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
('820299231', 'W12008872', 'W12008872', 'ID02', 'Saltzer Medical Group North', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12008873', 'W12008873', 'ID02', 'Saltzer Medical Group Rehab', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685970', '2082884987', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685970', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008874', 'W12008874', 'ID02', 'Saltzer Medical Group', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008875', 'W12008875', 'ID02', 'Saltzer Medical Group-Portico', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008876', 'W12008876', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12008877', 'W12008877', 'ID02', 'Saltzer Medical Group', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820510794', 'W12008879', 'W12008879', 'ID02', 'CT Derm PC', 'Tiffany', 'A', 'McCray', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '811 Nw 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', '811 Nw 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2011-03-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417999657', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('820510794', 'W12008881', 'W12008881', 'ID02', 'CT Derm PC', 'David', 'J', 'Barclay', 'PA-C', 'Dermatology', '', '', NULL, 'O', '811 Nw 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', '811 Nw 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2011-03-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285803445', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('743212651', 'W12007446', 'W12007446', 'UTMH1', 'JWH Thrive Inc', 'John', 'W', 'Howard', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2363 N Hillfield Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016283512', '8017797808', '2363 N Hillfield Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016283512', '8017797808', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689738130', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008888', 'W12008888', 'ID01', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'Y', 0, '2012-01-06', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008889', 'W12008889', 'ID01', 'Idaho Emergency Physicians PA', 'Hansel', '', 'Ashby', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548213457', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008890', 'W12008890', 'ID01', 'Idaho Emergency Physicians PA', 'Randy', 'L', 'Barnes', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1295811867', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008891', 'W12008891', 'ID01', 'Idaho Emergency Physicians PA', 'Dianna', 'L', 'Binnion', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1073567574', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008892', 'W12008892', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'M', 'Boesiger', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1982657896', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008893', 'W12008893', 'ID01', 'Idaho Emergency Physicians PA', 'Mark', 'A', 'Burriesci', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1831397835', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008894', 'W12008894', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'B', 'Campbell', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1790981025', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008895', 'W12008895', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'J', 'Conklin', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1922052448', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008896', 'W12008896', 'ID01', 'Idaho Emergency Physicians PA', 'Benjamin', 'L', 'Cornett', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821298001', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008897', 'W12008897', 'ID01', 'Idaho Emergency Physicians PA', 'Jeffrey', 'R', 'Dingman', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1972648913', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008898', 'W12008898', 'ID01', 'Idaho Emergency Physicians PA', 'Robert', 'L', 'Davis', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1054 N Curis Rd', 'Boise', 'Ada', 'ID', '83703', '2083221730', '2083221731', '1054 N Curis Rd', 'Boise', 'Ada', 'ID', '83703', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548295249', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008899', 'W12008899', 'ID01', 'Idaho Emergency Physicians PA', 'Robert', 'L', 'Davis', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548295249', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008900', 'W12008900', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008901', 'W12008901', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12008902', 'W12008902', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008903', 'W12008903', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12008905', 'W12008905', 'ID01', 'Idaho Emergency Physicians PA', 'John', 'P', 'Epperson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427081983', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008906', 'W12008906', 'ID01', 'Idaho Emergency Physicians PA', 'David', 'T', 'Gough', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1205873247', 0, 'Y', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008907', 'W12008907', 'ID01', 'Idaho Emergency Physicians PA', 'Heather', 'S', 'Hammerstedt', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1275621104', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008908', 'W12008908', 'ID01', 'Idaho Emergency Physicians PA', 'Mark', 'A', 'Henzler', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1518904598', 0, 'Y', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008910', 'W12008910', 'ID01', 'Idaho Emergency Physicians PA', 'Ryan', 'D', 'Heyborne', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659573889', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008911', 'W12008911', 'ID01', 'Idaho Emergency Physicians PA', 'Po', 'Y', 'Huang', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1215981741', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008912', 'W12008912', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'T', 'Judd', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1003934100', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008913', 'W12008913', 'ID01', 'Idaho Emergency Physicians PA', 'David', 'T', 'Kim', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1386681336', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008914', 'W12008914', 'ID01', 'Idaho Emergency Physicians PA', 'Frederick', 'J', 'Klein', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1144273079', 0, 'Y', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008915', 'W12008915', 'ID01', 'Idaho Emergency Physicians PA', 'Michael', 'J', 'Lamers', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629091491', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008916', 'W12008916', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'Y', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008917', 'W12008917', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'W', 'Moss', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1033384201', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008918', 'W12008918', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008919', 'W12008919', 'ID01', 'Idaho Emergency Physicians PA', 'Mike', 'W', 'Pool', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', '2011-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1154368918', 0, 'Y', 0, '2012-02-23', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008920', 'W12008920', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'M', 'Quinn', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1710978036', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008921', 'W12008921', 'ID01', 'Idaho Emergency Physicians PA', 'Kristen', 'H', 'Saak', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821128018', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008922', 'W12008922', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'E', 'Tobe', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1205889136', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008923', 'W12008923', 'ID01', 'Idaho Emergency Physicians PA', 'Jessica', 'N', 'Wasielewski', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427126127', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008924', 'W12008924', 'ID01', 'Idaho Emergency Physicians PA', 'Brandon', 'J', 'Wilding', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1851307367', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12008925', 'W12008925', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-02-21', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12008933', 'W12008933', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2011-01-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12008930', 'W12008930', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12008929', 'W12008929', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12008932', 'W12008932', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', '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', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W12008931', 'W12008931', 'ID01', 'Saint Alphonsus Express Care Inc', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083678555', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'W12008928', 'W12008928', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083672968', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083672968', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W12008935', 'W12008935', 'ID01', 'Saint Alphonsus Medical Group Cardiothoracic Services Boise', 'Jenna', '', 'Sielaff', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174707020', 0, 'N', 0, '2014-02-04', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'W12008937', 'W12008937', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12008938', 'W12008938', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('870609595', 'W12007959', 'W12007959', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12007961', 'W12007961', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12007960', 'W12007960', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007962', 'W12007962', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008945', 'W12008945', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Steven', '', 'Berg', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1336662633', 0, 'Y', 0, '2011-04-01', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008946', 'W12008946', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Clark', 'L', 'Brinton', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1750315792', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008947', 'W12008947', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Tyler', '', 'Daniels', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1427076785', 0, 'N', 0, '2011-04-01', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008948', 'W12008948', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Marguerite', '', 'Overton', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1366476301', 0, 'Y', 0, '2011-04-01', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008949', 'W12008949', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Clayton', '', 'Sanders', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1225056476', 0, 'N', 0, '2011-04-01', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12008950', 'W12008950', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Charles', '', 'Stiff', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2011-04-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1174557011', 0, 'N', 0, '2011-04-01', NULL, NULL, 0, 0, NULL, NULL),
