULL, NULL),
('000001007', 'W12030001', 'W12030001', 'TXHOUSTD', 'Houston Methodist Hospital', '', '', 'Houston Methodist Hospital', '', 'Hospital', '', '', NULL, 'O', 'Chg', 'Houston', 'Harris', 'TX', '77030', '0000000000', NULL, 'Chg', 'Houston', 'Harris', 'TX', '77030', '0000000000', '          ', '', '', 'METHOUST', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010038', 0, 'Y', 0, '2014-02-13', NULL, NULL, 29.7051, -95.4018, NULL, NULL),
('741180155', 'W12030004', 'W12030004', 'TXHOUSTD', 'Houston Methodist Hospital', '', '', 'Houston Methodist Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', '', '', 'METHOUST', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548387418', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'W12030010', 'W12030010', 'TXHOUSTD', 'Houston Methodist Willowbrook Hospital', '', '', 'Houston Methodist Willowbrook Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871619254', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'W12030009', 'W12030009', 'TXHOUSTD', 'Houston Methodist Willowbrook Hospital', '', '', 'Houston Methodist Willowbrook Hospital', '', 'Hospital', '', '', NULL, 'O', '18220 Tomball Pkwy', 'Houston', 'Harris', 'TX', '77070', '2814771000', NULL, '18220 Tomball Pkwy', 'Houston', 'Harris', 'TX', '77070', '2814771000', '          ', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871619254', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('760545192', 'W12030013', 'W12030013', 'TXHOUSTD', 'Houston Methodist West Houston Hospital', '', '', 'Houston Methodist West Houston Hospital', '', 'Hospital', '', '', NULL, 'O', '18500 Katy Fwy', 'Houston', 'Harris', 'TX', '77094', '8325221000', NULL, '18500 Katy Fwy', 'Houston', 'Harris', 'TX', '77094', '8325221000', '          ', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083937593', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7855, -95.6961, NULL, NULL),
('760545192', 'W12030014', 'W12030014', 'TXHOUSTD', 'Houston Methodist West Houston Hospital', '', '', 'Houston Methodist West Houston Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083937593', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('741287015', 'W12030016', 'W12030016', 'TXHOUSTD', 'Houston Methodist San Jacinto Hospital', '', '', 'Houston Methodist San Jacinto Hospital', '', 'Hospital', '', '', NULL, 'O', '4401 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814208600', NULL, '4401 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814208600', '          ', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891789772', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7687, -94.9775, NULL, NULL),
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('741287015', 'W12030023', 'W12030023', 'TXHOUSTD', 'Houston Methodist San Jacinto Hospital', '', '', 'Houston Methodist San Jacinto Hospital', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '4401 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814208600', NULL, '4401 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814208600', '          ', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396886263', 0, 'Y', 0, '2014-02-13', NULL, NULL, 29.7687, -94.9775, NULL, NULL),
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('752813815', 'W12030028', 'W12030028', 'TXDALSTD', 'Physicians Day Surgery Center', '', '', 'Baylor Physicians Day Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', '3920 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148270760', NULL, '3920 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148270760', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346248440', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.7908, -96.7759, NULL, NULL),
('202595845', 'W12030030', 'W12030030', 'IDBOISTD', 'Boise Kidney and Hypertension', 'Jerry', '', 'Meng', 'MD', 'Nephrology', '', '', NULL, 'O', '3525 E Louise Dr Ste 195 & 100', 'Meridian', 'Ada', 'ID', '83642', '2088468335', '2088468336', '3525 E Louise Dr Ste 195 & 100', 'Meridian', 'Ada', 'ID', '83642', '2088468335', '2088468336', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1295894939', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6028, -116.351, NULL, NULL),
('202595845', 'W12030031', 'W12030031', 'IDBOISTD', 'Boise Kidney and Hypertension', 'Jerry', '', 'Meng', 'MD', 'Nephrology', '', '', NULL, 'O', '4620 Enterprise Way Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', '2088468336', '4620 Enterprise Way Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', '2088468336', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1295894939', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6613, -116.641, NULL, NULL),
