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
('870621939', 'S77007260', 'S77007260', 'UT01', 'Alpine Womens Clinic', 'James', 'R', 'Nelson', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '48 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565826', NULL, '48 N 1100 E', 'American Fork', '', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588646350', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007261', 'S77007261', 'UT01', 'Utah Imaging Associates', 'Sandra', 'J', 'Althaus', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1326048018', 0, 'Y', 0, '2011-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007262', 'S77007262', 'UT01', 'Utah Imaging Associates', 'Lance', '', 'Arnder', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834663', 0, 'Y', 0, '2011-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007263', 'S77007263', 'UT01', 'Utah Imaging Associates', 'Craig', 'M', 'Carpenter', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326046558', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007264', 'S77007264', 'UT01', 'Utah Imaging Associates', 'David', 'R', 'Dedrickson', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144222779', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007265', 'S77007265', 'UT01', 'Utah Imaging Associates', 'Peter', '', 'Hathaway', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000834029', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77007266', 'S77007266', 'UT01', 'Utah Imaging Associates', 'Ronald', 'J', 'Miller', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1902807092', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007273', 'S77007273', 'UT01', 'Epic', 'Barbara', 'D', 'Dahl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832054', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007276', 'S77007276', 'UT01', 'Epic', 'Thomas', 'G', 'Darr', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624242', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831082', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007277', 'S77007277', 'UT01', 'Epic', 'Thomas', 'G', 'Darr', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831082', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007278', 'S77007278', 'UT01', 'Epic', 'Daniel', 'R', 'Duggleby', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834184', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007280', 'S77007280', 'UT01', 'Epic', 'Brett', 'J', 'Earl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832284', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007281', 'S77007281', 'UT01', 'Epic', 'Brett', 'J', 'Earl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832284', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007282', 'S77007282', 'UT01', 'Davis Hospital & Medical Center', 'Garrett', 'J', 'Emery', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833977', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007283', 'S77007283', 'UT01', 'Epic', 'John', 'A', 'Gezon', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1990 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015665691', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833884', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007285', 'S77007285', 'UT01', 'Epic', 'J Linke', NULL, 'Hebrew', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '211 S 100 E', 'Tooele', 'Tooele', 'UT', '84074', '4358821697', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833303', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007286', 'S77007286', 'UT01', 'Davis Hospital & Medical Center', 'Allen', 'R', 'Jensen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831494', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007289', 'S77007289', 'UT01', 'Nephi Medical Clinic', 'Molly', 'M', 'Brotherson', 'PA', 'Family Practice', '', '', NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '', '', NULL, '', '0.00', '11.00', '0.00', 3, '2006-11-01', '2009-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578598132', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007290', 'S77007290', 'UT01', 'Nephi Medical Clinic', 'Molly', 'M', 'Brotherson', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, '', '0.00', '11.00', '0.00', 3, '2006-11-01', '2009-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578598132', 0, 'Y', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007291', 'S77007291', 'UT01', 'Nephi Medical Clinic', 'Mark', 'C', 'Oveson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1417974098', 0, 'N', 0, '2013-09-23', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'S77007292', 'S77007292', 'UT01', 'Nephi Medical Clinic', 'Michael', 'C', 'Peterson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1902827322', 0, 'N', 0, '2011-04-08', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'S77007293', 'S77007293', 'UT01', 'Nephi Medical Clinic', 'Grant', 'J', 'Rasmussen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275563751', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007294', 'S77007294', 'UT01', 'Nephi Medical Clinic', 'James', 'A', 'Tatton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396785341', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007295', 'S77007295', 'UT01', 'Nephi Medical Clinic', 'James', 'A', 'Tatton', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', '', '', '0.00', '11.00', '0.00', 3, '2006-11-01', '2010-10-04', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396785341', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007296', 'S77007296', 'UT01', 'Nephi Medical Clinic', 'Jerald', 'B', 'Taylor', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083631659', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870421912', 'S77007298', 'S77007298', 'UT01', 'Valley Vision Clinic', 'David', 'M', 'Graf', 'OD', 'Optometry', '', '', NULL, 'O', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358968142', '4358969484', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358968142', '4358969484', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306805510', 0, 'N', 0, '2013-10-15', NULL, NULL, 38.7701, -112.083, NULL, NULL),
('870421912', 'S77007299', 'S77007299', 'UT01', 'Valley Vision Clinic', 'Richard', 'L', 'Luekenga', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358968142', '4358969484', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358968142', '4358969484', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891754933', 0, 'N', 0, '2012-10-12', NULL, NULL, 38.7701, -112.083, NULL, NULL),
('870422134', 'S77007300', 'S77007300', 'UT01', '', 'Richard', 'B', 'Nay', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 429', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287231', '4355287232', 'PO Box 429', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287231', '4355287232', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1780707711', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870427052', 'S77007301', 'S77007301', 'UT01', 'Plastic Surgery Associates', 'Louis', NULL, 'Morales', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'B', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', '5089 S 900 E', 'Salt Lake City', '', 'UT', '84117', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-04-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821060948', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635422', 'S77007302', 'S77007302', 'UT01', 'Rocky Mountain Foot And Ankle', 'Kelly', 'A', 'Gomez', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8013750346', NULL, 'PO Box 98', 'Springville', '', 'UT', '84663', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821021957', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635530', 'S77007303', 'S77007303', 'UT01', 'Mount Olympus Obstetrics and Gynecology', 'Diane', 'D', 'Heubusch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', NULL, '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-10-01', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1962449306', 0, 'N', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870635530', 'S77007304', 'S77007304', 'UT01', 'Mount Olympus Obstetrics and Gynecology', 'Eric', 'C', 'Nielson', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', NULL, '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013944289', 0, 'N', 0, '2012-05-25', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870635889', 'S77007305', 'S77007305', 'UT01', 'Tooele Clinic Corp', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-07-13', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007306', 'S77007306', 'UT01', 'Tooele Clinic Corp', 'Jennifer', 'A', 'Ziouras', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358435681', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831886', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007307', 'S77007307', 'UT01', 'Tooele Clinic Corp', 'Lisa', NULL, 'Zuraff-Perryman', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A-304', 'Brentwood', 'Williamson', 'TN', '37027', '8885479821', '6153457340', '196 E 2000 N', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-15', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832831', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007308', 'S77007308', 'UT01', 'Tooele Clinic Corp at Mtn West Surg Service', 'Lisa', NULL, 'Zuraff-Perryman', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 106', 'Tooele', 'Tooele', 'UT', '84074', '4358434930', '4358439997', '196 E 2000 N', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-15', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832831', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870637322', 'S77007309', 'S77007309', 'UT01', NULL, 'David', 'R', 'Boettger', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '9720 S 1300 E Ste W-120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015726700', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811937006', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870638151', 'S77007310', 'S77007310', 'UT01', 'Rock Canyon Family Medicine', 'Kenneth', 'L', 'Crump', 'MD', 'Family Practice', '', '', NULL, 'O', '3200 N Canyon Rd Ste E', 'Provo', 'Utah', 'UT', '84604', '8018123200', NULL, '3200 N Canyon Rd Ste E', 'Provo', 'Utah', 'UT', '84604', '8018123200', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-04-29', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891719308', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007314', 'S77007314', 'UT01', 'After Hours Medical Company', 'Michael', 'R', 'Adams', 'MD', 'Family Practice', '', 'Family Practice', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780781682', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007315', 'S77007315', 'UT01', 'After Hours Medical Company', 'David', 'L', 'Aune', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1598722340', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870624273', 'S77007327', 'S77007327', 'UT01', 'Mount Ogden Surgical Center', 'Richard', 'A', 'Boyce', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '4366 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794470', NULL, 'PO Box 1512', 'Layton', '', 'UT', '84041', '', '', '', NULL, '1000', '34.65', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275535932', 0, 'Y', 0, '2007-01-10', NULL, NULL, 41.1824, -111.971, NULL, NULL),
('870626821', 'S77007329', 'S77007329', 'UT01', NULL, 'Scott', 'Brett', 'Humpherys', 'DPM', 'Podiatry', '', '', NULL, 'O', '1928 N 1120 W Ste 6', 'Provo', 'Utah', 'UT', '84604', '8017859015', NULL, '1928 N 1120 W Ste 6', 'Provo', 'Utah', 'UT', '84604', '8017859015', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275647596', 0, 'N', 0, '2014-03-20', NULL, NULL, 40.2595, -111.676, NULL, NULL),
('870629690', 'S77007331', 'S77007331', 'UT01', 'Epic', 'Kathleen', NULL, 'Lawliss', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255397691', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007333', 'S77007333', 'UT01', 'Ogden Regional Medical Center', 'Mark', 'G', 'Oraskovich', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '830986', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007334', 'S77007334', 'UT01', 'Epic', 'Mark', 'G', 'Oraskovich', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '830986', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007335', 'S77007335', 'UT01', 'Epic', 'Lance', NULL, 'Owens', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834188', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007337', 'S77007337', 'UT01', 'Epic - Pioneer Valley Hospital', 'Cathey', NULL, 'Putnam', 'MD', 'Emergency Medicine', 'Hyperbaric Medicine ', NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8002250953', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833308', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007338', 'S77007338', 'UT01', 'Epic', 'L Val', NULL, 'Rollins', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831495', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007341', 'S77007341', 'UT01', 'Epic', 'Diane', NULL, 'Ruschke', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834179', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007342', 'S77007342', 'UT01', 'Epic - Jordan Valley Hospital', 'Diane', NULL, 'Ruschke', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834179', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007343', 'S77007343', 'UT01', 'Epic', 'Carol', NULL, 'Scott', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831517', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007344', 'S77007344', 'UT01', 'Epic - Lakeview Hospital', 'Carol', NULL, 'Scott', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831517', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007345', 'S77007345', 'UT01', 'Epic', 'Richard', 'J', 'Spence', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834191', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870427052', 'S77007346', 'S77007346', 'UT01', 'Plastic Surgery Associates', 'Rodney', 'E', 'Schmelzer', 'MD', 'Plastic Surgery', 'Emergency Medicine', NULL, NULL, 'B', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', '5089 S 900 E', 'Salt Lake City', '', 'UT', '84117', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-04-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487626297', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870427052', 'S77007347', 'S77007347', 'UT01', 'Plastic Surgery Associates', 'Rodney', 'Evan', 'Schmelzer', 'MD', 'Plastic Surgery', 'Emergency Medicine', NULL, NULL, 'O', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-12-31', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487626297', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77007351', 'S77007351', 'UT01', 'Beaver Medical Clinic', 'Mitchell', NULL, 'Melling', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', '', 'UT', '84713', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-04-02', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528063617', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77007352', 'S77007352', 'UT01', 'Beaver Medical Clinic', 'R', 'Wade', 'Oakden', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', '', 'UT', '84713', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital', NULL, NULL, 'HCFA|UB|', '1346245438', 0, 'N', 0, '2006-11-07', NULL, NULL, 38.2882, -112.643, NULL, NULL),
('870437878', 'S77007353', 'S77007353', 'UT01', 'Beaver Medical Clinic', 'R', 'Wade', 'Oakden', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'PO Box 1690', 'Beaver', '', 'UT', '84713', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital', NULL, NULL, 'HCFA|UB|', '1346245438', 0, 'Y', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77007354', 'S77007354', 'UT01', 'Beaver Medical Clinic', 'B', 'N', 'Robinson', 'MD', 'Family Practice', '', '', NULL, 'O', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', '1059 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Beaver Valley Hospital', '', '', '', 'HCFA|UB|', '1700881893', 0, 'N', 0, '2014-06-26', NULL, NULL, 38.2882, -112.643, NULL, NULL),