('260040706', 'W12008951', 'W12008951', 'UT01', '', 'Robin', '', 'Berger', 'MD', 'Dermatology', '', '', NULL, 'O', '640 E 700 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356737546', '4356737554', '640 E 700 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356737546', '4356737554', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1164690467', 0, 'N', 0, '2014-07-25', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('260040706', 'W12008952', 'W12008952', 'UT01', '', 'Robin', '', 'Berger', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 911928', 'St George', 'Washington', 'UT', '84770', '4356737546', '4356737554', 'PO Box 911928', 'St George', 'Washington', 'UT', '84770', '4356737546', '4356737554', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1164690467', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12008953', 'W12008953', 'UT01', 'Hofman Arthritis Institute', 'William', '', 'Bockoven', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2011-10-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831182476', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12008954', 'W12008954', 'UT01', 'Hoffman Arthritis Institute', 'William', '', 'Bockoven', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8013556468', '8013553450', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2011-10-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831182476', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'W12008959', 'W12008959', 'UT01', 'Alpine Orthopaedic Specialists', 'Spencer', 'B', 'Heninger', 'DPM', 'Podiatry', '', '', NULL, 'O', '1930 S Hwy 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357239704', '', '1930 S Hwy 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357239704', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', '', 'HCFA|UB|', '1790781292', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.4751, -112.025, NULL, NULL),
('870649259', 'W12008958', 'W12008958', 'UT01', 'Alpine Orthopaedic Specialists', 'Spencer', 'B', 'Heninger', 'DPM', 'Podiatry', '', '', NULL, 'O', '2310 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', '2310 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', '', 'HCFA|UB|', '1790781292', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'W12008960', 'W12008960', 'UT01', 'Alpine Orthopaedic Specialists', 'Spencer', 'B', 'Heninger', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357239704', '', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357239704', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', '', 'HCFA|UB|', '1790781292', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008961', 'W12008961', 'UT01', 'Tooele Clinic Corp', 'Ana', 'I', 'Holtey', 'DO', 'Family Practice', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358822692', NULL, '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358822692', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1689875049', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('528272978', 'W12008963', 'W12008963', 'UTMH1', 'Solutions Counseling ', 'Rocio', 'F', 'Paredes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1867 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8014251970', '8018251533', '1867 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8014251970', '8018251533', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265681860', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('528272978', 'W12008962', 'W12008962', 'UTMH1', 'Solutions Counseling ', 'Rocio', 'F', 'Paredes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2261 N Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8014251970', '8018251533', '2261 N Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8014251970', '8018251533', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265681860', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('134268836', 'W12008964', 'W12008964', 'UTMH1', 'Deborah Christensen , PhD and Associates', 'Cindy Jo', '', 'Schiers', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '12660 S Fort St Ste 103', 'Draper', 'Salt Lake', 'UT', '84020', '8018161801', '8015010249', '12660 S Fort St Ste 103', 'Draper', 'Salt Lake', 'UT', '84020', '8018161801', '8015010249', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316240534', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('134268836', 'W12008965', 'W12008965', 'UTMH1', 'Deborah Christensen , PhD and Associates', 'Cindy Jo', '', 'Schiers', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 1705', 'Draper', 'Salt Lake', 'UT', '84020', '8018161801', '8015010249', 'PO Box 1705', 'Draper', 'Salt Lake', 'UT', '84020', '8018161801', '8015010249', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316240534', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12008163', 'W12008163', 'UT01', 'Utah County Medical Associates', 'Gale', 'J', 'Skousen', 'MD', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305391', 0, 'Y', 0, '2013-06-19', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12008162', 'W12008162', 'UT01', 'Utah County Medical Associates', 'Gale', 'J', 'Skousen', 'MD', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305391', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12008161', 'W12008161', 'UT01', 'Utah County Medical Associates', 'Gale', 'J', 'Skousen', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305391', 0, 'Y', 0, '2013-06-19', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12008170', 'W12008170', 'UT01', 'Utah County Medical Associates', 'Marilyn', '', 'Sorensen', 'FNP', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568480713', 0, 'Y', 0, '2011-12-21', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12008172', 'W12008172', 'UT01', 'Utah County Medical Associates', 'Marilyn', '', 'Sorensen', 'FNP', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568480713', 0, 'Y', 0, '2014-03-21', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12008171', 'W12008171', 'UT01', 'Utah County Medical Associates', 'Marilyn', '', 'Sorensen', 'FNP', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568480713', 0, 'Y', 0, '2012-11-07', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12008169', 'W12008169', 'UT01', 'Utah County Medical Associates', 'Marilyn', '', 'Sorensen', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568480713', 0, 'Y', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12008185', 'W12008185', 'UT01', 'Utah County Medical Associates', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'Y', 0, '2014-04-18', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12008184', 'W12008184', 'UT01', 'Utah County Medical Associates', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'Y', 0, '2014-04-18', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12008183', 'W12008183', 'UT01', 'Utah County Medical Associates', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'Y', 0, '2014-04-18', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12008186', 'W12008186', 'UT01', 'Utah County Medical Associates', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'Y', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'W12008957', 'W12008957', 'UT01', 'Ogden Womens Clinic', 'Marylynn', '', 'Cardona', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1376703710', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('741849254', 'W12007628', 'W12007628', 'TX01', 'Southeast Surgical Associates', 'Allen', 'A', 'Alvarez', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-01-24', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497995484', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('741849254', 'W12007629', 'W12007629', 'TX01', 'Southwest Surgical Associates', 'Allen', 'A', 'Alvarez', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-01-24', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497995484', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('275068977', 'W12008966', 'W12008966', 'UT01', 'WCHS ', 'D', 'J', 'Balcombe', 'MD', 'Wound Care', 'Emergency Medicine', '', NULL, 'O', '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8013915420', NULL, '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8013915420', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1629037361', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.166, -111.97, NULL, NULL),
('261527457', 'W12008967', 'W12008967', 'ID01', '', 'Susan', 'K', 'Barnes', 'LCPC LMFT', 'Mental Health', 'Marriage and Family Therapy', 'Counseling', NULL, 'O', '1414 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083432730', '2083951948', '1414 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083432730', '2083951948', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-29', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053436618', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('263740168', 'W12008968', 'W12008968', 'UT01', '', 'Clayton', 'A', 'Bass', 'MD', 'Wound Care', '', '', NULL, 'O', '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8013915420', NULL, '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8013915420', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1972598506', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008969', 'W12008969', 'UTMH1', 'Life Mosaics Family Counseling', 'Rodger', 'D', 'Bischoff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2011-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770594350', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008970', 'W12008970', 'UTMH1', 'Life Mosaics Family Counseling', 'Rodger', 'D', 'Bischoff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2011-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770594350', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008971', 'W12008971', 'UTMH1', 'Life Mosaics Family Counseling', 'Barbara', 'J', 'Bronson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2011-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841302056', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008972', 'W12008972', 'UTMH1', 'Life Mosaics Family Counseling', 'Barbara', 'J', 'Bronson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2011-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841302056', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12008974', 'W12008974', 'UTMH1', 'Valley Mental Health  Inc', 'Christopher', '', 'Cavin', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637224', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637224', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2011-03-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114237807', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12007554', 'W12007554', 'ID02', 'Primary Health Medical Group', 'Judith', 'L', 'Chasin', 'MD', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', '435 S Eagle Rd Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-03-01', '2012-04-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427256841', 0, 'N', 0, '2014-05-29', NULL, NULL, 43.6915, -116.355, NULL, NULL),