('820200895', 'W12030033', 'W12030033', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Jackie', '', 'Callaway', 'PA-C', 'Family Practice', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-01-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1801196720', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'W12029896', 'W12029896', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise', 'Jackie', '', 'Callaway', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-01-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1801196720', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('870634650', 'W12030034', 'W12030034', 'UT01', 'OB GYN Associates ', 'Rixt', 'A', 'Luikenaar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1151 E 3900 S Ste B-299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012666288', '1151 E 3900 S Ste B-299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012666288', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-03-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1285688101', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('030527214', 'W12030035', 'W12030035', 'UT01', 'Riverwoods Neurological Center', 'Nichole', 'A', 'Quick', 'MD', 'Family Practice', '', '', NULL, 'O', '3152 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012291014', '8012291067', '3152 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012291014', '8012291067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265695811', 0, 'N', 0, '2013-03-18', NULL, NULL, 40.2767, -111.658, NULL, NULL),
('461698467', 'W12030036', 'W12030036', 'WY01', 'Bellkins Paps', '', '', 'Bellkins Paps LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2013-03-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245577410', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('461698467', 'W12030037', 'W12030037', 'WYT1', 'Bellkins Paps', '', '', 'Bellkins Paps LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2013-03-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245577410', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W40016139', 'W40016139', 'UTMH1', 'Northeastern Counseling Center', 'Christi', 'M', 'Harris', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821173394', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.4482, -109.55, NULL, NULL),
('752900902', 'W12029959', 'W12029959', 'TXDALSTD', 'Baylor Surgicare at Valley View', '', '', 'Baylor Surgicare at Valley View', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '5744 LBJ Fwy Ste 200', 'Dallas', 'Dallas', 'TX', '75240', '9724904333', NULL, '5744 LBJ Fwy Ste 200', 'Dallas', 'Dallas', 'TX', '75240', '9724904333', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750347472', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.9255, -96.8087, NULL, NULL),
('752592508', 'W12029973', 'W12029973', 'TXDALSTD', 'North Texas Surgery Center', '', '', 'North Texas Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7992 West Virginia Dr', 'Dallas', 'Dallas', 'TX', '75237', '9722832400', NULL, '7992 West Virginia Dr', 'Dallas', 'Dallas', 'TX', '75237', '9722832400', '          ', '', '', 'BAYSURG', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1609870336', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.6495, -96.8772, NULL, NULL),
('820200895', 'W12030038', 'W12030038', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673674', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673674', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-01-22', '2013-05-01', 0, 0, 0, '', NULL, '', '', 'HCFA|', '1063601177', 0, 'Y', 0, '2013-11-22', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('760545192', 'W12030006', 'W12030006', 'TXHOUSTD', 'Houston Methodist Sugar Land Hospital', '', '', 'Houston Methodist Sugar Land Hospital', '', 'Hospital', '', '', NULL, 'O', '16655 SW Fwy', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812747000', NULL, '16655 SW Fwy', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812747000', '          ', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497871628', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.5913, -95.6308, NULL, NULL),
('263091124', 'ELHCA0065', 'ELHCA0065', 'TXHOUSTD', 'Complete Womens Care Center', 'Susan', '', 'Hardwick Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1427017821', 0, 'N', 0, '2013-11-20', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('263091124', 'ELHCA0066', 'ELHCA0066', 'TXHOUSTD', 'Complete Womens Care Center', 'Susan', '', 'Hardwick Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1427017821', 0, 'Y', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('760386549', 'W12030039', 'W12030039', 'TXBEAUSTD', 'Michael Rotenberg MD', 'Michael', '', 'Rotenberg', 'MD', 'Cardiology', '', '', NULL, 'O', '3345 Plaza 10 Dr Ste E', 'Beaumont', 'Jefferson', 'TX', '77707', '4098336554', '4098382009', '3345 Plaza 10 Dr Ste E', 'Beaumont', 'Jefferson', 'TX', '77707', '4098336554', '4098382009', 'BEAUMONT2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871570705', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0782, -94.1369, NULL, NULL),