('870438335', 'S77007355', 'S77007355', 'UT01', NULL, 'Corey', 'A', 'Miller', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1485 E 3900 S Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012771087', '8013631113', '1485 E 3900 S Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012771087', '8013631113', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1699796482', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6871, -111.849, NULL, NULL),
('870629690', 'S77007373', 'S77007373', 'UT01', 'Epic', 'Jonathan', NULL, 'Appelbaum', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007374', 'S77007374', 'UT01', 'Epic Salt Lake Regional', 'Russell', NULL, 'Bradley', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8002250953', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834183', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007375', 'S77007375', 'UT01', 'Epic', 'Barbara', 'D', 'Dahl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832054', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007376', 'S77007376', 'UT01', 'Epic', 'Barbara', 'D', 'Dahl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832054', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007377', 'S77007377', 'UT01', 'Ogden Regional Medical Center', 'Barbara', 'D', 'Dahl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832054', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007378', 'S77007378', 'UT01', 'Epic', 'Barbara', 'D', 'Dahl', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832054', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007382', 'S77007382', 'UT01', 'Ogden Regional Medical Center', 'Garrett', 'J', 'Emery', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833977', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007383', 'S77007383', 'UT01', 'Epic', 'Garrett', 'J', 'Emery', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833977', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007384', 'S77007384', 'UT01', 'Epic', 'Ruth', NULL, 'Filloux', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624242', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834175', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007385', 'S77007385', 'UT01', 'Epic', 'Les', 'H', 'Greenwood', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007386', 'S77007386', 'UT01', 'Davis Hospital & Medical Center', 'Les', 'H', 'Greenwood', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007387', 'S77007387', 'UT01', 'Epic', 'Craig', NULL, 'Turner', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834180', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007388', 'S77007388', 'UT01', 'Epic - Jordan Valley Hospital', 'Craig', NULL, 'Turner', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834180', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007389', 'S77007389', 'UT01', 'Davis Hospital & Medical Center', 'Quinn', 'M', 'Weber', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832725', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007390', 'S77007390', 'UT01', 'Epic', 'Quinn', 'M', 'Weber', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624242', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832725', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007391', 'S77007391', 'UT01', 'Epic', 'Quinn', 'M', 'Weber', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832725', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007394', 'S77007394', 'UT01', 'Davis Hospital & Medical Center', 'Blake', 'J', 'Yerman', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832692', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870630371', 'S77007395', 'S77007395', 'UT01', 'Jordan Valley Internal Medicine', 'Kevin', 'B', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', NULL, '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-01-31', NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255456497', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('870631334', 'S77007396', 'S77007396', 'UT01', 'Elizabeth E Auger DPM', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 115', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012709000', '8015218544', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679590558', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870631334', 'S77007397', 'S77007397', 'UT01', 'Elizabeth E Auger DPM', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '9355 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012709000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679590558', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870641072', 'S77007425', 'S77007425', 'UT01', 'Parkway Pediatrics', 'J', 'Tucker', 'Davis', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1548206873', 0, 'Y', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77007429', 'S77007429', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'Dirk', 'R', 'Davis', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134187263', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007430', 'S77007430', 'UT01', 'Epic', 'Les', 'H', 'Greenwood', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007431', 'S77007431', 'UT01', 'Epic', 'Les', 'H', 'Greenwood', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007433', 'S77007433', 'UT01', 'Epic', 'Allen', 'R', 'Jensen', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831494', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007435', 'S77007435', 'UT01', 'Epic', 'Robert', 'S', 'Keddington', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833304', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007436', 'S77007436', 'UT01', 'Epic', 'Sharon', NULL, 'Kolber', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834172', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007437', 'S77007437', 'UT01', 'Epic', 'Kathleen', NULL, 'Lawliss', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624242', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255397691', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007438', 'S77007438', 'UT01', 'Ogden Regional Medical Center', 'Kathleen', NULL, 'Lawliss', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255397691', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007444', 'S77007444', 'UT01', 'Epic', 'Cathey', NULL, 'Putnam', 'MD', 'Emergency Medicine', 'Hyperbaric Medicine ', NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833308', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007445', 'S77007445', 'UT01', 'Ogden Regional Medical Center', 'L Val', NULL, 'Rollins', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831495', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634122', 'S77007446', 'S77007446', 'UT01', 'Medical Associates of Salt Lake', 'Patrice', 'F', 'Hirning', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', '508 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-03-18', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1770580078', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007447', 'S77007447', 'UT01', 'Ob/Gyn Associates', 'Linda', 'P', 'Alexander', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831210', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007448', 'S77007448', 'UT01', 'Ob/Gyn Associates', 'Peter', 'S', 'Barnard', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, '1151 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710993753', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007449', 'S77007449', 'UT01', 'OBGYN Associates', 'Peter', 'S', 'Barnard', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1710993753', 0, 'N', 0, '2014-07-03', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870634650', 'S77007450', 'S77007450', 'UT01', 'Ob/Gyn Associates', 'Kaydon', 'B', 'Lusty', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, '1151 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801801691', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007451', 'S77007451', 'UT01', 'OBGYN Associates', 'Kaydon', 'B', 'Lusty', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1801801691', 0, 'N', 0, '2011-07-22', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870634650', 'S77007452', 'S77007452', 'UT01', 'Ob/Gyn Associates', 'Stephanie', NULL, 'Singer', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, '1151 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184630071', 0, 'Y', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007453', 'S77007453', 'UT01', 'Ob/Gyn Associates', 'Daren', 'A', 'Watts', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, '1151 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679589600', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635422', 'S77007454', 'S77007454', 'UT01', 'Rocky Mountain Foot And Ankle', 'Kelly', 'A', 'Gomez', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013756677', NULL, 'PO Box 98', 'Springville', '', 'UT', '84663', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-04-16', '2007-04-16', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821021957', 0, 'N', 0, NULL, 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
('870635889', 'S77007455', 'S77007455', 'UT01', '', 'Melissa', '', 'Augustyn', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 107', 'Tooele', 'Tooele', 'UT', '84074', '4358433678', NULL, '196 E 2000 N', 'Tooele', 'Tooele', 'UT', '84074', '4358433678', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-29', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1619940590', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007456', 'S77007456', 'UT01', 'Tooele Clinic Corp', 'Srinivas', NULL, 'Chakravarthy', 'MD', 'Pulmonary', 'Hospitalist', NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '4358828770', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924074', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007457', 'S77007457', 'UT01', 'Deseret Peak Womens Center', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'O', '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', '4358439473', '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', '4358439473', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 40.5653, -112.298, NULL, NULL),
('870635889', 'S77007458', 'S77007458', 'UT01', 'Tooele Clinic Corp', 'Travis ', '', 'Klingler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-04-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679560387', 0, 'Y', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870642984', 'S77007473', 'S77007473', 'UT01', 'InVision Eye Health', 'Brenden', 'R', 'White', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '82 N 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353364403', '82 N 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353364403', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558357954', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77007474', 'S77007474', 'UT01', 'Circle of Life Womens Center', 'David', 'R', 'Bierer', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'South Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447273024', 0, 'N', 0, '2011-04-25', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643173', 'S77007475', 'S77007475', 'UT01', 'Step Mountain Medical', 'Kirt', 'Webb', 'Larson', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '2332 W 12600 S Ste 2C', 'Riverton', 'Salt Lake', 'UT', '84065', '8014462760', '8014462762', '2332 W 12600 S', 'Riverton', '', 'UT', '84065', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619196771', 0, 'N', 0, '2006-11-07', NULL, NULL, 40.5224, -111.951, NULL, NULL),
('870643195', 'S77007477', 'S77007477', 'UT01', 'Cache Valley Womens Center', 'David', 'A', 'Kirkman', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285624478', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643195', 'S77007478', 'S77007478', 'UT01', 'Cache Valley Womens Center', 'Barry', 'A', 'Noorda', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558351742', 0, 'N', 0, '2014-01-21', NULL, NULL, 41.756, -111.819, NULL, NULL),
('870643195', 'S77007479', 'S77007479', 'UT01', 'Cache Valley Womens Center', 'Kenneth', 'A', 'Wade', 'PA', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834856', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643310', 'S77007480', 'S77007480', 'UT01', 'Allergy Clinics of Utah', 'Allan', 'Curtis', 'Edson', 'DO', 'Allergy', 'Family Practice', NULL, NULL, 'B', '1492 S 800 W Ste J', 'Woods Cross', 'Davis', 'UT', '84087', '8012945224', '8012945269', '1492 S 800 W', 'Woods Cross', '', 'UT', '84087', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508811092', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007486', 'S77007486', 'UT01', 'Davis Hospital & Medical Center', 'William', 'K', 'Sheffield', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831496', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007487', 'S77007487', 'UT01', 'Epic', 'William', 'K', 'Sheffield', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831496', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007488', 'S77007488', 'UT01', 'Epic', 'Quinn', 'M', 'Weber', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832725', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007490', 'S77007490', 'UT01', 'Epic', 'Blake', 'J', 'Yerman', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832692', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007491', 'S77007491', 'UT01', 'Epic', 'Blake', 'J', 'Yerman', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832692', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007493', 'S77007493', 'UT01', 'Epic', 'Michael', NULL, 'Zufelt', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833312', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007495', 'S77007495', 'UT01', 'Epic - Lakeview Hospital', 'Michael', NULL, 'Zufelt', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833312', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007496', 'S77007496', 'UT01', 'Epic - Pioneer Valley Hospital', 'Michael', NULL, 'Zufelt', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8002250953', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833312', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870631334', 'S77007498', 'S77007498', 'UT01', 'Auger DPM, Elizabeth E', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 95642', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012539753', '8012539754', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679590558', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870631334', 'S77007499', 'S77007499', 'UT01', 'Auger DPM, Elizabeth E', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 95642', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012539753', '8012539754', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679590558', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007500', 'S77007500', 'UT01', 'Oquirrh Surgical Services', 'Gail', '', 'Strindberg', 'MD', 'General Surgery', '', '', NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', '4358439997', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', '4358439997', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1104812395', 0, 'N', 0, '2012-08-24', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870636938', 'S77007501', 'S77007501', 'UT01', 'Rocky Mountain Associated Physicians', 'Steven', 'C', 'Simper', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', 'WCSTRMAP5', 'WUSTDSURG5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174617336', 0, 'N', 0, '2012-02-01', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870637322', 'S77007502', 'S77007502', 'UT01', NULL, 'David', 'R', 'Boettger', 'MD', 'Pediatrics', '', '', NULL, 'O', '9720 S 1300 E Ste W120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015726700', NULL, '9720 S 1300 E Ste W120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015726700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1811937006', 0, 'N', 0, '2014-05-26', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('870637613', 'S77007504', 'S77007504', 'UT01', NULL, 'David', 'C', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '3920 S 1100 E Ste 115', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857129', NULL, '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857129', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-17', NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619914751', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870638632', 'S77007507', 'S77007507', 'UT01', 'Mountain Peaks Family Practice', 'Vaughn', 'T', 'Johnson', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '501 E 770 N', 'Orem', 'Utah', 'UT', '84097', '8017249840', NULL, '501 E 770 N', 'Orem', '', 'UT', '84097', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-13', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659453694', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870638931', 'S77007508', 'S77007508', 'UT01', 'Hensley Family Medical Center', 'Linda', 'R', 'Hensley', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '8806 Redwood Rd Ste 105', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668813', '8015615629', '8806 S Redwood Rd', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-10', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831565', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007511', 'S77007511', 'UT01', 'After Hours Medical Company', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007526', 'S77007526', 'UT01', 'Intermountain Neurology Clinic', 'Khaldoun', 'M', 'Al-Rayess', 'MD', 'Endocrinology', 'Internal Medicine', NULL, NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939223', '8015939626', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003808122', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007527', 'S77007527', 'UT01', 'Intermountain Neurology Clinic', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1492 W Antelope Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', NULL, '1492 W Antelope Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-07-31', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('870643939', 'S77007528', 'S77007528', 'UT01', 'Utah Physiatry Associates', 'Stuart', 'W', 'King', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 970188', 'Orem', 'Utah', 'UT', '84097', '8012240891', NULL, 'PO Box 970188', 'Orem', 'Utah', 'UT', '84097', '8012240891', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366518730', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870644582', 'S77007529', 'S77007529', 'UT01', '', 'David', 'Arthur', 'Rawling', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '6011 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012937001', '8012939500', '6011 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012937001', '8012939500', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1750362844', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870631360', 'S77007539', 'S77007539', 'UT01', 'Brigham Pediatrics', 'Carey', 'D', 'Lloyd', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '980 Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342433', NULL, 'PO Box 12173', 'Harrisville', 'Box Elder', 'UT', '84412', '4357342433', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164523494', 0, 'N', 0, '2010-11-18', NULL, NULL, 41.4889, -112.026, NULL, NULL),
('870632306', 'S77007543', 'S77007543', 'UT01', 'Antelope Womens Center', 'Karen', '', 'Boheen', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 205', 'Layton', 'Davis', 'UT', '84041', '8017280600', NULL, '1492 W Antelope Dr Ste 205', 'Layton', 'Davis', 'UT', '84041', '8017280600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-11', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467452383', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('870633260', 'S77007544', 'S77007544', 'UT01', NULL, 'Tazeem', 'A', 'Aizad', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1561 W 7000 S Ste 202', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015698344', NULL, '1561 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015698344', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588620413', 0, 'N', 0, '2011-08-01', NULL, NULL, 40.6241, -111.935, NULL, NULL),
('870634038', 'S77007546', 'S77007546', 'UT01', 'Medical Associates of Salt Lake', 'Dorene', 'K', 'Sambado', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014812121', '8013591665', 'PO Box 95970', 'South Jordan', '', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-04-07', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '926237', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634056', 'S77007547', 'S77007547', 'UT01', 'Medical Associates of Salt Lake', 'Lorraine', 'B', 'Szczesny', 'MD', 'Internal Medicine', '', '', NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518022896', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870634212', 'S77007548', 'S77007548', 'UT01', '', 'Darrin', 'F', 'Hansen', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W110', 'Sandy', 'Salt Lake', 'UT', '84093', '8015719511', NULL, '9720 S 1300 E Ste W110', 'Sandy', 'Salt Lake', 'UT', '84093', '8015719511', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1952417990', 0, 'N', 0, '2013-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007549', 'S77007549', 'UT01', 'Ob/Gyn Associates', 'Linda', 'P', 'Alexander', 'CNM', 'Nurse Midwife', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B-299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831210', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007551', 'S77007551', 'UT01', 'OBGYN Associates', 'Alisa', '', 'Carlton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '8015233059', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '8015233059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497766083', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870635422', 'S77007552', 'S77007552', 'UT01', 'Rocky Mountain Foot And Ankle', 'John', 'L', 'Black', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8013750346', NULL, 'PO Box 98', 'Springville', '', 'UT', '84663', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255389136', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635530', 'S77007595', 'S77007595', 'UT01', 'Mount Olympus Obstetrics and Gynecology', 'Kathleen', 'G', 'Miller', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', NULL, '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1740221738', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870635530', 'S77007596', 'S77007596', 'UT01', 'Mount Olympus Obstetrics and Gynecology', 'Pascale', '', 'Stephani', 'CNM', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', NULL, '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-02-01', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1811935430', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007597', 'S77007597', 'UT01', 'Tooele Clinic Corp', 'Srinivas', NULL, 'Chakravarthy', 'MD', 'Pulmonary', 'Hospitalist', NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924074', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007598', 'S77007598', 'UT01', 'Deseret Peak Womens Center', 'Travis ', '', 'Klingler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1959 N Aaron Dr Ste C', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', '4358439473', '1959 N Aaron Dr Ste C', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', '4358439473', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-04-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679560387', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007599', 'S77007599', 'UT01', 'Tooele Clinic Corp', 'Mark', NULL, 'Martinez', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '4358828770', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '927539', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007600', 'S77007600', 'UT01', 'Tooele Clinic Corp', 'Mark', NULL, 'Martinez', 'MD', 'Hospitalist', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '927539', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007601', 'S77007601', 'UT01', 'Tooele Clinic Corp', 'Mark', NULL, 'Rasmus', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '4358828770', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924905', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007602', 'S77007602', 'UT01', 'Tooele Clinic Corp', 'Mark', NULL, 'Rasmus', 'MD', 'Hospitalist', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924905', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007603', 'S77007603', 'UT01', 'Tooele Clinic Corp', 'Gail', '', 'Strindberg', 'MD', 'General Surgery', '', '', NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1104812395', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77007604', 'S77007604', 'UT01', 'Tooele Clinic Corp', 'Jennifer', 'A', 'Ziouras', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831886', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870638151', 'S77007606', 'S77007606', 'UT01', 'Rock Canyon Family Medicine', 'Shauna', NULL, 'Whatcott', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3200 N Canyon Rd Ste E', 'Provo', 'Utah', 'UT', '84604', '8018123200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908430', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870641072', 'S77007609', 'S77007609', 'UT01', 'Parkway Pediatrics', 'J', 'Tucker', 'Davis', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1288 W 12700 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1548206873', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870641300', 'S77007611', 'S77007611', 'UT01', 'Utah Hyperbaric Physicians', 'Mark', 'G', 'Flammer', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', '8002250953', '4056821586', NULL, NULL, '', NULL, NULL, '', '', 'WUEPIC5', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2007-01-01', '2007-03-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833301', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77007614', 'S77007614', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'V', 'D', 'Bohman', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1336105360', 0, 'Y', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77007615', 'S77007615', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'Dirk', 'R', 'Davis', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134187263', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77007616', 'S77007616', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'Bryan', 'R', 'Larsen', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972561165', 0, 'N', 0, '2013-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77007619', 'S77007619', 'UT01', 'Circle of Life Womens Center', 'Julia', 'W', 'Johansson', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'South Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174546998', 0, 'N', 0, '2011-08-23', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643070', 'S77007620', 'S77007620', 'UT01', 'Circle of Life Womens Center', 'Karen', 'E', 'McBride', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1568485001', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870444053', 'S77007629', 'S77007629', 'UT01', NULL, 'Jeff', 'H', 'Seeholzer', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '124 N Main St', 'Logan', 'Cache', 'UT', '84321', '8017525334', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326196569', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870444057', 'S77007630', 'S77007630', 'UT01', 'Roosevelt Vision Clinic', 'Scott', 'H', 'Kowallis', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '165 W 200 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357222981', '4357223732', '165 W 200 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357222981', '4357223732', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861487050', 0, 'N', 0, '2013-11-15', NULL, NULL, 40.3021, -109.995, NULL, NULL),
('870649259', 'S77007648', 'S77007648', 'UT01', 'Alpine Orthopaedic Specialists', 'Terry', 'I', 'Finlayson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '4357871913', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1316935539', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870638632', 'S77007652', 'S77007652', 'UT01', 'Mountain Peaks Family Practice', 'Robert', 'G', 'Durrans', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '501 E 770 N', 'Orem', 'Utah', 'UT', '84097', '8017249840', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447332465', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870638931', 'S77007653', 'S77007653', 'UT01', 'Hensley Family Medical Center', 'Linda', 'R', 'Hensley', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8015668813', '8015615629', '8806 S Redwood Rd', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831565', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007654', 'S77007654', 'UT01', 'After Hours Urgent Care Draper', 'Eileen', NULL, 'Hyde', 'NP', 'Urgent Care', NULL, NULL, NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467418483', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007655', 'S77007655', 'UT01', 'After Hours Medical Company', 'Bert', 'K', 'Lopansri', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538261292', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77007656', 'S77007656', 'UT01', 'After Hours Urgent Care Draper', 'Bert', 'K', 'Lopansri', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538261292', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639350', 'S77007659', 'S77007659', 'UT01', '', 'Richard', 'F', 'Labasky', 'MD', 'Urology', NULL, NULL, NULL, 'O', '9600 S 1300 E Ste 303', 'Sandy', 'Salt Lake', 'UT', '84094', '8015015300', NULL, '9600 S 1300 E Ste 303', 'Sandy', 'Salt Lake', 'UT', '84094', '8015015300', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538226600', 0, 'N', 0, '2013-09-13', NULL, NULL, 40.5756, -111.853, NULL, NULL),
('870643070', 'S77007661', 'S77007661', 'UT01', 'Circle Of Life Womens Center', 'Bryan', 'T', 'Oshiro', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780608489', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643173', 'S77007663', 'S77007663', 'UT01', 'Step Mountain Medical', 'Jane', NULL, 'Ricks', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2332 W 12600 S Ste 2C', 'Riverton', 'Salt Lake', 'UT', '84065', '8014462760', '8014462762', '2332 W 12600 S', 'Riverton', '', 'UT', '84065', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295745651', 0, 'N', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870643195', 'S77007664', 'S77007664', 'UT01', 'Cache Valley Womens Center', 'Kenneth', 'A', 'Wade', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1699826149', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.756, -111.819, NULL, NULL),