('202630141', 'W12007555', 'W12007555', 'ID02', 'Primary Health Medical Group', 'Judith', 'L', 'Chasin', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-03-01', '2012-04-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427256841', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12008975', 'W12008975', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Andrew', 'D', 'Cooper', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1477547164', 0, 'N', 0, '2011-03-16', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12008976', 'W12008976', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Andrew', 'D', 'Cooper', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1477547164', 0, 'N', 0, '2011-03-16', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12008977', 'W12008977', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Andrew', 'D', 'Cooper', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1477547164', 0, 'N', 0, '2011-03-16', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008978', 'W12008978', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'Leland', '', 'Pack', 'DMD', 'Pedodontist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008024', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008979', 'W12008979', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'Leland', '', 'Powell', 'DDS', 'Dentist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008244', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008980', 'W12008980', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'David', '', 'Babcock', 'DMD', 'Dentist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005138', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008981', 'W12008981', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'Heath', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1932116589', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008983', 'W12008983', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'Darren', '', 'Wible', 'DDS', 'Dentist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004153', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('273381165', 'W12008985', 'W12008985', 'UTDT01', 'Hillfield Pediatric & Family Dentistry', 'Jennifer', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004154', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('202853765', 'W12008986', 'W12008986', 'UTDT01', '', 'Bradford', '', 'Bowen', 'DDS', 'Dentist', '', '', NULL, 'O', '1356 S 2100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810054', NULL, '1356 S 2100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810054', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005376', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12007714', 'W12007714', 'UT01', 'Wasatch Pediatrics at St Marks', 'Angela', '', 'DeLaO', 'MD', 'Pediatrics', '', '', NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1598930125', 0, 'N', 0, '2014-01-16', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'W12007715', 'W12007715', 'UT01', 'Wasatch Pediatrics', 'Angela', '', 'DeLaO', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1598930125', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W12006950', 'W12006950', 'UT01', 'Lone Peak Primary Care', 'Nichole', 'A', 'Delaplante', 'DO', 'Family Practice', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8015458480', '8015458495', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8015458480', '8015458495', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831344910', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W12006948', 'W12006948', 'UT01', 'Lone Peak Primary Care', 'Nichole', 'A', 'Delaplante', 'DO', 'Family Practice', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831344910', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W12006949', 'W12006949', 'UT01', 'Lone Peak Primary Care', 'Nichole', 'A', 'Delaplante', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831344910', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('010967947', 'W12008987', 'W12008987', 'UT01', 'East Falls Cardiovascular and Thoracic Surgery', 'Michael ', '', 'Denyer', '', 'Cardiovascular Disease', '', '', NULL, 'O', '2860 Channing Way Ste 112', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354600', '2085354609', '2860 Channing Way Ste 112', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354600', '2085354609', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235133844', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('010967947', 'W12008988', 'W12008988', 'UT01', 'East Falls Cardiovascular and Thoracic Surgery', 'Michael ', '', 'Denyer', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741310', 'Atlanta', 'Fulton', 'GA', '30384', '2085354600', '2085354609', 'PO Box 741310', 'Atlanta', 'Fulton', 'GA', '30384', '2085354600', '2085354609', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235133844', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12008005', 'W12008005', 'TX01', 'Health Texas Medical Group of San Antonio', 'Tamara', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'O', '20821 US Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '2105461600', '2105461610', '20821 US Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '2105461600', '2105461610', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-03-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1104049592', 0, 'N', 0, '2014-04-09', NULL, NULL, 29.639, -98.4576, NULL, NULL),
('202148889', 'W12008006', 'W12008006', 'TX01', 'Health Texas Medical Group of San Antonio', 'Tamara', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-03-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1104049592', 0, 'N', 0, '2014-04-09', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12008007', 'W12008007', 'TX01', 'Health Texas Medical Group of San Antonio', 'Tamara', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-03-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1104049592', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('263150414', 'W12008989', 'W12008989', 'UT01', 'HepFree Inc', 'Stewart', 'L', 'Ellington', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018152437', '8016067330', '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018152437', '8016067330', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', '2013-10-08', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1437179041', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008990', 'W12008990', 'UTMH1', 'Life Mosaics Family Counseling', 'Sarah', '', 'Engler', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', '1358 W Business Park Dr', 'Orem', 'Utah', 'UT', '84058', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760717052', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W12008991', 'W12008991', 'UTMH1', 'Life Mosaics Family Counseling', 'Sarah', '', 'Engler', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'PO Box 539', 'Orem', 'Utah', 'UT', '84059', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760717052', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'W12008037', 'W12008037', 'UT01', 'Foothill Family Clinic', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-03-29', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'W12008036', 'W12008036', 'UT01', 'Foothill Family Clinic', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8014856339', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-03-29', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12006946', 'W12006946', 'UT01', '', 'John', 'M', 'Hemmersmeier', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1073582995', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12006945', 'W12006945', 'UT01', '', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12008994', 'W12008994', 'UT01', 'Canyon View Medical Group', 'Jeffrey', 'J', 'Juchau', 'MD', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-17', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1225083504', 0, 'N', 0, '2013-08-26', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12008995', 'W12008995', 'UT01', 'Canyon View Pediatrics', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', NULL, 'O', '15 S 1000 E', 'Payson', 'Utah', 'UT', '84651', '8014659480', NULL, '15 S 1000 E', 'Payson', 'Utah', 'UT', '84651', '8014659480', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2011-09-25', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1265609929', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12008996', 'W12008996', 'UT01', 'Canyon View Medical Group', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', NULL, 'O', '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', NULL, '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2011-09-25', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1265609929', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12008997', 'W12008997', 'UT01', 'Canyon View Medical Group', 'Miguel', 'L', 'Knochel', 'MD', 'Pediatrics', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730136243', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('942938348', 'W12008998', 'W12008998', 'UTMH1', 'Valley Mental Health  Inc', 'Julie', 'W', 'Larsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2011-03-17', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679888754', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008999', 'W12008999', 'UT01', 'Nexus Pain Care', 'Tao', '', 'Li', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-17', '2011-11-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376725143', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009000', 'W12009000', 'UT01', 'Nexus Pain Care', 'Tao', '', 'Li', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-17', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376725143', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('810608733', 'W12009001', 'W12009001', 'UT01', 'Nexus Pain Care', 'Tao', '', 'Li', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-17', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376725143', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009002', 'W12009002', 'UT01', 'Nexus Pain Care', 'Tao', '', 'Li', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-17', '2011-11-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376725143', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12007557', 'W12007557', 'UT01', 'Home Ox of Utah', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1025 N 3rd St Ste 125', 'Lawrence', 'Douglas', 'KS', '66044', '8668308102', '8012943074', '1025 N 3rd St Ste 125', 'Lawrence', 'Douglas', 'KS', '66044', '8668308102', '8012943074', 'WLINCARE', '', '', '0.00', '20.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952465189', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12007556', 'W12007556', 'UT01', 'Home Ox of Utah', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '577 W 1350 S  Ste C', 'Bountiful', 'Davis', 'UT', '84010', '8882945759', '8012943074', '577 W 1350 S  Ste C', 'Bountiful', 'Davis', 'UT', '84010', '8882945759', '8012943074', 'WLINCARE', '', '', '0.00', '20.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952465189', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12009003', 'W12009003', 'UT01', 'Canyon View Medical Group', 'Carter', 'S', 'Lytle', 'MD', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1588619506', 0, 'N', 0, '2013-08-19', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12009004', 'W12009004', 'UT01', 'Canyon View Medical Group', 'Michael', '', 'McLay', 'MD', 'Family Practice', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', NULL, '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1063605475', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.1723, -111.61, NULL, NULL),