('760410028', 'W12030040', 'W12030040', 'TXBEAUSTD', 'William Hawkins MD', 'William', '', 'Hawkins', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3560 Delaware Ste 1001', 'Beaumont', 'Jefferson', 'TX', '77706', '4093471133', '4098994715', '3560 Delaware Ste 1001', 'Beaumont', 'Jefferson', 'TX', '77706', '4093471133', '4098994715', 'BEAUMONT3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1629079231', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.1045, -94.1394, NULL, NULL),
('522258226', 'W12030041', 'W12030041', 'UTMH1', 'Hurricane Valley Counseling Center', 'Jeffery', 'P', 'Voorhees', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '1155 W State St', 'Hurricane', 'Washington', 'UT', '84737', '4356806276', '8882491560', '1155 W State St', 'Hurricane', 'Washington', 'UT', '84737', '4356806276', '8882491560', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447480876', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'W12030043', 'W12030043', 'TXHOUSTD', 'Suyang Hao MD', 'Suyang', '', 'Hao', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1750371910', 0, 'Y', 0, '2014-04-25', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030044', 'W12030044', 'TXHOUSTD', 'Abida Haque MD', 'Abida', '', 'Haque', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1033167549', 0, 'Y', 0, '2014-04-25', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030045', 'W12030045', 'TXHOUSTD', 'Bisong Haupt MD', 'Bisong', '', 'Haupt', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1841488202', 0, 'Y', 0, '2014-04-25', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030046', 'W12030046', 'TXHOUSTD', 'Tracie Koen MD', 'Tracie', '', 'Koen', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1730398652', 0, 'Y', 0, '2014-04-25', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030047', 'W12030047', 'TXHOUSTD', 'Ognjen Kosarac MD', 'Ognjen', '', 'Kosarac', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1114172632', 0, 'Y', 0, '2014-04-25', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030048', 'W12030048', 'TXHOUSTD', 'Geoffrey Land MD', 'Geoffrey', '', 'Land', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003958554', 0, 'Y', 0, '2013-08-29', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030049', 'W12030049', 'TXHOUSTD', 'Christopher Leveque MD', 'Christopher', '', 'Leveque', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912902248', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030050', 'W12030050', 'TXHOUSTD', 'Joyce Maldonado MD', 'Joyce', '', 'Maldonado', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083619316', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030051', 'W12030051', 'TXHOUSTD', 'Dina Mody MD', 'Dina', '', 'Mody', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871551176', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030052', 'W12030052', 'TXHOUSTD', 'Claudia Molina MD', 'Claudia', '', 'Molina', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780883546', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030053', 'W12030053', 'TXHOUSTD', 'Seema Mullick MD', 'Seema', '', 'Mullick', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144288424', 0, 'Y', 0, '2013-08-28', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030054', 'W12030054', 'TXHOUSTD', 'James Musser MD', 'James', '', 'Musser', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952514119', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030055', 'W12030055', 'TXHOUSTD', 'Thu Huy Ngo MD', 'Thu Huy', '', 'Ngo', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043268576', 0, 'Y', 0, '2013-08-28', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('371520288', 'W12030059', 'W12030059', 'TXHOUSTD', 'Andreana Rivera MD', 'Andreana', '', 'Rivera', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699909846', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('371520288', 'W12030061', 'W12030061', 'TXHOUSTD', 'Mary Schwartz MD', 'Mary', '', 'Schwartz', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477501948', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030062', 'W12030062', 'TXHOUSTD', 'Steven Shen MD', 'Steven', '', 'Shen', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942258405', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, 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