('870643310', 'S77007665', 'S77007665', 'UT01', 'Edson, Allan C', 'Allan', 'C', 'Edson', 'DO', 'Allergy', 'Family Practice', NULL, NULL, 'O', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8012945224', '8012950311', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508811092', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007668', 'S77007668', 'UT01', 'Intermountain Neurology Clinic', 'Ahmad', 'N', 'Al-Sadat', 'MD', 'Neurology', 'Neurophysiology', NULL, NULL, 'O', '6112 S 1550 E', 'South Ogden', 'Weber', 'UT', '84405', '8014757707', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104828987', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007669', 'S77007669', 'UT01', 'Intermountain Neurology Clinic', 'Ahmad', 'N', 'Al-Sadat', 'MD', 'Neurology', 'Neurophysiology', NULL, NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939223', '8015939626', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104828987', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007670', 'S77007670', 'UT01', 'Intermountain Neurology Clinic', 'Jamal', NULL, 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', NULL, NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939223', '8015939626', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770585564', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007671', 'S77007671', 'UT01', 'Intermountain Neurology Clinic', 'Jahan', '', 'Imani', 'MD', 'Neurology', 'Neuromuscular Disease & EMG', '', NULL, 'O', '2102 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8015939223', '8015939626', '2102 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8015939223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1063414969', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870643939', 'S77007672', 'S77007672', 'UT01', 'Utah Physiatry Assoc', 'Stuart', 'W', 'King', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', NULL, '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366518730', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870644653', 'S77007673', 'S77007673', 'UT01', 'Workman, Allen', 'Allen', 'E', 'Workman', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '196 W 2000 N Ste 105', 'Tooele', 'Tooele', 'UT', '84074', '4358433859', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407896277', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870450466', 'S77007685', 'S77007685', 'UT01', 'Pulmonary Internal Medicine', 'Mark', 'S', 'Shockey', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1220 E 3900 S Ste 2 C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632482', '8012632424', '1220 E 3900 S Ste 2 C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632482', '8012632424', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1902839657', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870649259', 'S77007689', 'S77007689', 'UT01', 'Alpine Orthopedic Specialists', 'Jonathan', 'T', 'Finnoff', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834388', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007691', 'S77007691', 'UT01', 'Alpine Orthopaedic Specialists', 'Gregory', 'J', 'Hicken', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', NULL, 'HCFA|UB|', '1225027931', 0, 'Y', 0, '2011-05-18', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007693', 'S77007693', 'UT01', 'Bear Lake Community Health Center', 'Gregory', 'J', 'Hicken', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', NULL, 'PO Box 6250', 'Logan', 'Rich', 'UT', '84341', '4359463660', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', NULL, 'HCFA|UB|', '1225027931', 0, 'N', 0, '2011-05-18', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('870649259', 'S77007695', 'S77007695', 'UT01', 'Alpine Orthopaedic Specialists', 'Lorraine', 'C', 'Novich-Welter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-07-21', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1497741383', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007696', 'S77007696', 'UT01', 'Alpine Orthopaedic Specialists', 'Whitney', 'M', 'Werner', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1629011754', 0, 'N', 0, '2014-04-14', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870651355', 'S77007697', 'S77007697', 'UT01', 'Utah Valley Obstetrics & Gynecology', 'C', 'Joseph', 'Glenn', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013577377', '8013577378', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013577377', '8013577378', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1942302211', 0, 'N', 0, '2014-06-11', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870653164', 'S77007698', 'S77007698', 'UT01', 'Utah Digestive Health Institute', 'Jeffrey', 'S', 'Poole', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', NULL, '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-05-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1649266776', 0, 'N', 0, '2013-10-21', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('870653551', 'S77007699', 'S77007699', 'UT01', 'Park City Healthcare', 'Joseph', NULL, 'Albano', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'PO Box 680670', 'Park City', '', 'UT', '84068', '', '', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834238', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007700', 'S77007700', 'UT01', 'Park City Healthcare', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007701', 'S77007701', 'UT01', 'Park City Healthcare', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Salt Lake', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'S77007733', 'S77007733', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Melissa', 'A', 'Boll', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124080775', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'S77007735', 'S77007735', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Kathryn', '', 'Hardy', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-10-18', NULL, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1710940952', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'S77007736', 'S77007736', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Jacqueline', 'G', 'Hyland', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3688 Campus Dr Ste 200', 'Eagle Mountain', 'Utah', 'UT', '84043', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831668', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'S77007737', 'S77007737', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Claudia', '', 'Killebrew', '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', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497717052', 0, 'N', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870454444', 'S77007742', 'S77007742', 'UT01', 'Joe R Nielsen', 'Joe', 'R', 'Nielsen', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '415 Medical Dr Ste D200', 'Bountiful', 'Davis', 'UT', '84010', '8012926277', NULL, '415 Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992766885', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870454444', 'S77007743', 'S77007743', 'UT01', NULL, 'Joe', 'R', 'Nielsen', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '415 Medical Dr Ste D200', 'Bountiful', 'Davis', 'UT', '84010', '8012926277', NULL, '415 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926277', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1992766885', 0, 'N', 0, '2011-04-20', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870653551', 'S77007744', 'S77007744', 'UT01', 'Park City Healthcare', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'N', 0, '2014-04-08', 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
('870653551', 'S77007745', 'S77007745', 'UT01', 'Park City Healthcare', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007746', 'S77007746', 'UT01', 'Park City Healthcare', 'June', 'E', 'Neeley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1508965369', 0, 'N', 0, '2010-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007747', 'S77007747', 'UT01', 'Park City Healthcare', 'June', 'E', 'Neeley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Salt Lake', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1508965369', 0, 'Y', 0, '2010-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007748', 'S77007748', 'UT01', 'Park City Healthcare', 'Sandra', 'L', 'VanLeuven', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', NULL, NULL, '', NULL, NULL, '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831904', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007749', 'S77007749', 'UT01', 'Park City Healthcare', 'Robert', 'T', 'Winn', 'MD', 'Family Practice', 'Pediatrics', 'Urgent Care', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1912951393', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870654617', 'S77007750', 'S77007750', 'UT01', 'Castle Country Family Medicine', 'Jeannee', 'L', 'Hunt', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356132200', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356132200', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1194810937', 0, 'N', 0, '2010-09-20', NULL, NULL, 39.607, -110.835, NULL, NULL),
('870641072', 'S77007754', 'S77007754', 'UT01', 'Parkway Pediatrics', 'Jimmy', 'L', 'Ryan', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1288 W 12700 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', '1288 W 12700 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508800145', 0, 'N', 0, '2012-05-31', NULL, NULL, 40.5206, -111.929, NULL, NULL),
('870641300', 'S77007756', 'S77007756', 'UT01', 'Utah Hyperbaric Physicians', 'Mark', 'G', 'Flammer', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '520 Medical Dr Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8013970890', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUEPIC5', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2007-01-01', '2007-03-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833301', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870641300', 'S77007757', 'S77007757', 'UT01', 'Utah Hyperbaric Physicians', 'Tommy', NULL, 'Love', 'DO', 'Hyperbaric Medicine ', NULL, NULL, NULL, 'O', '520 Medical Dr Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8013970890', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUEPIC5', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2007-01-01', '2007-03-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832571', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77007765', 'S77007765', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'Bryan', 'R', 'Larsen', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'PO Box 25692', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972561165', 0, 'Y', 0, '2013-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77007766', 'S77007766', 'UT01', 'Circle of Life Womens Center', 'Machel', 'M', 'Knowles', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780608828', 0, 'N', 0, '2012-05-15', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643070', 'S77007767', 'S77007767', 'UT01', 'Circle of Life Womens Center', 'Kathleen', 'C', 'Mark', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1851314389', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870460998', 'S77007784', 'S77007784', 'UT01', 'Prevention & Medical Screening', 'Lombardo', '', 'Palma', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012652604', NULL, '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012652604', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356388730', 0, 'Y', 0, '2012-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870462017', 'S77007787', 'S77007787', 'UT01', 'South Valley Womens Health', 'John', 'M', 'Nichols', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3570 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-12-31', NULL, 0, NULL, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114906252', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870463394', 'S77007788', 'S77007788', 'UT01', 'Blaine P Andersen, MD', 'Blaine', 'P', 'Andersen', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'B', '500 E 1300 N Ste 260', 'Logan', 'Cache', 'UT', '84341', '8017533400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WULOGANI5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538279609', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77007790', 'S77007790', 'UT01', 'Wasatch Physical Therapy And Rehab', 'Lawrence', 'L', 'Baer', 'PAC', 'Physical Therapy', NULL, NULL, NULL, 'B', '5323 S Woodrow St Ste 202', 'Murray', NULL, 'UT', NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', '57.75', 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346234010', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870658212', 'S77007796', 'S77007796', 'UT01', NULL, 'Brian', 'J', 'Rodgers', 'DO', 'Family Practice', '', '', NULL, 'O', '425 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012983812', NULL, '425 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012983812', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1629008065', 0, 'N', 0, '2014-05-16', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870658625', 'S77007798', 'S77007798', 'UT01', 'Wasatch Peak Family Practice', 'Jeffery', 'L', 'DeGrauw', 'MD', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8017734770', '', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8017734770', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-04-10', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1780796441', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77007799', 'S77007799', 'UT01', 'Circle of Life Womens Center', 'Byron', 'H', 'Naisbitt', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336163443', 0, 'Y', 0, '2012-04-25', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643195', 'S77007801', 'S77007801', 'UT01', 'Cache Valley Womens Center', 'Gary', 'K', 'Fowers', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'O', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', '1325 N 600 E', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457342818', 0, 'N', 0, '2011-05-18', NULL, NULL, 41.756, -111.819, NULL, NULL),
('870643195', 'S77007802', 'S77007802', 'UT01', 'Cache Valley Womens Center', 'David', 'A', 'Kirkman', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', '1325 N 600 E', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285624478', 0, 'N', 0, '2011-04-19', NULL, NULL, 41.756, -111.819, NULL, NULL),
('870643195', 'S77007803', 'S77007803', 'UT01', 'Cache Valley Womens Center', 'Barry', 'A', 'Noorda', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558351742', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007819', 'S77007819', 'UT01', 'Alpine Orthopaedic Specialists', 'Michael', 'L', 'Clegg', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1679561708', 0, 'Y', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007820', 'S77007820', 'UT01', 'Alpine Orthopaedic Specialists', 'Lance', '', 'Delange', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1861476939', 0, 'Y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007825', 'S77007825', 'UT01', 'Alpine Orthopaedic Specialists', 'Kevin', 'R', 'Kellogg', 'PAC', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003899493', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007826', 'S77007826', 'UT01', 'Alpine Orthopaedic Specialists', 'Keith', 'J', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '8777872031', NULL, 'PO Box 6250', 'Logan', 'Box Elder', 'UT', '84341', '8777872031', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1245229954', 0, 'N', 0, '2011-05-25', NULL, NULL, 41.4751, -112.025, NULL, NULL),
('870465963', 'S77007828', 'S77007828', 'UT01', 'Holt DO, Charles E', 'Darin', 'T', 'Smith', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 88', 'Tooele', 'Tooele', 'UT', '84074', '4358828610', '4358820186', 'PO Box 88', 'Tooele', 'Tooele', 'UT', '84074', '4358828610', '4358820186', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538375415', 0, 'Y', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870467007', 'S77007829', 'S77007829', 'UT01', NULL, 'Todd', 'A', 'Brown', 'MD', 'Family Practice', '', '', NULL, 'O', '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355636211', '4355639481', '291 S Main St Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355636211', '4355639481', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992765531', 0, 'N', 0, '2014-01-17', NULL, NULL, 41.8304, -111.833, NULL, NULL),