('273771762', 'W12009005', 'W12009005', 'UT01', 'Diabetes Health Management', 'Syed', 'I', 'Nabi', 'MD', 'Internal Medicine', 'Sleep Medicine', '', NULL, 'O', '2376 N 400 E Ste 207', 'Tooele', 'Tooele', 'UT', '84074', '8019384069', '8019941393', '2376 N 400 E Ste 207', 'Tooele', 'Tooele', 'UT', '84074', '8019384069', '8019941393', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-10-18', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1831205731', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('010858024', 'W12008810', 'W12008810', 'UT01', 'Interwest Comprehensive Pain Center', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '4357139681', NULL, '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '4357139681', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2012-03-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('010858024', 'W12008812', 'W12008812', 'UT01', 'Interwest Comprehensive Pain Center', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '274  N Main St', 'Logan', 'Cache', 'UT', '84321', '4357139681', NULL, '274  N Main St', 'Logan', 'Cache', 'UT', '84321', '4357139681', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('010858024', 'W12008811', 'W12008811', 'UT01', 'Interwest Comprehensive Pain Center', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '950 S 500 W Ste 103A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349471', NULL, '950 S 500 W Ste 103A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349471', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12008074', 'W12008074', 'TX01', 'Health Texas Medical Group of San Antonio', 'Thomas', '', 'Leytham', 'MD', 'Family Practice', '', '', NULL, 'O', '20821 Us Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '2105461600', '2105461610', '20821 Us Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '2105461600', '2105461610', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-12-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629060785', 0, 'N', 0, '2011-04-29', NULL, NULL, 29.639, -98.4576, NULL, NULL),
('870549057', 'W12009008', 'W12009008', 'Group', 'Utah Valley Pediatrics', '', '', 'Utah Valley Pediatrics', 'Group', 'Pediatrics', '', '', NULL, 'O', '1355 N Universtiy Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', '1355 N Universtiy Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497812721', 0, 'N', 0, '2011-07-05', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12009009', 'W12009009', 'WY01', 'Sweetwater Medical Group', 'Chris', '', 'Moser', 'MD', 'Family Practice', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', '2013-11-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962441618', 0, 'N', 0, '2013-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870482687', 'W12009010', 'W12009010', 'UT01', 'Bear River Eye Center', 'Phillip', 'L', 'Purcell', 'OD', 'Optometry', '', '', NULL, 'O', '495 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '4352576229', '495 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '4352576229', '', '', 'OPT01', '0.00', '0.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356653513', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.7188, -112.175, NULL, NULL),
('870482687', 'W12009011', 'W12009011', 'UT01', 'Bear River Eye Center', 'Phillip', 'L', 'Purcell', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '4352576229', 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '4352576229', '', '', 'OPT01', '0.00', '0.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356653513', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12009016', 'W12009016', 'UT01', 'Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-12-31', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12009015', 'W12009015', 'UT01', 'Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8015691999', '8015692001', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-12-31', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12009014', 'W12009014', 'UT01', 'Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-12-31', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('820478504', 'W12008128', 'W12008128', 'ID01', 'Personal Solutions', 'Kristina', 'L', 'Palmer', 'LPC', 'Mental Health', '', '', NULL, 'O', '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2089383837', '2089383857', '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2089383837', '2089383857', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-03-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447423462', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('518829110', 'W12009017', 'W12009017', 'ID01', 'Remedy Counseling', 'Kristina', 'L', 'Palmer', 'LPC', 'Mental Health', '', '', NULL, 'O', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2083661601', '2083661602', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2083661601', '2083661602', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-14', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447423462', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12009018', 'W12009018', 'UT01', 'Canyon View Medical Group', 'Richard', 'D', 'Paxton', 'MD', 'Pediatrics', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1922046234', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12009019', 'W12009019', 'UT01', 'Canyon View Medical Group', 'Marc', 'A', 'Penrod', 'MD', 'Family Practice', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', NULL, '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1831137140', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.1723, -111.61, NULL, NULL),
('810608733', 'W12009020', 'W12009020', 'UT01', 'Nexus Pain Care', 'Alex', 'H', 'Phan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316091531', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009021', 'W12009021', 'UT01', 'Nexus Pain Care', 'Alex', 'H', 'Phan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316091531', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009022', 'W12009022', 'UT01', 'Nexus Pain Care', 'Alex', 'H', 'Phan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316091531', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009023', 'W12009023', 'UT01', 'Nexus Pain Care', 'Alex', 'H', 'Phan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316091531', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12009026', 'W12009026', 'UT01', 'Canyon View Medical Group', 'James', 'J', 'Rose', 'MD', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1013955327', 0, 'Y', 0, '2013-08-26', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('810608733', 'W12009027', 'W12009027', 'UT01', 'Nexus Pain Care', 'Richard', '', 'Rosenthal', 'MD', 'Pain Management', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-11-17', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073512745', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009028', 'W12009028', 'UT01', 'Nexus Pain Care', 'Richard', '', 'Rosenthal', 'MD', 'Pain Management', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073512745', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('810608733', 'W12009029', 'W12009029', 'UT01', 'Nexus Pain Care', 'Richard', '', 'Rosenthal', 'MD', 'Pain Management', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073512745', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12009030', 'W12009030', 'UT01', 'Nexus Pain Care', 'Richard', '', 'Rosenthal', 'MD', 'Pain Management', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-18', '2011-11-17', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073512745', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('010967947', 'W12009031', 'W12009031', 'UT01', 'East Falls Cardiovascular and Thoracic Surgery', 'Brian ', '', 'Rundall', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '2860 Channing Way Ste 112', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354600', '2085354609', '2860 Channing Way Ste 112', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354600', '2085354609', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841217585', 0, 'N', 0, '2011-04-06', NULL, NULL, 0, 0, NULL, NULL),
('010967947', 'W12009032', 'W12009032', 'UT01', 'East Falls Cardiovascular and Thoracic Surgery', 'Brian ', '', 'Rundall', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741310', 'Atlanta', 'Fulton', 'GA', '30384', '2085354600', '2085354609', 'PO Box 741310', 'Atlanta', 'Fulton', 'GA', '30384', '2085354600', '2085354609', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841217585', 0, 'N', 0, '2011-04-06', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12009033', 'W12009033', 'UT01', 'Canyon View Medical Group', 'Roman', 'Y', 'Takasaki', 'MD', 'Family Practice', '', '', NULL, 'O', '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', NULL, '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1669428611', 0, 'N', 0, '2013-09-13', NULL, NULL, 39.9756, -111.787, NULL, NULL),
('841367175', 'W12009034', 'W12009034', 'UT01', 'Canyon View Medical Group', 'Roman', 'Y', 'Takasaki', 'MD', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1669428611', 0, 'N', 0, '2013-09-13', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12009035', 'W12009035', 'UT01', 'Canyon View Medical Group', 'John', 'S', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', NULL, '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1740228055', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.1723, -111.61, NULL, NULL),