('371520288', 'W12030063', 'W12030063', 'TXHOUSTD', 'Nour Sneige MD', 'Nour', '', 'Sneige', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467558288', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030064', 'W12030064', 'TXHOUSTD', 'Hidehiro Takei MD', 'Hidehiro', '', 'Takei', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7131903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7131903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023104528', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030065', 'W12030065', 'TXHOUSTD', 'Michael Thrall MD', 'Michael', '', 'Thrall', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255486197', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030066', 'W12030066', 'TXHOUSTD', 'Arthur Zieske MD', 'Arthur', '', 'Zieske', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770519415', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030067', 'W12030067', 'TXHOUSTD', 'Luan Truong MD', 'Luan', '', 'Truong', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104874650', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030068', 'W12030068', 'TXHOUSTD', 'Ping Wang MD', 'Ping', '', 'Wang', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306002092', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('371520288', 'W12030069', 'W12030069', 'TXHOUSTD', 'Youli Zu MD', 'Youli', '', 'Zu', 'MD', 'Pathology', '', '', NULL, 'O', '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', NULL, '6550 Fannin Ste 447', 'Houston', 'Harris', 'TX', '77030', '7137903333', '          ', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376501775', 0, 'Y', 0, '2013-04-23', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('260270360', 'W12030070', 'W12030070', 'TXDALSTD', 'Texas Vision and Laser Center', '', '', 'Texas Vision and Laser Center', '', 'Ophthalmology', '', '', NULL, 'O', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659575926', 0, 'Y', 0, '2013-02-15', NULL, NULL, 33.1987, -96.6495, NULL, NULL),
('260270360', 'W12030071', 'W12030071', 'TXDALSTD', 'Texas Vision and Laser Center', '', '', 'Texas Vision and Laser Center', '', 'Ophthalmology', '', '', NULL, 'B', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659575926', 0, 'Y', 0, '2013-02-15', NULL, NULL, 33.1085, -96.8143, NULL, NULL),
('260270360', 'W12030074', 'W12030074', 'TXDALSTD', 'Texas Vision and Laser Center', 'Jason', 'D', 'Bullajian', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1063415552', 0, 'N', 0, '2013-02-15', NULL, NULL, 33.1093, -96.8096, NULL, NULL),
('260270360', 'W12030073', 'W12030073', 'TXDALSTD', 'Texas Vision and Laser Center', 'Jason', 'D', 'Bullajian', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1063415552', 0, 'N', 0, '2013-02-15', NULL, NULL, 33.1987, -96.6495, NULL, NULL),
('260270360', 'W12030077', 'W12030077', 'TXDALSTD', 'Texas Vision and Laser Center', 'Caleb', 'R', 'Sawyer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', '8380 Warren Pkwy Ste 101', 'Frisco', 'Denton', 'TX', '75034', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1568482578', 0, 'N', 0, '2013-02-15', NULL, NULL, 33.1093, -96.8096, NULL, NULL),
('260270360', 'W12030076', 'W12030076', 'TXDALSTD', 'Texas Vision and Laser Center', 'Caleb', 'R', 'Sawyer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', '2709 Virginia Pkwy Ste 200', 'Mckinney', 'Collin', 'TX', '75071', '9725482015', '9725482014', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1568482578', 0, 'N', 0, '2013-02-15', NULL, NULL, 33.1987, -96.6495, NULL, NULL),
('651172480', 'W12030080', 'W12030080', 'TXHOUSTD', 'Town and Country Family Physicians', '', '', 'Town and Country Family Physicians, PLLP', '', 'Family Practice', '', '', NULL, 'O', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477756922', 0, 'Y', 0, '2013-02-13', NULL, NULL, 29.7817, -95.5562, NULL, NULL),
('651172480', 'W12030082', 'W12030082', 'TXHOUSTD', 'Town and Country Family Physicians', 'Laurel', 'M', 'Tucker', 'MD', 'Family Practice', '', '', NULL, 'O', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1528063633', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7817, -95.5562, NULL, NULL),
('651172480', 'W12030084', 'W12030084', 'TXHOUSTD', 'Town and Country Family Physicians', 'Anthony', 'J', 'Popek', 'MD', 'Family Practice', '', '', NULL, 'O', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1083619183', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7817, -95.5562, NULL, NULL),
('651172480', 'W12030086', 'W12030086', 'TXHOUSTD', 'Town and Country Family Physicians', 'Bo', 'J', 'Allaire', 'MD', 'Family Practice', '', '', NULL, 'O', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1235363862', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7817, -95.5562, NULL, NULL),
('651172480', 'W12030088', 'W12030088', 'TXHOUSTD', 'Town and Country Family Physicians', 'Stephanie', 'M', 'Heflin', 'NP', 'Family Practice', '', '', NULL, 'O', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', '10497 Town and Country Way Ste 360', 'Houston', 'Harris', 'TX', '77024', '7133412100', '7139327072', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-13', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1104136316', 0, 'N', 0, '2014-03-20', NULL, NULL, 29.7817, -95.5562, NULL, NULL),
('741916484', 'W12030089', 'W12030089', 'TXHOUSTD', 'Park Plaza Orthopedic Associates', '', '', 'Houston Orthopedic and Spine Physicians', '', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275608788', 0, 'Y', 0, '2013-12-10', NULL, NULL, 29.7244, -95.3875, NULL, NULL),