('870467635', 'S77007830', 'S77007830', 'UT01', 'Highland Family Practice', 'Derek', 'D', 'Muse', 'MD', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720157555', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870467635', 'S77007831', 'S77007831', 'UT01', 'Highland Family Practice', 'Amanda', 'J', 'Wirth', 'MD', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1376612150', 0, 'N', 0, '2012-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870467896', 'S77007836', 'S77007836', 'UT01', NULL, 'Layne', 'B', 'Croxford', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 210', 'Roy', 'Weber', 'UT', '84067', '8018254700', NULL, '4695 S 1900 W', 'Roy', '', 'UT', '84067', '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225048937', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870467930', 'S77007837', 'S77007837', 'UT01', 'Kane County Medical Clinic', 'Darin', 'D', 'Ott', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '355 N Main St', 'Kanab', 'Kane', 'UT', '84741', '4356444100', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '5.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, 'Kane County Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295805893', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870468116', 'S77007838', 'S77007838', 'UT01', '', 'Scott', 'A', 'Leckman', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 3G', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012684924', NULL, '1220 E 3900 S Ste 3G', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012684924', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588637730', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870658625', 'S77007839', 'S77007839', 'UT01', 'Wasatch Peak Family Practice', 'Kevin', 'L', 'Gardner', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790897452', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870658625', 'S77007840', 'S77007840', 'UT01', 'Wasatch Peak Family Practice', 'Douglas', 'S', 'Linford', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821180134', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77007854', 'S77007854', 'UT01', 'Intermountain Neurology Clinic', 'Khaldoun', 'M', 'Al-Rayess', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '1492 W Antelope Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', NULL, '1492 W Antelope Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1003808122', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('870643872', 'S77007855', 'S77007855', 'UT01', 'Intermountain Neurology Clinic', 'Ahmad', 'N', 'Al-Sadat', 'MD', 'Neurology', 'Neurophysiology', '', NULL, 'O', '1492 W Antelope Ste 205', 'Layton', 'Davis', 'UT', '84041', '8017768080', NULL, '1492 W Antelope Ste 205', 'Layton', 'Davis', 'UT', '84041', '8017768080', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-02-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1104828987', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870643939', 'S77007856', 'S77007856', 'UT01', 'Utah Physiatry Assoc', 'Valton', 'N', 'King', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', NULL, '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457427817', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870643939', 'S77007857', 'S77007857', 'UT01', 'Utah Physiatry Associates', 'Valton', 'N', 'King', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 970188', 'Orem', 'Utah', 'UT', '84097', '8012240891', NULL, 'PO Box 970188', 'Orem', 'Utah', 'UT', '84097', '8012240891', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457427817', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870644653', 'S77007858', 'S77007858', 'UT01', NULL, 'Allen', 'E', 'Workman', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 105', 'Tooele', 'Tooele', 'UT', '84074', '4358433859', NULL, '196 E 2000 N', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407896277', 0, 'N', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870644792', 'S77007859', 'S77007859', 'UT01', '', 'David', 'A', 'Smith', 'OD', 'Optometry', '', '', NULL, 'O', '169 Springcreek Pkwy Ste 130', 'Providence', 'Cache', 'UT', '84332', '4357134444', NULL, '169 Springcreek Pkwy Ste 130', 'Providence', 'Cache', 'UT', '84332', '4357134444', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417067950', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007868', 'S77007868', 'UT01', 'Alpine Orthopaedic Specialists', 'Keith', 'J', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1245229954', 0, 'Y', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007869', 'S77007869', 'UT01', 'Alpine Orthopaedic Specialists', 'Lorraine', 'C', 'Novich-Welter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-07-21', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1497741383', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77007870', 'S77007870', 'UT01', 'Alpine Orthopaedic Specialists', 'Whitney', 'M', 'Werner', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1629011754', 0, 'Y', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870649536', 'S77007871', 'S77007871', 'UT01', 'Intermountain Epilepsy & Sleep Center', 'Maya', '', 'Thomas', 'MD', 'Neurology', '', '', NULL, 'O', '5323 S Woodrow St Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012665559', '', '5323 S Woodrow St Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012665559', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730138629', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870649956', 'S77007872', 'S77007872', 'UT01', 'Alta View Sports Medicine Center', 'Jay', 'D', 'Parkin', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', '9844 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-09-01', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1780679340', 0, 'N', 0, '2011-08-29', NULL, NULL, 0, 0, NULL, NULL),
('870651047', 'S77007873', 'S77007873', 'UT01', 'Flegal Clinic', 'Douglas', 'C', 'Flegal', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '740 E 3900 S Ste 108', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012663113', NULL, '740 E 3900 S Ste 108', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012663113', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1710955745', 0, 'N', 0, '2013-03-15', NULL, NULL, 40.6871, -111.87, NULL, NULL),
('870653164', 'S77007874', 'S77007874', 'UT01', 'Utah Digestive Health Institute', 'John', 'E', 'Lowe', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'South Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-05-01', '2007-05-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1851387195', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653164', 'S77007875', 'S77007875', 'UT01', 'Utah Digestive Health Institute', 'Brian', 'W', 'Pugh', 'DO', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-05-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1023005808', 0, 'N', 0, '2012-06-13', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('870653164', 'S77007876', 'S77007876', 'UT01', 'Utah Digestive Health Institute', 'Dennis', 'W', 'Sobotka', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-05-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1932196714', 0, 'N', 0, '2012-06-13', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('870653164', 'S77007877', 'S77007877', 'UT01', 'Utah Digestive Health Institute', 'Dennis', 'W', 'Sobotka', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'South Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-05-01', '2007-05-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1932196714', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007879', 'S77007879', 'UT01', 'Park City Healthcare', 'Joseph', NULL, 'Albano', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 680670', 'Park City', '', 'UT', '84068', '', '', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834238', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007880', 'S77007880', 'UT01', 'Park City Healthcare', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870661473', 'S77007900', 'S77007900', 'UT01', 'Park City Urgent Care', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', NULL, '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870661563', 'S77007901', 'S77007901', 'UT01', 'Castle View Anesthesia', NULL, NULL, 'Castle View Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939500', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1000', '36.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833035', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870661563', 'S77007902', 'S77007902', 'UT01', 'Castle View Anesthesia', NULL, NULL, 'Castle View Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '8019939500', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1000', '36.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833035', 0, 'Y', 0, '2007-01-10', NULL, NULL, 39.6051, -110.832, NULL, NULL),
('870661635', 'S77007903', 'S77007903', 'UT01', NULL, 'Joseph', 'E', 'Morgan', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2006-12-01', '2007-11-30', 1, 12, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1023121464', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77007905', 'S77007905', 'UT01', 'Precision Medical Management', 'Kurt', 'V', 'King', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', '2008-08-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649267949', 0, 'Y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77007906', 'S77007906', 'UT01', 'Precision Medical Management', 'Patrick', NULL, 'Scherer', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77007907', 'S77007907', 'UT01', 'Precision Medical Management', 'Bruce', NULL, 'Taylor', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77007908', 'S77007908', 'UT01', 'Precision Medical Management', 'Cameron', '', 'Williams', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952398463', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007923', 'S77007923', 'UT01', 'Park City Healthcare', 'Eileen', 'Price', 'Burke', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-10-17', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1649379413', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007924', 'S77007924', 'UT01', 'Park City Healthcare', 'Camellia', 'R', 'Koleyni', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', 'PO Box 680670', 'Park City', '', 'UT', '84068', '', '', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356469217', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007926', 'S77007926', 'UT01', 'Park City Healthcare', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77007927', 'S77007927', 'UT01', 'Park City Healthcare', 'Sandra', 'L', 'VanLeuven', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', NULL, NULL, '', NULL, NULL, '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831904', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870654931', 'S77007929', 'S77007929', 'UT01', NULL, 'Kelly', 'W', 'Hubbard', 'MD', 'Dermatology', '', '', NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', '4357539521', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', '4357539521', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1871542308', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77007930', 'S77007930', 'UT01', 'Utah Bone & Joint Center', 'Aaron', 'C', 'Hall', 'PT-M', 'Physical Therapy', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', NULL, '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', '          ', '', '', '', '0.00', '0.00', '57.75', 6, '2006-12-01', '2011-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942294616', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('870469392', 'S77007941', 'S77007941', 'UT01', 'Gourley, George C', 'George', NULL, 'Gourley', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 305', 'Provo', 'Utah', 'UT', '84604', '8013577190', '8013563107', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457469249', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870666061', 'S77007947', 'S77007947', 'UT01', 'Copperview Medical Center', 'Martin', 'A', 'Hollingsworth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1821054842', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870666450', 'S77007949', 'S77007949', 'UT01', NULL, 'Ralph', 'D', 'Wade', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '520 Medical Dr Ste 210', 'Bountiful', 'Davis', 'UT', '84010', '8012989155', NULL, '520 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012989155', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Lakeview Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1447256953', 0, 'N', 0, '2011-03-10', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('870667124', 'S77007951', 'S77007951', 'UT01', '', 'Ina', 'J', 'Amber', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686830', '', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686830', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lone Peak Hospital', 'Lakeview Hospital', '', 'HCFA|UB|', '1760549927', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870668900', 'S77007952', 'S77007952', 'UT01', 'Castleview Hospital', 'George', 'Nicholas', 'Baldwin', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834484', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77007953', 'S77007953', 'UT01', 'Mountain Valley Imaging', 'George', 'Nicholas', 'Baldwin', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834484', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77007954', 'S77007954', 'UT01', 'Mountain Valley Imaging', 'Barry', 'M', 'Birkin', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', 'Weber', NULL, '1850 Sidewinder Dr', 'Park City', 'Weber', 'UT', '84060', 'Weber', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-11-15', NULL, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144289521', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77007955', 'S77007955', 'UT01', 'Mountain Valley Imaging', 'William', 'John', 'Dubiel', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '1850 Sidewinder Dr Ste 410', 'Park City', 'Summit', 'UT', '84060', '4356150250', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834550', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77007956', 'S77007956', 'UT01', 'Castleview Hospital', 'John', 'C', 'Olson', 'MD', 'Radiology', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169604', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870669215', 'S77007958', 'S77007958', 'UT01', NULL, 'Burk', 'T', 'Young', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '175 N 100 W Ste 201', 'Vernal', 'Uintah', 'UT', '84078', '4357897845', NULL, '175 N 100 W Ste 201', 'Vernal', 'Uintah', 'UT', '84078', '4357897845', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1366490963', 0, 'N', 0, '2014-05-13', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('870646870', 'S77007971', 'S77007971', 'UT01', '', 'Douglas', 'C', 'Walker', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 278', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573684', '4352577554', 'PO Box 278', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573684', '4352577554', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1821095142', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77007974', 'S77007974', 'UT01', 'Utah Bone & Joint Center', 'Russell', 'L', 'Nelson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', NULL, '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285628966', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870658282', 'S77007980', 'S77007980', 'UT01', NULL, 'Brent', 'H', 'Goodsell', 'DO', 'Dermatology', '', '', NULL, 'O', '162 S 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017569669', '8017560202', '162 S 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017569669', '8017560202', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528172863', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.3737, -111.769, NULL, NULL),
('870658282', 'S77007981', 'S77007981', 'UT01', NULL, 'Brent', 'H', 'Goodsell', 'DO', 'Dermatology', '', '', NULL, 'O', '250 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356374048', NULL, '250 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356374048', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528172863', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.6058, -110.835, NULL, NULL),
('870658625', 'S77007983', 'S77007983', 'UT01', 'Wasatch Peak Family Practice', 'Kevin', 'L', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8017734770', '', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8017734770', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-04-10', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1790897452', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870670524', 'S77008004', 'S77008004', 'UT01', NULL, 'Jeffrey', 'C', 'Margetts', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012649521', '8012612562', '1250 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012649521', '8012612562', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346391430', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870673066', 'S77008007', 'S77008007', 'UT01', 'Northern Utah Pathology', 'Matthew', 'M', 'Kershisnik', 'MD', 'Pathology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '8436644300', NULL, 'PO Box 551', 'Logan', '', 'UT', '84323', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851363600', 0, 'Y', 0, '2006-12-11', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('870673378', 'S77008008', 'S77008008', 'UT01', 'Collins-Kronmiller Urologic', 'Dean', 'L', 'Bristow', 'MD', 'Urology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 5', 'Payson', 'Utah', 'UT', '84651', '8014652511', NULL, '50 S Medical Dr Ste 5', 'Payson', 'Millard', 'UT', '84651', '8014652511', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-03-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255442976', 0, 'N', 0, '2010-06-08', NULL, NULL, 0, 0, NULL, NULL),