('841367175', 'W12009036', 'W12009036', 'UT01', 'Canyon View Medical Group', 'Orlando', 'R', 'Valdez', 'MD', 'Pediatrics', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2011-09-30', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912945239', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009039', 'W12009039', 'UT01', 'Central Utah Clinic PC', 'Jennifer', '', 'Walker', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8017565288', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8017565288', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386948479', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12009040', 'W12009040', 'UT01', 'Central Utah Clinic PC', 'Jennifer', '', 'Walker', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386948479', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12009041', 'W12009041', 'UT01', 'Canyon View Medical Group', 'Matthew', 'S', 'Walton', 'DO', 'Family Practice', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1497905566', 0, 'N', 0, '2011-03-18', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('741849254', 'W12008217', 'W12008217', 'TX01', 'Southeast Surgical Associates', 'Naveed', '', 'Zafar', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-02-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659690196', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('741849254', 'W12008218', 'W12008218', 'TX01', 'Southeast Surgical Associates', 'Naveed', '', 'Zafar', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-02-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659690196', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12009044', 'W12009044', 'ID02', 'Intermountain Eye & Laser Centers', 'Deric', '', 'Simmons', 'OD', 'Optometry', '', '', NULL, 'O', '3090 Gentry way Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2088880005', '2088989924', '3090 Gentry way Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2088880005', '2088989924', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801886841', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12009043', 'W12009043', 'ID02', 'Intermountain Eye & Laser Centers', 'Deric', '', 'Simmons', 'OD', 'Optometry', '', '', NULL, 'O', '323 E Riverside Dr Ste 122', 'Eagle', 'Ada', 'ID', '83616', '2089384749', '2089384902', '323 E Riverside Dr Ste 122', 'Eagle', 'Ada', 'ID', '83616', '2089384749', '2089384902', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801886841', 0, 'N', 0, '2013-01-10', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('260553931', 'W12009052', 'W12009052', 'ID01', 'Saint Alphonsus Medical Group Heart Care Boise', 'Steven', 'J', 'Fonken', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063437630', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('260553931', 'W12009053', 'W12009053', 'ID01', 'Saint Alphonsus Medical Group Heart Care Emmett', 'J Antonio', 'G', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1326011503', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('260553931', 'W12009054', 'W12009054', 'ID01', 'Saint Alphonsus Medical Group Heart Care', 'J Antonio', 'G', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1326011503', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, 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
('260553931', 'W12009055', 'W12009055', 'ID01', 'Saint Alponsus Medical Group Heart Care Boise Moreau Bldg', 'David', 'F', 'Oakes', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083642987', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820425454', 'W12009058', 'W12009058', 'ID01', 'Boise Anesthesia PA', 'Nathan', '', 'Steenblik', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '5033722754', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '5033722754', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2011-02-15', '2011-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1306143185', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12009061', 'W12009061', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Mario', '', 'Martinez', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-02-15', '2011-10-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1891904132', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12009060', 'W12009060', 'ID01', 'Northwest Pulmonary Saint Alphonsus ', 'Mario', '', 'Martinez', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-02-15', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1891904132', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('260553931', 'W12009062', 'W12009062', 'ID01', 'Saint Alphonsus Medical Group Heart Care Boise', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '6140 W Curtisian Ave Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ave Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('260553931', 'W12009063', 'W12009063', 'ID01', 'Saint Alphonsus Medical Group Heart Care Eagle', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675734', '2083675744', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2012-06-26', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('273291370', 'W12009064', 'W12009064', 'ID02', 'Northwest Neurobehavioral Health', 'Trevor', 'A', 'Hall', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2950 E Magic View Dr Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2950 E Magic View Dr Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-09-27', '2011-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013223445', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009071', 'W12009071', 'ID01', 'Anesthesiology Consultants of ID', 'Bradley', 'P', 'Bretz', 'MD', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1124016464', 0, 'N', 0, '2013-05-03', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009073', 'W12009073', 'ID01', 'Anesthesiology Consultants of ID', 'Michael', 'J', 'Decker', 'MD', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-31', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174511406', 0, 'N', 0, '2011-07-22', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009075', 'W12009075', 'ID01', 'Anesthesiology Consultants of ID', 'Ryan', 'H', 'Mecham', 'MD', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1255423265', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009077', 'W12009077', 'ID01', 'Anesthesiology Consultants of ID', 'Curtis', 'T', 'Rigby', 'DO', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-01', 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1821200742', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009079', 'W12009079', 'ID01', 'Anesthesiology Consultants of ID', 'Michael', 'D', 'Severson', 'MD', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1205827904', 0, 'N', 0, '2013-05-03', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12009081', 'W12009081', 'ID01', 'Anesthesiology Consultants of ID', 'Kerri', 'D', 'Trainer', 'DO', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-02-15', '2011-03-01', 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1477537280', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('274156695', 'W12009088', 'W12009088', 'UT01', 'Sleep and Lung Clinic of Utah Inc', 'Ali', '', 'Ahmed', 'MD', 'Pulmonary', 'Critical Care', '', NULL, 'O', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1013994813', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.6454, -111.882, NULL, NULL),
('201030213', 'W12012486', 'W12012486', 'UT01', 'Sanders Chiropractic and Wellness', 'Ronald', 'Eric', 'Sanders', '', 'Chiropractic', '', '', NULL, 'O', '180 E Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8012560006', '8012560005', '180 E Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8012560006', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.45', 3, '2011-01-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619044179', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('880379704', 'W12009089', 'W12009089', 'ID01', 'Foster Chiropractic', 'Matthew', 'J', 'Caldwell', 'DC', 'Chiropractic', '', '', NULL, 'O', '1675 N Maple Grove', 'Boise', 'Ada', 'ID', '83704', '2083764940', '2083766812', '1675 N Maple Grove', 'Boise', 'Ada', 'ID', '83704', '2083764940', '2083766812', 'IDCHIRO1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073789400', 0, 'N', 0, '2014-02-05', NULL, NULL, 43.6204, -116.294, NULL, NULL),
('274156695', 'W12009090', 'W12009090', 'UT01', 'Sleep and Lung Clinic of Utah', 'Sunny', '', 'Pandita', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'O', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023095809', 0, 'N', 0, '2012-02-09', NULL, NULL, 40.6454, -111.882, NULL, NULL),
('870549057', 'W12009091', 'W12009091', 'UT01', 'Utah Valley Pediatrics', 'Ross', 'M', 'Adams', 'DO', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912965138', 0, 'N', 0, '2013-08-19', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('870543342', 'W12009092', 'W12009092', 'UT01', 'Moab Regional Hospital', '', '', 'Moab Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193500', '          ', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4357193500', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2011-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770513236', 0, 'N', 0, '2014-03-27', NULL, NULL, 38.5743, -109.56, NULL, NULL),
('870622942', 'W12009093', 'W12009093', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '450 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597191', '4352595172', '450 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597191', '4352595172', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2011-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'N', 0, '2013-04-15', NULL, NULL, 38.5743, -109.56, NULL, NULL),
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('870549057', 'W12009118', 'W12009118', 'UT01', 'Utah Valley Pediatrics', 'Richard', 'Y', 'Farnsworth', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1780693929', 0, 'N', 0, '2013-08-14', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('870549057', 'W12009119', 'W12009119', 'UT01', 'Utah Valley Pediatrics', 'Phil', '', 'Freestone', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811964695', 0, 'N', 0, '2011-03-24', NULL, NULL, 40.3003, -111.705, NULL, NULL),
('870549057', 'W12009120', 'W12009120', 'UT01', 'Utah Valley Pediatrics', 'Michael', 'P', 'Fullmer', 'DO', 'Pediatrics', '', '', NULL, 'O', '15 S 100 E Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652800', '8014654770', '15 S 100 E Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652800', '8014654770', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780789099', 0, 'N', 0, '2011-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'W12009121', 'W12009121', 'UT01', 'Utah Valley Pediatrics', 'Gordon', 'B', 'Glade', 'MD', 'Pediatrics', '', '', NULL, 'O', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565209', '8017565200', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565209', '8017565200', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1699703702', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.3805, -111.769, NULL, NULL),
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('870549057', 'W12009123', 'W12009123', 'UT01', 'Utah Valley Pediatrics', 'Jeffrey', 'L', 'Jensen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275591471', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.2519, -111.659, NULL, NULL),
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('870549057', 'W12009125', 'W12009125', 'UT01', 'Utah Valley Pediatrics', 'Richard', 'W', 'Later', 'MD', 'Pediatrics', '', '', NULL, 'O', '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577883', '8013577975', '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577883', '8013577975', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962476002', 0, 'N', 0, '2014-01-28', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870549057', 'W12009126', 'W12009126', 'UT01', 'Utah Valley Pediatrics', 'Michael', '', 'Lauret', 'MD', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '8013776811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821056029', 0, 'N', 0, '2014-01-28', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('870549057', 'W12009127', 'W12009127', 'UT01', 'Utah Valley Pediatrics', 'Garron', 'E', 'Miller', 'MD', 'Pediatrics', '', '', NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2013-08-21', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114992856', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'W12009128', 'W12009128', 'UT01', 'Utah Valley Pediatrics', 'Scott', 'H', 'Mumford', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565209', '8017565200', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565209', '8017565200', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275561391', 0, 'N', 0, '2013-08-21', NULL, NULL, 40.3805, -111.769, NULL, NULL),