('741916484', 'W12030091', 'W12030091', 'TXHOUSTD', 'Park Plaza Orthopedic Associates', 'Jonathan', 'G', 'Lee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1104933704', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7244, -95.3875, NULL, NULL),
('741916484', 'W12030093', 'W12030093', 'TXHOUSTD', 'Park Plaza Orthopedic Associates', 'Cecil', '', 'Christensen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1295842896', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7244, -95.3875, NULL, NULL),
('741916484', 'W12030095', 'W12030095', 'TXHOUSTD', 'Park Plaza Orthopedic Associates', 'William', 'H', 'Hadnott', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2014-01-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194832709', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7244, -95.3875, NULL, NULL),
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('621801360', 'W12030208', 'W12030208', 'TXHOUSTD', 'Alvin Emergency Center', '', '', 'Alvin Emergency Center', '', 'Hospital', '', '', NULL, 'O', '301 Medic Ln', 'Alvin', 'Brazoria', 'TX', '77511', '2813316141', '0000000000', '301 Medic Ln', 'Alvin', 'Brazoria', 'TX', '77511', '2813316141', '0000000000', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010054', 0, 'Y', 0, '2013-02-15', NULL, NULL, 29.4322, -95.2418, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('202630141', 'W12030250', 'W12030250', 'IDBOISTD', 'Primary Health Medical Group', 'David', '', 'Peterman', 'MD', 'Pediatrics', '', '', NULL, 'O', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1942245840', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6119, -116.261, NULL, NULL),
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('364195126', 'ELP000001', 'ELP000001', 'ILCHIGSTD', 'Presence Mercy Medical Center', '', '', 'Presence Mercy Medical Center', '', 'Hospital', '', '', NULL, 'O', '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308592222', NULL, '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308592222', '          ', '', '', 'PresProvMer', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265454391', 0, 'N', 0, '2013-10-15', '140174', NULL, 41.7856, -88.3289, NULL, NULL),
('364195126', 'ELP000008', 'ELP000008', 'ILCHIGSTD', 'Provena Regional Cancer Center', '', '', 'Presence Mercy Medical Center', '', 'Hospital', '', '', NULL, 'O', '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '6308592222', NULL, '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '6308592222', '          ', '', '', 'PresProvMer', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265454391', 0, 'Y', 0, '2013-10-15', '140174', NULL, 41.3669, -88.4239, NULL, NULL),
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('363200170', 'ELP000018', 'ELP000018', 'ILCHIGSTD', 'Presence Saint Joseph Hospital', '', '', 'Presence Saint Joseph Hospital', '', 'Mental Health', '', '', NULL, 'B', '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '          ', '', '', 'PresStJo', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366521296', 0, 'Y', 0, '2013-10-09', '140224', NULL, 0, 0, NULL, NULL),
('362171079', 'ELP000024', 'ELP000024', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'B', '1117 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '1117 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140094', NULL, 0, 0, NULL, NULL),
('362171079', 'ELP000033', 'ELP000033', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '1127 N Oakley', 'Chicago', 'Cook', 'IL', '60622', '7084100615', NULL, '1127 N Oakley', 'Chicago', 'Cook', 'IL', '60622', '7084100615', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.902, -87.6845, NULL, NULL),
('362171079', 'ELP000027', 'ELP000027', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7732782000', NULL, '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7732782000', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.9075, -87.686, NULL, NULL),
('362171079', 'ELP000021', 'ELP000021', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.9041, -87.6825, NULL, NULL),
('363330926', 'ELP000063', 'ELP000063', 'ILCHIGSTD', 'Presence Resurrection Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'B', '62415 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', NULL, '62415 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', '          ', '', '', 'PresResMC', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140117', NULL, 0, 0, NULL, NULL),
('363330926', 'ELP000060', 'ELP000060', 'ILCHIGSTD', 'Presence Resurrection Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '          ', '', '', 'PresResMC', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396832622', 0, 'Y', 0, '2013-10-09', '140117', NULL, 41.9884, -87.8124, NULL, NULL),
('364195126', 'ELP000047', 'ELP000047', 'ILCHIGSTD', 'Provena St Joseph Hospital', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Clinic', '', '', NULL, 'B', '2669 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2669 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', '2013-08-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568538387', 0, 'Y', 0, '2013-08-05', '140217', NULL, 0, 0, NULL, NULL),