('870673378', 'S77008010', 'S77008010', 'UT01', 'Collins-Kronmiller Urologic', 'Dean', 'L', 'Bristow', 'MD', 'Urology', NULL, NULL, NULL, 'O', '64 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '8014652511', NULL, '64 E 100 N', 'Gunnison', 'Millard', 'UT', '84634', '8014652511', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-03-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255442976', 0, 'N', 0, '2010-06-08', NULL, NULL, 0, 0, NULL, NULL),
('870673378', 'S77008011', 'S77008011', 'UT01', 'Collins-Kronmiller Urologic', 'William', 'T', 'Collins', 'MD', 'Urology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 5', 'Payson', 'Utah', 'UT', '84651', '8014652511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851402572', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77008017', 'S77008017', 'UT01', 'Alpine Orthopedic Specialists', 'Lance', '', 'Delange', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1861476939', 0, 'n', 0, '2012-06-25', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'S77008019', 'S77008019', 'UT01', 'Alpine Orthopaedic Specialists', 'Brent', 'A', 'Felix', 'MD', 'Orthopedic Surgery', 'Spine', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'St Marks Hospital', 'Logan Regional Hospital', NULL, 'HCFA|UB|', '1851383350', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'S77008020', 'S77008020', 'UT01', 'Alpine Orthopaedic Specialists', 'Brent', 'A', 'Felix', 'MD', 'Orthopedic Surgery', 'Spine', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'St Marks Hospital', 'Logan Regional Hospital', NULL, 'HCFA|UB|', '1851383350', 0, 'Y', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77008021', 'S77008021', 'UT01', 'Alpine Orthopedic Specialists', 'Jonathan', 'T', 'Finnoff', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834388', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77008023', 'S77008023', 'UT01', 'Alpine Orthopaedic Specialists', 'Gregory', 'J', 'Hicken', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Franklin', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', NULL, 'HCFA|UB|', '1225027931', 0, 'N', 0, '2011-05-18', NULL, NULL, 42.0971, -111.874, NULL, NULL),
('870649259', 'S77008024', 'S77008024', 'UT01', 'Alpine Orthopaedic Specialists', 'Kevin', 'R', 'Kellogg', 'PA-C', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357872000', NULL, 'PO Box 6250', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003899493', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77008025', 'S77008025', 'UT01', 'Alpine Orthopaedic Specialists', 'Richard', 'A', 'St Onge', 'MD', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'O', '44N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357872000', '4357871913', 'PO Box 6250', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144219593', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77008026', 'S77008026', 'UT01', 'Alpine Orthopaedic Specialists', 'Richard', 'A', 'St Onge', 'MD', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144219593', 0, 'Y', 0, NULL, 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
('870661473', 'S77008037', 'S77008037', 'UT01', 'Park City Urgent Care', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', NULL, '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870661473', 'S77008038', 'S77008038', 'UT01', 'Park City Urgent Care', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', NULL, 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870661635', 'S77008039', 'S77008039', 'UT01', NULL, 'Joseph', 'E', 'Morgan', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019939506', NULL, '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2006-12-01', '2007-11-30', 1, 12, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1023121464', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870661855', 'S77008040', 'S77008040', 'UT01', 'Cache Orthopaedics', 'James', 'T', 'Malouf', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357924100', NULL, '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357924100', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-13', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1790788503', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870474764', 'S77008053', 'S77008053', 'UT01', NULL, 'Kipley', 'J', 'Siggard', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '3465 Pioneer Pkwy Ste 5', 'West Valley', 'Salt Lake', 'UT', '84120', '8019670282', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962595082', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870673378', 'S77008055', 'S77008055', 'UT01', 'Collins-Kronmiller Urologic', 'Patrick', NULL, 'Kronmiller', 'MD', 'Urology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 5', 'Payson', 'Utah', 'UT', '84651', '8014652511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801907514', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870673881', 'S77008057', 'S77008057', 'UT01', NULL, 'Brian', 'H', 'Richman', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 110', 'Layton', 'Davis', 'UT', '84041', '8018254709', NULL, '1660 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018254709', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Davis Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1831124247', 0, 'N', 0, '2011-08-08', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('870675632', 'S77008060', 'S77008060', 'UT01', 'Valley Family Clinic', 'Laura', 'L', 'Mahler', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '266 W 100 N Ste 6', 'Vernal', 'Uintah', 'UT', '84078', '4357890064', '4357890537', '266 W 100 N Ste 6', 'Vernal', 'Uintah', 'UT', '84078', '4357890064', '4357890537', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740373125', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.4571, -109.534, NULL, NULL),
('870676738', 'S77008062', 'S77008062', 'UT01', 'Audiology Professionals at Rocky Mountain Plaza', NULL, NULL, 'Audiology Professionals at Rocky Mountain Plaza', 'GROUP', NULL, NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013944399', NULL, '3955 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834800', 0, 'Y', 0, '2006-08-31', NULL, NULL, 41.191, -111.949, NULL, NULL),
('870678440', 'S77008063', 'S77008063', 'UT01', 'Utah Valley Obstetrical Ultrasound', 'Jodie', 'G', 'Layton', 'MS', 'Radiologist', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 303A', 'Provo', 'Utah', 'UT', '84604', '8013577377', '8013577378', 'PO Box 143', 'Provo', '', 'UT', '84604', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832518', 0, 'Y', 0, '2006-11-30', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870678993', 'S77008064', 'S77008064', 'UT01', 'Families First Pediatrics', 'Michael', 'R', 'Johnson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1396839403', 0, 'N', 0, '2014-07-10', NULL, NULL, 40.5622, -111.928, NULL, NULL),
('870678993', 'S77008065', 'S77008065', 'UT01', 'Families First Pediatrics', 'Michael', 'R', 'Johnson', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1396839403', 0, 'Y', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870649755', 'S77008067', 'S77008067', 'UT01', NULL, 'Craig', 'R', 'Foley', 'MD', 'Colon and Rectal Surgery', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872562', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872562', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1164528964', 0, 'N', 0, '2012-06-08', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870653164', 'S77008068', 'S77008068', 'UT01', 'Utah Digestive Health Institute', 'Jeffrey', 'S', 'Poole', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 320', 'Layton', 'Davis', 'UT', '84041', '8017732268', NULL, '1660 W Antelope Dr Ste 320', 'Layton', 'Davis', 'UT', '84041', '8017732268', '          ', 'WUSTDGAST4', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-11-08', 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1649266776', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('870653164', 'S77008070', 'S77008070', 'UT01', 'Utah Digestive Health Institute', 'Brian', 'W', 'Pugh', 'DO', 'Gastroenterology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', '1660 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017732268', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-11-07', 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1023005808', 0, 'N', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008072', 'S77008072', 'UT01', 'Park City Healthcare', 'Eileen', 'Price', 'Burke', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Salt Lake', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-10-17', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1649379413', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008073', 'S77008073', 'UT01', 'Park City Healthcare', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008074', 'S77008074', 'UT01', 'Park City Healthcare', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008075', 'S77008075', 'UT01', 'Park City Healthcare', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008076', 'S77008076', 'UT01', 'Park City Healthcare', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008078', 'S77008078', 'UT01', 'Park City Healthcare', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77008080', 'S77008080', 'UT01', 'Park City Healthcare', 'Robert', 'T', 'Winn', 'MD', 'Family Practice', 'Pediatrics', 'Urgent Care', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1912951393', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77008081', 'S77008081', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Glori', 'M', 'Allen', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1801824297', 0, 'Y', 0, '2014-02-05', NULL, NULL, 39.6051, -110.832, NULL, NULL),
('870662864', 'S77008082', 'S77008082', 'UT01', 'Precision Medical Management', 'Travis', 'C', 'Engar', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174512669', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77008083', 'S77008083', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Travis', 'C', 'Engar', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174512669', 0, 'Y', 0, '2014-02-05', NULL, NULL, 39.6051, -110.832, NULL, NULL),
('870662864', 'S77008084', 'S77008084', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Kurt', 'V', 'King', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', '2008-08-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649267949', 0, 'Y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870664133', 'S77008085', 'S77008085', 'UT01', NULL, 'Hyrum', 'D', 'Woods', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4440', 'Ogden', 'Weber', 'UT', '84403', '8013874490', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013874490', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811958184', 0, 'N', 0, '2011-01-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870664692', 'S77008086', 'S77008086', 'UT01', NULL, 'Susan', 'Carol', 'Hustad', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'O', '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '8014758686', '425 E 5350 S', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770589145', 0, 'N', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870665148', 'S77008087', 'S77008087', 'UT01', NULL, 'Frank', 'E', 'Tilaro', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 335', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '8014758686', '425 E 5350 S', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821027525', 0, 'N', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870665351', 'S77008093', 'S77008093', 'UT01', NULL, 'Timothy', 'Scott', 'Grange', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '4052 W Pioneer Pkwy Ste 208', 'West Valley', 'Salt Lake', 'UT', '84120', '8019551232', NULL, '4052 Pioneer Pkwy', 'West Valley', '', 'UT', '84120', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169430', 0, 'N', 0, '2007-04-09', NULL, NULL, 40.6985, -111.988, NULL, NULL),
('870680455', 'S77008110', 'S77008110', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'James', 'W', 'Adams', 'MD', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598757080', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008111', 'S77008111', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Ann', 'Carol', 'Cottrell', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833986', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008112', 'S77008112', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Carl', 'A', 'Mattsson', 'MD', 'Orthopedic Surgery', 'Sports Medicine', NULL, NULL, 'O', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', 'WiseOGORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982696076', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008113', 'S77008113', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Allisyn', NULL, 'Okawa', 'MD', 'Plastic Surgery', 'Hand Surgery', NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538151063', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680539', 'S77008115', 'S77008115', 'UT01', 'Jordan River Family Health', 'Michael', 'D', 'Jones', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 271555', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014332873', NULL, 'PO Box 271555', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014332873', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1538173422', 0, 'Y', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870681398', 'S77008116', 'S77008116', 'UT01', 'Medical Associates of Salt Lake', 'Kathryn', '', 'Casull', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-03-18', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831256635', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77008117', 'S77008117', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Michael', 'H', 'Bourne', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1073505582', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008118', 'S77008118', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Bruce', 'G', 'Evans', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942292446', 0, 'N', 0, '2011-05-31', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870656268', 'S77008122', 'S77008122', 'UT01', 'Wasatch Physical Therapy & Rehabilitation Center', 'Wasatch Physical Therapy', NULL, NULL, 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 204', 'Salt Lake City', NULL, 'UT', NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', '57.75', 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77008123', 'S77008123', 'UT01', 'Utah Bone & Joint Center', 'McCall', '', 'Fagan', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5323 WooDrow St Ste 202', 'Murray', NULL, 'UT', NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77008124', 'S77008124', 'UT01', 'Wasatch Physical Therapy And Rehab', 'Aaron', 'C', 'Hall', 'PAC', 'Physical Therapy', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 204', 'Salt Lake City', NULL, 'UT', NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', '57.75', 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942294616', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870656268', 'S77008125', 'S77008125', 'UT01', 'Utah Bone & Joint Center', 'John', 'G', 'Skedros', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', NULL, '5323 S Woodrow St Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8017130606', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972597730', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870281028', 'S77008126', 'S77008126', 'UT01', 'Central Utah Clinic Cascade Family Medicine', 'Steven', 'L', 'Berry', 'MD', 'Family