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('870549057', 'W12009133', 'W12009133', 'UT01', 'Utah Valley Pediatrics', 'John', 'R', 'Wynn', 'MD', 'Pediatrics', '', '', NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012241057', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1255308102', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.3003, -111.705, NULL, NULL),
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('870574059', 'W12009135', 'W12009135', 'UT01', 'Mountain Land Moab', 'James', 'A', 'Lewis', 'PT', 'Physical Therapy', '', '', NULL, 'O', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352593600', '4352597718', '450 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352593600', '4352597718', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2011-03-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1992899116', 0, 'N', 0, '2011-06-03', NULL, NULL, 0, 0, NULL, NULL),
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('870488222', 'W12006609', 'W12006609', 'UT01', 'Willow Creek Chiropractic', 'Brian', '', 'Thomas', 'DC', 'Chiropractic', '', '', NULL, 'O', '8170 S Highland Dr Ste E2', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424999', '8019428816', '8170 S Highland Dr Ste E2', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424999', '8019428816', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235269366', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12009156', 'W12009156', 'UTIHCPHY', 'Southwest Urology', 'David', 'Michael', 'Adams', 'MD', 'Urology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1669695920', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12009157', 'W12009157', 'UTIHCPHY', 'Utah Heart-Park City', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('942854057', 'W12009162', 'W12009162', 'UTIHCPHY', 'Utah Valley Hyperbaric and Wound Care', 'Eugene', 'R', 'Worth', 'MD', 'Hyperbaric Medicine', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578156', '8013573040', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578156', '8013573040', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801816061', 0, 'N', 0, '2013-06-03', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12009164', 'W12009164', 'UTIHCPHY', 'Dixie Maternal Fetal Medicine', '', '', 'Dixie Maternal Fetal Medicine', 'Group', 'Clinic', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093013203', 0, 'N', 0, '2011-03-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12009166', 'W12009166', 'UTIHCPHY', 'Dixie High Risk OB', '', '', 'Dixie High Risk OB', 'Group', 'Clinic', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134428279', 0, 'N', 0, '2011-03-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12009168', 'W12009168', 'UTIHCPHY', 'Utah Valley Hyperbaric and Wound Care', '', '', 'Utah Valley Hyperbaric and Wound Care', 'Group', 'Clinic', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578156', '8013573040', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578156', '8013573040', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104127901', 0, 'N', 0, '2011-03-28', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('841368924', 'W12009172', 'W12009172', 'SINCLAIRDEN', '', 'Gerard', '', 'Cournoyer', '', 'Family Practice', '', '', NULL, 'O', '2620 Comercial Way Ste 110', 'Rock Springs', 'Sweetwater', 'WY', '84901', '3073829101', NULL, '2620 Comercial Way Ste 110', 'Rock Springs', 'Sweetwater', 'WY', '84901', '3073829101', '          ', 'WYSINCLAIR8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003801051', 0, 'N', 0, '2011-03-29', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W12009189', 'W12009189', 'UT01', 'U of U Emergency Physicians', 'Liena', 'M', 'Brady', 'APRN', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-28', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629210646', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12009192', 'W12009192', 'UT01', 'University Health Care', 'Elizabeth', 'H', 'Doby', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932371358', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12009193', 'W12009193', 'UT01', 'University Health Care', 'Elizabeth', 'H', 'Doby', 'MD', 'Pediatrics', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932371358', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12009221', 'W12009221', 'UT01', 'U of U Hospitals and Clinics', 'Scott', 'D', 'Miller', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUNIVOP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-05-20', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982831632', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('200580755', 'W12009230', 'W12009230', 'UTDT01', 'Quality Plaza Dental Care', 'Aaron S', '', 'Goldberg', 'DDS', 'Dentist', '', '', NULL, 'O', '1050 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014872206', NULL, '1050 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014872206', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006431', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('900660044', 'W12009239', 'W12009239', 'ID01', '', 'Julia', 'P', 'Gerhardt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6550 W Emerald St Ste 110', 'Boise', 'Ada', 'ID', '83704', '2082978585', NULL, '6550 W Emerald St Ste 110', 'Boise', 'Ada', 'ID', '83704', '2082978585', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457477986', 0, 'N', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12009270', 'W12009270', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 320', 'San Antonio', 'Bexar', 'TX', '78212', '2103965310', NULL, '1200 Brooklyn Ave Ste 320', 'San Antonio', 'Bexar', 'TX', '78212', '2103965310', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('743003947', 'W12009266', 'W12009266', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045506', '2108045510', '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045506', '2108045510', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('743003947', 'W12009269', 'W12009269', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2108045506', '2108045510', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2108045506', '2108045510', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('743003947', 'W12009271', 'W12009271', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2103965270', NULL, '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2103965270', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('743003947', 'W12009272', 'W12009272', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('743003947', 'W12009267', 'W12009267', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 235', 'San Antonio', 'Bexar', 'TX', '7822', '2108045506', '2108045510', '4212 E Southcross Blvd Ste 235', 'San Antonio', 'Bexar', 'TX', '7822', '2108045506', '2108045510', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2011-06-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12009268', 'W12009268', 'TX01', 'The San Antonio Orthopaedic Group', 'Stephen', 'J', 'Bell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 9585', 'San Antonio', 'Bexar', 'TX', '0491', '8004454263', NULL, 'PO Box 9585', 'San Antonio', 'Bexar', 'TX', '0491', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326028804', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12009275', 'W12009275', 'UTMH1', 'Northeastern Counseling Center', 'Grant', '', 'Child', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', '', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144422007', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12009274', 'W12009274', 'UTMH1', 'Northeastern Counseling Center', 'Grant', '', 'Child', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144422007', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('826000428', 'W12009276', 'W12009276', 'UT01', 'Oneida County Clinic', 'Tyson', 'A', 'Cluff', 'PA', 'Family Practice', '', '', NULL, 'O', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087662600', '2087664258', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087662600', '2087664258', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2012-04-05', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|', '1023253754', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12009278', 'W12009278', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Darryl', '', 'Collier-Freed', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '193 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8015619987', '8015619987', '193 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8015619987', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942440078', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12009277', 'W12009277', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Darryl', '', 'Collier-Freed', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942440078', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12009279', 'W12009279', 'UTMH1', 'Northeastern Counseling Center', 'Charles', 'L', 'Crane', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194901637', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12009280', 'W12009280', 'UT01', 'Utah County Medical Associates', 'Nolan', 'B', 'Money', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194759027', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('200791511', 'W12009281', 'W12009281', 'UT01', '', 'Mark', 'P', 'Pulver', 'PA', 'Dermatology', '', '', NULL, 'O', '602 E Fort Union Blvd 2nd Floor', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', '602 E Fort Union Blvd 2nd Floor', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205007093', 0, 'N', 0, '2011-05-03', NULL, NULL, 40.6207, -111.874, NULL, NULL),
('200791511', 'W12009282', 'W12009282', 'UT01', '', 'Mark', 'P', 'Pulver', 'PA', 'Dermatology', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8013131010', '8017472116', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8013131010', '8017472116', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205007093', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('870617263', 'W12009283', 'W12009283', 'UT01', 'St Marks Family Medicine', 'Leslie', 'H', 'Rassner', 'MD', 'Family Practice', '', '', NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1427022938', 0, 'N', 0, '2011-11-03', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870609595', 'W12009284', 'W12009284', 'UT01', 'Utah County Medical Associates', 'Gale', 'J', 'Skousen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305391', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('274672188', 'W12009351', 'W12009351', 'ID02', 'Treasure Valley Colon & Rectal Clinic', 'Johnny', 'B', 'Green', 'MD', 'General Surgery', 'Colon and Rectal Surgery', '', NULL, 'O', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-24', '2014-07-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386612414', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6139, -116.261, NULL, NULL),