('364195126', 'ELP000044', 'ELP000044', 'ILCHIGSTD', 'Provena St Joseph Hospital', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Clinic', '', '', NULL, 'O', '77 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', '2013-08-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568538387', 0, 'Y', 0, '2013-08-05', '140217', NULL, 42.0362, -88.328, NULL, NULL),
('364195126', 'ELP000056', 'ELP000056', 'ILCHIGSTD', 'Provena Outpatient Rehabilitation Center', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Clinic', '', '', NULL, 'O', '87 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476955904', NULL, '87 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476955904', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', '2013-08-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568538387', 0, 'Y', 0, '2013-08-05', '140217', NULL, 42.0367, -88.3277, NULL, NULL),
('364195126', 'ELP000046', 'ELP000046', 'ILCHIGSTD', 'Presence Saint Joseph Hospital Elgin', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Hospital', '', '', NULL, 'B', '2669 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2669 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598845828', 0, 'Y', 0, '2013-10-15', '140217', NULL, 0, 0, NULL, NULL),
('364195126', 'ELP000043', 'ELP000043', 'ILCHIGSTD', 'Presence Saint Joseph Hospital Elgin', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Hospital', '', '', NULL, 'O', '77 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598845828', 0, 'N', 0, '2013-10-15', '140217', NULL, 42.0362, -88.328, NULL, NULL),
('364195126', 'ELP000055', 'ELP000055', 'ILCHIGSTD', 'Provena Outpatient Rehabilitation Center', '', '', 'Provena Outpatient Rehabilitation Center', '', 'Hospital', '', '', NULL, 'O', '87 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476955904', NULL, '87 N Airlite St', 'Elgin', 'Kane', 'IL', '60123', '8476955904', '          ', '', '', 'PresProvStJo', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598845828', 0, 'N', 0, '2013-10-15', '140217', NULL, 42.0367, -88.3277, NULL, NULL),
('364195126', 'ELP000002', 'ELP000002', 'ILCHIGSTD', 'Presence Mercy Medical Center', '', '', 'Presence Mercy Medical Center', '', 'Mental Health', '', '', NULL, 'O', '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308592222', NULL, '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308592222', '          ', '', '', 'PresProMer', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639186638', 0, 'Y', 0, '2013-10-15', NULL, NULL, 41.7856, -88.3289, NULL, NULL),
('364195126', 'ELP000004', 'ELP000004', 'ILCHIGSTD', 'Presence Mercy Medical Center', '', '', 'Presence Mercy Medical Center', '', 'Mental Health', '', '', NULL, 'B', '2667 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2667 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', '', '', 'PresProMer', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639186638', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'ELP000011', 'ELP000011', 'ILCHIGSTD', 'Presence Saint Joseph Hospital Chicago', '', '', 'Presence Saint Joseph Hospital', '', 'Hospital', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '          ', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '          ', '', '', 'PresStJo', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679659585', 0, 'N', 0, '2014-05-07', '140224', NULL, 41.9349, -87.6367, NULL, NULL),
('363200170', 'ELP000012', 'ELP000012', 'ILCHIGSTD', 'Presence Saint Joseph Hospital', '', '', 'Presence Saint Joseph Hospital', '', 'Hospital', '', '', NULL, 'B', '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '', '', '', 'PresStJo', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679659585', 0, 'Y', 0, '2014-05-07', '140224', NULL, 0, 0, NULL, NULL),
('362171079', 'ELP000023', 'ELP000023', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'B', '1117 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '1117 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140094', NULL, 0, 0, NULL, NULL),
('362171079', 'ELP000032', 'ELP000032', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'O', '1127 N Oakley', 'Chicago', 'Cook', 'IL', '60622', '7084100615', NULL, '1127 N Oakley', 'Chicago', 'Cook', 'IL', '60622', '7084100615', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.902, -87.6845, NULL, NULL),
('362171079', 'ELP000026', 'ELP000026', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'O', '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7732782000', NULL, '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7732782000', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.9075, -87.686, NULL, NULL),
('362171079', 'ELP000020', 'ELP000020', 'ILCHIGSTD', 'Saints Mary and Elizabeth Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', '', '', 'PresStMandE', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140094', NULL, 41.9041, -87.6825, NULL, NULL);