Practice', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-02-06', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528095312', 0, 'Y', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870665351', 'S77008128', 'S77008128', 'UT01', 'Alta Medical Management', 'Timothy', 'Scott', 'Grange', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8019551232', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169430', 0, 'Y', 0, '2007-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870666061', 'S77008129', 'S77008129', 'UT01', 'Copperview Medical Center Urgent Care (Appts Preferred) M-F 8am-10pm', '', '', 'Copperview Medical Center Urgent Care (Appt''s Preferred)', 'MD', 'Urgent Care', NULL, NULL, NULL, 'O', '3556 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', NULL, '3556 W 9800 S', 'South Jordan', '', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003085', 0, 'N', 0, '2006-10-17', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870666061', 'S77008130', 'S77008130', 'UT01', 'Copperview Medical Center', 'Paul', 'S', 'Lei', 'MD', 'Pediatrics', '', '', NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1851357230', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870666819', 'S77008131', 'S77008131', 'UT01', 'Wasatch Neurological Surgery', 'Todd', 'E', 'Stanford', 'PA', 'Neurology', NULL, NULL, NULL, 'O', '1486 E Skyline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755990', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870667680', 'S77008132', 'S77008132', 'UT01', 'Oasis Family Medicine', 'Sarah', 'Jane', 'Cormier', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358330229', '4358330231', '196 E 2000 N', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-01-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811917271', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870668774', 'S77008134', 'S77008134', 'UT01', 'Salt Lake Family Health Center', 'Paul', 'R', 'Swoboda', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1002 E S Temple Ste 404', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504479', NULL, '1002 E S Temple Ste 404', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504479', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598898363', 0, 'N', 0, '2012-05-16', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('870668900', 'S77008135', 'S77008135', 'UT01', 'Castleview Hospital', 'Ben', 'Paul', 'Babusis', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834605', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008137', 'S77008137', 'UT01', 'Castleview Hospital', 'Roy', 'Charles', 'Hammond', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834384', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77008154', 'S77008154', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Kade', 'T', 'Huntsman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730171232', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008155', 'S77008155', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Jeffrey', 'G', 'Randle', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1063404424', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008156', 'S77008156', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Steven', 'M', 'Scott', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154313690', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870684853', 'S77008160', 'S77008160', 'UT01', 'Bountiful Neurology', 'Jozef', 'A', 'Ottowicz', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8016770027', NULL, 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8016770027', '', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1861484297', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'S77008161', 'S77008161', 'UT01', 'UNI Home Project', 'Philip', 'L', 'Baese', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2007-01-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184669848', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'S77008162', 'S77008162', 'UT01', 'UNI Home Project', 'Barbara', '', 'Faust', 'NP', 'Pediatrics', 'Psychiatry', 'Neurology', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710920566', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685287', 'S77008163', 'S77008163', 'UT01', 'Southwest Childrens Clinic', 'Holly', 'J', 'Molberg', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', NULL, '8822 S Redwood Rd', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356564892', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('870687771', 'S77008166', 'S77008166', 'UT01', 'Mountain Valley Imaging Of Eastern Utah', 'David', NULL, 'Perry', 'MD', NULL, NULL, NULL, NULL, 'B', 'PO Box 629', 'Ogden', 'Weber', 'UT', '84402', '4357893342', NULL, 'PO Box 629', 'Ogden', '', 'UT', '84402', '', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912074352', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870658282', 'S77008169', 'S77008169', 'UT01', NULL, 'Brent', 'H', 'Goodsell', 'DO', 'Dermatology', NULL, NULL, NULL, 'B', 'PO Box 945', 'American Fork', 'Utah', 'UT', '84003', '8017569669', '8017560202', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528172863', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870658401', 'S77008171', 'S77008171', 'UT01', '', 'Donald', 'N', 'Harline', 'MD', 'Family Practice', '', '', NULL, 'O', '423 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8014268141', '8014268142', '423 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8014268141', '8014268142', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659305126', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870658625', 'S77008172', 'S77008172', 'UT01', 'Wasatch Peak Family Practice', 'Jeffery', 'L', 'DeGrauw', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780796441', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870673378', 'S77008181', 'S77008181', 'UT01', 'Collins-Kronmiller Urologic', 'Dean', 'L', 'Bristow', 'MD', 'Urology', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8014652511', NULL, '48 W 1500 N', 'Nephi', 'Millard', 'UT', '84648', '8014652511', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-03-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255442976', 0, 'N', 0, '2010-06-08', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008204', 'S77008204', 'UT01', 'Garfield Memorial Clinic', '', '', 'Garfield Memorial Clinic', 'GROUP', 'Clinic', NULL, NULL, NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834487', 0, 'Y', 0, '2007-03-20', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('876000309', 'S77008205', 'S77008205', 'UT01', 'Bryce Valley Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', NULL, '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'N', 0, '2010-08-28', NULL, NULL, 37.5669, -112.054, NULL, NULL),
('876000309', 'S77008206', 'S77008206', 'UT01', 'Circleville Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', NULL, '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'N', 0, '2010-08-28', NULL, NULL, 38.1717, -112.273, NULL, NULL),
('876000309', 'S77008207', 'S77008207', 'UT01', 'Kazan Memorial Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', NULL, '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'N', 0, '2010-08-28', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008208', 'S77008208', 'UT01', 'Bryce Valley Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008209', 'S77008209', 'UT01', 'Orderville Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008210', 'S77008210', 'UT01', 'Bryce Valley Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'O', '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', NULL, '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'N', 0, '2014-04-07', NULL, NULL, 37.5669, -112.054, NULL, NULL),
('876000309', 'S77008211', 'S77008211', 'UT01', 'Circleville Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'O', '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', NULL, '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'N', 0, '2014-04-07', NULL, NULL, 38.1717, -112.273, NULL, NULL),
('876000309', 'S77008212', 'S77008212', 'UT01', 'Garfield Memorial Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008215', 'S77008215', 'UT01', 'Garfield Memorial Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'N', 0, '2014-04-07', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('876000309', 'S77008218', 'S77008218', 'UT01', 'Orderville Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'O', '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', '2008-07-31', 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'N', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870676738', 'S77008233', 'S77008233', 'UT01', '', 'Lisa', 'K', 'Christensen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013944399', '8013945003', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013944399', '8013945003', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-09-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720076565', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870678603', 'S77008234', 'S77008234', 'UT01', 'Northern Utah Nephrology', 'Adhish', 'K', 'Agarwal', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014791117', NULL, '425 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014791117', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164424750', 0, 'N', 0, '2010-10-18', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870678993', 'S77008235', 'S77008235', 'UT01', 'Families First Pediatrics', 'Brian', 'P', 'Good', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770688335', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870679270', 'S77008237', 'S77008237', 'UT01', 'Kaysville Clinic', 'Douglas', 'P', 'Barney', 'MD', 'Wound Care', 'Hyperbaric Wound', 'Family Practice', NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', NULL, '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-10', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013081801', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870679270', 'S77008239', 'S77008239', 'UT01', 'Kaysville Clinic', 'Layne', 'K', 'Kamalu', 'MD', 'Family Practice', '', '', NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '8015443724', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '8015443724', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-01-26', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104987916', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870679508', 'S77008241', 'S77008241', 'UT01', 'Art City Foot & Ankle', 'Matthew', 'G', 'Ollerton', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014913668', NULL, '5 E 400 N', 'Springville', '', 'UT', '846631347', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518959733', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008242', 'S77008242', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Donald', 'W', 'Bryan', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '844033271', '8013872600', '8013872625', 'WiseOGORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-06-30', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1366434433', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008243', 'S77008243', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Donald', 'W', 'Bryan', 'MD', 'Orthopedic Surgery', 'Sports Medicine', NULL, NULL, 'B', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366434433', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008244', 'S77008244', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Jack', 'W', 'Crosland', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750373247', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008259', 'S77008259', 'UT01', 'Circleville Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008260', 'S77008260', 'UT01', 'Garfield Memorial Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4346768811', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008263', 'S77008263', 'UT01', 'Garfield Memorial Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008264', 'S77008264', 'UT01', 'Health Clinics of Utah', 'Dan', 'S', 'Albu-Zaruba', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-11-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1912969270', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008265', 'S77008265', 'UT01', 'Health Clinics Of Utah', 'Bruce', 'M', 'Burnham', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '929029', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008266', 'S77008266', 'UT01', 'Health Clinics Of Utah', 'Frankie', 'Lynn', 'Davis', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831623', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008267', 'S77008267', 'UT01', 'Health Clinics Of Utah', 'Joseph', 'K', 'Miner', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '150 E Ctr St Ste 1100', 'Provo', 'Utah', 'UT', '84606', '8013747011', NULL, '3195 S Main St', 'Salt Lake City', 'Utah', 'UT', '84115', '8013747011', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1881652980', 0, 'N', 0, '2011-12-28', NULL, NULL, 40.2337, -111.656, NULL, NULL),
('876000545', 'S77008268', 'S77008268', 'UT01', 'Health Clinics Of Utah', 'Virginia', NULL, 'Mol', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831625', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008269', 'S77008269', 'UT01', 'Health Clinics Of Utah', 'Gary', 'E', 'Nelson', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '150 E Ctr St Ste 1100', 'Provo', 'Utah', 'UT', '84606', '8013747011', NULL, '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '830997', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008271', 'S77008271', 'UT01', 'Blanding Clinic', '', '', 'Blanding Medical Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', NULL, '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', '          ', '', '', '', '0.00', '8.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1821045840', 0, 'Y', 0, '2012-06-01', NULL, NULL, 37.8741, -109.348, NULL, NULL),
('876000616', 'S77008272', 'S77008272', 'UT01', 'San Juan Hospital - Pro Fees', '', '', 'Blanding Medical Clinic', 'GROUP', 'Clinic', NULL, NULL, NULL, 'B', 'PO Box 1054 ', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', NULL, NULL, NULL, '0.00', '8.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1821045840', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008273', 'S77008273', 'UT01', 'San Juan Hospital Pro Fees', 'San Juan Hospital Professional', NULL, NULL, 'GROUP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1054 ', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', NULL, NULL, NULL, '0.00', '8.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1659315877', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870661855', 'S77008274', 'S77008274', 'UT01', 'Cache Orthopaedics', 'James', 'T', 'Malouf', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2380 N 400 E', 'North Logan', 'Cache', 'UT', '84341', '4357924100', NULL, '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357924100', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-13', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1790788503', 0, 'N', 0, '2011-09-20', 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
('870662864', 'S77008279', 'S77008279', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Cameron', '', 'Williams', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952398463', 0, 'Y', 0, '2014-02-05', NULL, NULL, 39.6051, -110.832, NULL, NULL),
('870665148', 'S77008280', 'S77008280', 'UT01', NULL, 'Frank', 'E', 'Tilaro', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 71128', 'Cottonwood', 'Salt Lake', 'UT', '84171', '8013522700', '8014758580', '425 E 5350 S', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821027525', 0, 'Y', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870666061', 'S77008283', 'S77008283', 'UT01', 'Copperview Medical Center', 'Michael', 'C', 'Flynn', 'MD', 'Internal Medicine', 'Pediatrics', NULL, NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S', 'South Jordan', '', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306936901', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870666144', 'S77008284', 'S77008284', 'UT01', 'Deseret Peak Anesthesia', 'Kyle', 'H', 'Jones', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8018254700', NULL, 'PO Box 210', 'Roy', '', 'UT', '84067', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720092752', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.5716, -112.295, NULL, NULL),