('870476172', 'W12009286', 'W12009286', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Vinessa', 'K', 'Trotter', 'PHD', 'Mental Health', '', '', NULL, 'O', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8015619987', '8015619987', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8015619987', '8015619987', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952553794', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12009285', 'W12009285', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Vinessa', 'K', 'Trotter', 'PHD', 'Mental Health', '', '', NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '8015619987', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952553794', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('274411193', 'W12009290', 'W12009290', 'UT01', 'Granite Peaks Gastroenterology', 'Robert', 'K', 'Barnett', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1134119357', 0, 'N', 0, '2011-09-01', NULL, NULL, 40.5706, -111.857, NULL, NULL),
('274411193', 'W12009291', 'W12009291', 'UT01', 'Granite Peaks Gastroenterology', 'Christopher', 'S', 'Cutler', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1437162013', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.5706, -111.857, NULL, NULL),
('274411193', 'W12009292', 'W12009292', 'UT01', 'Granite Peaks Gastroenterology', 'Steven', 'G', 'Desautels', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1790891430', 0, 'N', 0, '2011-09-01', NULL, NULL, 40.5706, -111.857, NULL, NULL),
('274411193', 'W12009293', 'W12009293', 'UT01', 'Granite Peaks Gastroenterology', 'Andrew', 'M', 'Heiner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1497768014', 0, 'N', 0, '2011-09-02', NULL, NULL, 40.5706, -111.857, NULL, NULL),
('274411193', 'W12009294', 'W12009294', 'UT01', 'Granite Peaks Gastroenterology', 'John', 'D', 'Schmidt', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', '9829 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8016199000', '8016199001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1972760106', 0, 'N', 0, '2011-11-28', NULL, NULL, 40.5706, -111.857, NULL, NULL),
('271419508', 'W12009295', 'W12009295', 'UT01', 'Utah Pain Relief Institute South ', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'O', '32 W 6400 S Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012810555', '8012560696', '32 W 6400 S Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012810555', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.6332, -111.893, NULL, NULL),
('264572055', 'W12009296', 'W12009296', 'UT01', 'Old Farm OB/GYN', 'Spencer', 'P', 'Barney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', '8012613605', NULL, '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', '8012613605', '          ', 'WISE+5OB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982839130', 0, 'N', 0, '2013-06-17', NULL, NULL, 40.6861, -111.871, NULL, NULL),
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('942854057', 'W12009532', 'W12009532', 'UTIHC01', 'Infectious Disease', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-05-01', '2012-07-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-09-25', NULL, NULL, 0, 0, NULL, NULL),
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('263452005', 'W12009545', 'W12009545', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', NULL, '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12009546', 'W12009546', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', NULL, '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12009543', 'W12009543', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('274409223', 'W12009548', 'W12009548', 'WY01', 'Davis ENT Specialists', 'Thomas', '', 'Davis', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', 'Sleep Medicine', NULL, 'O', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '', '', '', '0.00', '18.00', '0.00', 3, '2011-03-04', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336139120', 0, 'N', 0, '2013-11-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009551', 'W12009551', 'UT01', 'Central Utah Clinic', 'Igor', 'Z', 'Abolnik', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1055 N 500 W Ste 202', 'Provo', 'Utah', 'UT', '84604', '8013742362', NULL, '1055 N 500 W Ste 202', 'Provo', 'Utah', 'UT', '84604', '8013742362', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1194783829', 0, 'N', 0, '2013-06-05', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870376403', 'W12009552', 'W12009552', 'UT01', 'Alta View Eye Care Center', 'Scott', 'R', 'Barnes', 'OD', 'Optometry', '', '', NULL, 'O', '9720 S 1300 E Ste E210', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720631', '8015720670', '9720 S 1300 E Ste E210', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720631', '8015720670', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215102298', 0, 'N', 0, '2014-07-16', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('870281028', 'W12009553', 'W12009553', 'UT01', 'Central Utah Clinic', 'Nancy', '', 'Ahlstrom', 'MD', 'Nephrology', '', '', NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', NULL, '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962431122', 0, 'N', 0, '2013-11-11', NULL, NULL, 40.248, -111.667, NULL, NULL),
('820525508', 'W12009554', 'W12009554', 'ID01', 'Whole Health Chiropractic', 'Nathan', 'T', 'Berrett', 'DC', 'Chiropractic', '', '', NULL, 'O', '430 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084421123', '2084421127', '430 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084421123', '2084421127', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-04-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942505896', 0, 'N', 0, '2014-07-24', NULL, NULL, 43.5543, -116.579, NULL, NULL),
('274156695', 'W12009555', 'W12009555', 'UT01', 'Sleep and Lung Clinic of Utah', 'David', 'G', 'Dienhart', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'O', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1184601940', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6454, -111.882, NULL, NULL),
('820315557', 'W12009556', 'W12009556', 'ID01', 'Boise Psychological Services', 'Patricia', 'A', 'Moore', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083763546', NULL, '315 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083763546', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164431029', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
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('274156695', 'W12009557', 'W12009557', 'UT01', 'Sleep and Lung Clinic of Utah', 'Patricia', 'L', 'Nelson', 'MD', 'Pulmonary', '', '', NULL, 'O', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', '5801 S Fashion Blvd Ste 280', 'Murray', 'Salt Lake', 'UT', '84107', '8012605864', '8012605865', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1629051206', 0, 'N', 0, '2014-03-13', NULL, NULL, 40.6454, -111.882, NULL, NULL),
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('870281028', 'W12009585', 'W12009585', 'UT01', 'Central Utah Clinic', 'Bruce', 'H', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '750 W 800 N Ste ', 'Provo', 'Utah', 'UT', '84604', '          ', NULL, '750 W 800 N Ste ', 'Provo', 'Utah', 'UT', '84604', '          ', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2012-11-05', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1285664078', 0, 'N', 0, '2012-11-08', NULL, NULL, 0, 0, NULL, NULL),
('352395602', 'W12009254', 'W12009254', 'UT01', 'University of Utah Pediatric Adolescent Professional Services', '', '', 'University of Utah Pediatric Adolescent Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407155591', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('300655693', 'W12009257', 'W12009257', 'UT01', 'University of Utah Adult Professional Services', '', '', 'University of Utah Adult Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699074781', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12009587', 'W12009587', 'UT01', 'Central Utah Clinic PC', 'David', 'B', 'Young', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '8017567589', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '8017567589', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1679756852', 0, 'Y', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12009593', 'W12009593', 'UT01', 'Central Utah Clinic PC', 'Dalton', 'H', 'Wright', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1174569131', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12009599', 'W12009599', 'UT01', 'Central Utah Clinic PC', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009600', 'W12009600', 'UT01', 'Central Utah Clinic PC', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8018124699', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8018124699', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.3121, -111.713, 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
('870281028', 'W12009601', 'W12009601', 'UT01', 'Central Utah Clinic', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8018124699', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8018124699', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009602', 'W12009602', 'UT01', 'Central Utah Clinic PC', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013577350', NULL, '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12009603', 'W12009603', 'UT01', 'Central Utah Clinic PC', 'Alan', 'L', 'Colledge', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629169370', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870281028', 'W12009604', 'W12009604', 'UT01', 'Central Utah Clinic PC', 'Aaron ', 'N', 'Weaver', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', NULL, '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750594222', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009605', 'W12009605', 'UT01', 'Central Utah Clinic PC', 'Aaron ', 'N', 'Weaver', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'Po Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013734366', NULL, 'Po Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013734366', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750594222', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009606', 'W12009606', 'UT01', 'Central Utah Clinic PC', 'William', 'T', 'Collins', 'MD', 'Urology', '', '', NULL, 'O', '15 S 1000 E Ste 250', 'Payson', 'Utah', 'UT', '84651', '8014652511', '8014659779', '15 S 1000 E Ste 250', 'Payson', 'Utah', 'UT', '84651', '8014652511', '8014659779', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851402572', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009607', 'W12009607', 'UT01', 'Central Utah Clinic PC', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'O', '1055 N 500 W Ste 112', 'Provo', 'Utah', 'UT', '84604', '8013548215', NULL, '1055 N 500 W Ste 112', 'Provo', 'Utah', 'UT', '84604', '8013548215', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009608', 'W12009608', 'UT01', 'Central Utah Clinic PC', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8018124699', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8018124699', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009609', 'W12009609', 'UT01', 'Central Utah Clinic', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017565288', '8017567589', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017565288', '8017567589', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2011-05-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009610', 'W12009610', 'UT01', 'Central Utah Clinic', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2011-05-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009611', 'W12009611', 'UT01', 'Central Utah Clinic PC', 'Robert', 'E', 'Corniea', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014298050', '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014298050', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1447218664', 0, 'N', 0, '2014-01-29', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009612', 'W12009612', 'UT01', 'Central Utah Clinic', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '8017567589', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '8017567589', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2011-05-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'Y', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009613', 'W12009613', 'UT01', 'Central Utah Clinic PC', 'David', 'C', 'Wang', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', NULL, '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649491440', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009614', 'W12009614', 'UT01', 'Central Utah Clinic PC', 'David', 'C', 'Wang', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649491440', 0, 'Y', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009615', 'W12009615', 'UT01', 'Central Utah Clinic PC', 'David', 'T', 'Cragun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014298191', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014298191', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821005349', 0, 'N', 0, '2013-03-30', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009616', 'W12009616', 'UT01', 'Central Utah Clinic PC', 'Steven', 'L', 'Wallentine', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '1055 N 500 W Ste 202', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014298015', '1055 N 500 W Ste 202', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014298015', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1790736122', 0, 'N', 0, '2013-11-21', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009617', 'W12009617', 'UT01', 'Central Utah Clinic PC', 'Steven', 'L', 'Wallentine', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298015', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298015', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1790736122', 0, 'Y', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009618', 'W12009618', 'UT01', 'Central Utah Clinic PC', 'Jeffrey', 'M', 'Wallentine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 121', 'Orem', 'Utah', 'UT', '84057', '8013737350', NULL, '1055 N 500 W Ste 121', 'Orem', 'Utah', 'UT', '84057', '8013737350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124121934', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12009692', 'W12009692', 'UT01', 'Central Utah Clinic PC', 'Joseph', 'L', 'Richey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8013737350', '8013742615', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8013737350', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1982708913', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870281028', 'W12009693', 'W12009693', 'UT01', 'Central Utah Clinic PC', 'Joseph', 'L', 'Richey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013737350', '8013742615', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013737350', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1982708913', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.044, -111.716, 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
('870281028', 'W12009694', 'W12009694', 'UT01', 'Central Utah Clinic PC', 'C', 'W', 'Bacon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1962505750', 0, 'N', 0, '2013-12-09', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12009695', 'W12009695', 'UT01', 'Central Utah Clinic PC', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009696', 'W12009696', 'UT01', 'Central Utah Clinic PC', 'C', 'W', 'Bacon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1962505750', 0, 'N', 0, '2013-12-09', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870281028', 'W12009697', 'W12009697', 'UT01', 'Central Utah Clinic PC', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870281028', 'W12009698', 'W12009698', 'UT01', 'Central Utah Clinic PC', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'Y', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009699', 'W12009699', 'UT01', 'Central Utah Clinic PC', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15 S 1000 E', 'Payson', 'Utah', 'UT', '84651', '8013577350', NULL, '15 S 1000 E', 'Payson', 'Utah', 'UT', '84651', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12009701', 'W12009701', 'UT01', 'Central Utah Clinic PC', 'McKay', 'L', 'Platt', 'MD', 'Urology', '', '', NULL, 'O', '1055 N 500 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8013577327', NULL, '1055 N 500 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8013577327', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1336230085', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009703', 'W12009703', 'UT01', 'Central Utah Clinic PC', 'McKay', 'L', 'Platt', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1336230085', 0, 'Y', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009704', 'W12009704', 'UT01', 'Central Utah Clinic PC', 'Samuel', 'R', 'Peterson', 'MD', 'Dermatology', '', '', NULL, 'O', '1055 N 500 W Ste 111', 'Provo', 'Utah', 'UT', '84604', '8013748999', NULL, '1055 N 500 W Ste 111', 'Provo', 'Utah', 'UT', '84604', '8013748999', '', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073571295', 0, 'N', 0, '2014-06-25', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009705', 'W12009705', 'UT01', 'Central Utah Clinic PC', 'Samuel', 'R', 'Peterson', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073571295', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009706', 'W12009706', 'UT01', 'Central Utah Clinic PC', 'Michael', 'C', 'Peterson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8013742615', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902827322', 0, 'Y', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009709', 'W12009709', 'UT01', 'Central Utah Clinic PC', 'Gus', 'C', 'Pendleton', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '4356738557', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649361874', 0, 'N', 0, '2013-10-16', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('870281028', 'W12009710', 'W12009710', 'UT01', 'Central Utah Clinic PC', 'Gus', 'C', 'Pendleton', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '4356738557', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649361874', 0, 'Y', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009711', 'W12009711', 'UT01', 'Central Utah Clinic PC', 'Richard', 'K', 'Olsen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013742362', NULL, '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013742362', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932157138', 0, 'N', 0, '2014-01-28', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009712', 'W12009712', 'UT01', 'Central Utah Clinic PC', 'Richard', 'K', 'Olsen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932157138', 0, 'Y', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009713', 'W12009713', 'UT01', 'Central Utah Clinic PC', 'Lawrence', 'K', 'Nobuhara', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1740399385', 0, 'N', 0, '2014-04-07', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009714', 'W12009714', 'UT01', 'Central Utah Clinic PC', 'Lawrence', 'K', 'Nobuhara', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1740399385', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009715', 'W12009715', 'UT01', 'Central Utah Clinic PC', 'Thu', 'A', 'Nguyen', 'MD', 'Neurology', '', '', NULL, 'O', '1175 E 50 S Ste 161', 'American Fork', 'Utah', 'UT', '84003', '8014925992', NULL, '1175 E 50 S Ste 161', 'American Fork', 'Utah', 'UT', '84003', '8014925992', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649204389', 0, 'N', 0, '2013-11-25', NULL, NULL, 40.3757, -111.77, NULL, NULL),
('870281028', 'W12009716', 'W12009716', 'UT01', 'Central Utah Clinic PC', 'Thu', 'A', 'Nguyen', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649204389', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009717', 'W12009717', 'UT01', 'Central Utah Clinic PC', 'Erica', 'C', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '          ', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2014-07-13', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386974525', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.3722, -111.769, NULL, NULL),
('870281028', 'W12009718', 'W12009718', 'UT01', 'Central Utah Clinic PC', 'Erica', 'C', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '          ', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2014-07-13', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386974525', 0, 'Y', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009719', 'W12009719', 'UT01', 'Central Utah Clinic PC', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013737350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013737350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12009720', 'W12009720', 'UT01', 'Central Utah Clinic PC', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870281028', 'W12009721', 'W12009721', 'UT01', 'Central Utah Clinic PC', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009722', 'W12009722', 'UT01', 'Central Utah Clinic PC', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013737350', NULL, '15 S 1000 E Ste 150', 'Payson', 'Utah', 'UT', '84651', '8013737350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12009723', 'W12009723', 'UT01', 'Central Utah Clinic PC', 'Chun', '', 'Hwang', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', NULL, '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-03-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649238080', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009724', 'W12009724', 'UT01', 'Central Utah Clinic PC', 'Bartley', 'B', 'Mortensen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 122', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', '1055 N 500 W Ste 122', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659473361', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12009725', 'W12009725', 'UT01', 'Central Utah Clinic PC', 'Bartley', 'B', 'Mortensen', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659473361', 0, 'Y', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
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