('870680455', 'S77008285', 'S77008285', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Michael', 'C', 'Hawkins', 'PA-C', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639161078', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680539', 'S77008287', 'S77008287', 'UT01', 'Jordan River Family Health', 'Michael', 'D', 'Jones', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1325 W S Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', '1325 W S Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-03', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1538173422', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870680602', 'S77008288', 'S77008288', 'UT01', 'Ashdown Surgical', 'Jan', 'M', 'Ashdown', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '950 S 500 W Ste 104', 'Brigham City', 'Box Elder', 'UT', '84302', '4357231114', NULL, '950 S 500 W Ste 104', 'Brigham City', 'Box Elder', 'UT', '84302', '4357231114', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Franklin County Medical Center ', NULL, NULL, 'HCFA|UB|', '1871591958', 0, 'N', 0, '2012-09-27', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('870680811', 'S77008289', 'S77008289', 'UT01', 'Mountainview  Healthcare', 'Ronald', 'R', 'Trudel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', NULL, '1959 N Aaron Dr Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1962455626', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.5653, -112.298, NULL, NULL),
('870681544', 'S77008292', 'S77008292', 'UT01', NULL, 'Merwin', NULL, 'Rasmussen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '8017335623', '3460 Pioneer Pkwy', 'West Valley City', '', 'UT', '841202049', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497770978', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77008293', 'S77008293', 'UT01', 'Salt Lake Orthopaedic Clinic', 'E', 'Marc', 'Mariani', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760474266', 0, 'N', 0, NULL, NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008294', 'S77008294', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Christopher', 'H', 'Martin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1891787339', 0, 'N', 0, '2014-05-21', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008295', 'S77008295', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Tony', 'L', 'Miller', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275576274', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008296', 'S77008296', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Bruce', 'Y', 'Newton', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679565170', 0, 'N', 0, '2012-05-18', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008297', 'S77008297', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Peter', 'J', 'Novak', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104818608', 0, 'N', 0, '2012-05-15', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008298', 'S77008298', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Stephen', 'G', 'Roper', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124061155', 0, 'N', 0, NULL, NULL, NULL, 40.6871, -111.858, NULL, NULL),
('876000616', 'S77008313', 'S77008313', 'UT01', 'Blanding Medical Clinic', 'Mahana', 'S', 'Fisher', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '804 N 400 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356782254', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1700878949', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008314', 'S77008314', 'UT01', 'San Juan Clinic', 'Mahana', 'S', 'Fisher', 'MD', 'Family Practice', '', '', NULL, 'O', '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, 'Blue mountain hospital', '', '', '', 'HCFA|', '1700878949', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.8741, -109.348, NULL, NULL),
('876000616', 'S77008315', 'S77008315', 'UT01', 'San Juan Clinic', 'Blen', NULL, 'Freestone', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1487646337', 0, 'y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008318', 'S77008318', 'UT01', 'San Juan Clinic', 'Jane', 'B', 'Palmer', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1054 ', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1154314169', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008319', 'S77008319', 'UT01', 'San Juan Clinic', 'Jane', 'B', 'Palmer', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '380 W 100 N ', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1154314169', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870666819', 'S77008328', 'S77008328', 'UT01', 'Wasatch Neurological Surgery PC', 'Brent', 'Lee', 'Clyde', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3401 S US HWY 89', 'Bountiful', 'Davis', 'UT', '84010', '8012952438', '8666300782', '3401 S US HWY 89', 'Bountiful', 'Davis', 'UT', '84010', '8012952438', '8666300782', 'WUWASTCHN5', 'WUSTDNEUR5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Davis Hospital', 'Star Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1700896552', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.8512, -111.905, NULL, NULL),
('870668017', 'S77008329', 'S77008329', 'UT01', 'Ackerson Eyecare', 'John', 'H', 'Ackerson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '736 W 100 S', 'Heber City', 'Wasatch', 'UT', '84032', '4356571212', '4356579522', '736 W 100 S', 'Heber City', 'Wasatch', 'UT', '84032', '4356571212', '4356579522', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295753465', 0, 'N', 0, '2013-11-05', NULL, NULL, 40.5068, -111.424, NULL, NULL),
('870668774', 'S77008331', 'S77008331', 'UT01', 'Salt Lake Family Health Center', 'Mara', 'L', 'Rabin', 'MD', 'Family Practice', '', '', NULL, 'O', '1002 E S Temple Ste 404', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504479', '', '1002 E S Temple Ste 404', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504479', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1225161003', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('870668900', 'S77008332', 'S77008332', 'UT01', 'Mountain Valley Imaging', 'Ben', 'Paul', 'Babusis', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834605', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008333', 'S77008333', 'UT01', 'Castleview Hospital', 'Barry', 'M', 'Birkin', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144289521', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008334', 'S77008334', 'UT01', 'Castleview Hospital', 'William', 'John', 'Dubiel', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834550', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008335', 'S77008335', 'UT01', 'Mountain Valley Imaging', 'Roy', 'Charles', 'Hammond', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834384', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008336', 'S77008336', 'UT01', 'Castleview Hospital', 'Dinesh', 'K', 'Sharma', 'MD', 'Radiologist', 'Radiology Diagnostic', NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834551', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77008337', 'S77008337', 'UT01', 'Mountain Valley Imaging', 'Dinesh', 'K', 'Sharma', 'MD', 'Radiologist', 'Radiology Diagnostic', NULL, NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834551', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870669005', 'S77008338', 'S77008338', 'UT01', NULL, 'Douglas', '', 'Denys', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1159 E 200 N Ste 325', 'American Fork', 'Utah', 'UT', '84003', '8018552930', '8018552934', '1159 E 200 N Ste 325', 'American Fork', 'Utah', 'UT', '84003', '8018552930', '8018552934', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1831149616', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('870683247', 'S77008342', 'S77008342', 'UT01', 'First Med', 'Terry', NULL, 'Brown', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '8822 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012560009', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834848', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870683247', 'S77008343', 'S77008343', 'UT01', 'First Med', 'Janet', 'M', 'Williams', 'PA', 'Emergency Medicine', NULL, NULL, NULL, 'O', '8822 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012560009', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '835682', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870685287', 'S77008347', 'S77008347', 'UT01', 'Southwest Childrens Clinic', 'Pari', '', 'Mashkuri', 'MD', 'Pediatrics', '', '', NULL, 'O', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', NULL, '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1407079908', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('870685287', 'S77008348', 'S77008348', 'UT01', 'Southwest Childrens Clinic', 'Renee', 'E', 'Olesen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', NULL, '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-02-09', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1578786851', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('870686529', 'S77008350', 'S77008350', 'UT01', 'Pioneer Valley Ob/Gyn', 'Scott', 'F', 'Epstein', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793339', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870687038', 'S77008351', 'S77008351', 'UT01', 'Western Gyn & Ob Clinic', 'May', '', 'Chambers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste G50', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144440', '8013144437', '5770 S 250 E Ste G50', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144440', '8013144437', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669512026', 0, 'N', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77008352', 'S77008352', 'UT01', 'Western Neurological Associates', 'Mary', 'Kathryn', 'Alderson', 'MD', 'Neurology', NULL, NULL, NULL, 'B', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '8012699005', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832436', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870676756', 'S77008392', 'S77008392', 'UT01', '', 'Kim', 'E', 'Scott', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1777 Sun Peak Dr Ste 150', 'Park City', 'Summit', 'UT', '84098', '4356450800', '4356473003', '1777 Sun Peak Dr Ste 150', 'Park City', 'Summit', 'UT', '84098', '4356450800', '4356473003', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-17', 0, 0, 0, 'Park City Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497712376', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870676756', 'S77008393', 'S77008393', 'UT01', NULL, 'Kim', 'E', 'Scott', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Park City Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497712376', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870678237', 'S77008394', 'S77008394', 'UT01', 'Davis Vision Center', 'Brian', 'R', 'Davis', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679583470', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870687511', 'S77008396', 'S77008396', 'UT01', 'Brigham City Arthritis Clinic', 'Harold', NULL, 'Vonk', 'MD', 'Rheumatology', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014791115', NULL, '984 S Medical Dr', 'Brigham City', '', 'UT', '84302', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235201526', 0, 'Y', 0, '2007-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870687579', 'S77008397', 'S77008397', 'UT01', 'Ogden Internal Medicine', 'Seth', 'R', 'Lewis', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'O', '5405 S 500 E Ste 101', 'Ogden', 'Weber', 'UT', '84405', '8014755100', NULL, '5405 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014755100', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-08', NULL, 0, NULL, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851409544', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('870687771', 'S77008398', 'S77008398', 'UT01', 'Mountain Valley Imaging Of Eastern Utah', 'David', NULL, 'Perry', 'MD', NULL, NULL, NULL, NULL, 'O', '1240 S 850 W', 'Vernal', 'Uintah', 'UT', '84078', '4357893342', NULL, 'PO Box 629', 'Ogden', '', 'UT', '84402', '', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912074352', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.4385, -109.545, NULL, NULL),
('876000309', 'S77008401', 'S77008401', 'UT01', 'Garfield Memorial Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'N', 0, '2010-08-28', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('876000309', 'S77008402', 'S77008402', 'UT01', 'Circleville Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008405', 'S77008405', 'UT01', 'Bryce Valley Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'O', '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'N', 0, '2007-03-20', NULL, NULL, 37.5669, -112.054, NULL, NULL),
('876000309', 'S77008406', 'S77008406', 'UT01', 'Garfield Memorial Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'Y', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008408', 'S77008408', 'UT01', 'Bryce Valley Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '25 S Redrock Dr', 'Cannonville', 'Garfield', 'UT', '84718', '4356798545', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008409', 'S77008409', 'UT01', 'Health Clinics of Utah', 'Marilyn', '', 'Cox', 'NP', 'Family Practice', '', '', NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619946605', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.2198, -111.971, NULL, NULL),
('870678440', 'S77008438', 'S77008438', 'UT01', 'Utah Valley Obstetrical Ultrasound', 'Jodie', 'G', 'Layton', 'MS', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 143', 'Provo', 'Utah', 'UT', '84603', '8012255407', NULL, 'PO Box 143', 'Provo', '', 'UT', '84604', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832518', 0, 'Y', 0, '2006-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870678589', 'S77008439', 'S77008439', 'UT01', '', 'Marcia', 'J', 'Litzinger', 'MD', 'Pediatric Neurology', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 135', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528367', NULL, '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '840888857', '8013528367', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-01', NULL, 0, NULL, 'Jordan Valley Medical Center', 'Primary Childrens Hospital', '', '', 'HCFA|UB|', '1306806047', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('870678589', 'S77008440', 'S77008440', 'UT01', '', 'Marcia', 'J', 'Litzinger', 'MD', 'Pediatric Neurology', NULL, NULL, NULL, 'B', 'PO Box 1954', 'Sandy', 'Salt Lake', 'UT', '84091', '8013528367', NULL, '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '840888857', '8013528367', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-01', NULL, 0, NULL, 'Jordan Valley Medical Center', 'Primary Childrens Hospital', '', '', 'HCFA|UB|', '1306806047', 0, 'Y', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'S77008442', 'S77008442', 'UT01', 'Families First Pediatrics', 'Matthew', 'N', 'Cox', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1811081904', 0, 'Y', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'S77008443', 'S77008443', 'UT01', 'Families First Pediatrics', 'Brian', 'P', 'Good', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '          ', NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '          ', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770688335', 0, 'Y', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870679120', 'S77008444', 'S77008444', 'UT01', '', 'David', 'T', 'Roberts', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014656969', '8014656999', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014656969', '8014656999', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-07-06', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1326031782', 0, 'N', 0, '2011-07-06', NULL, NULL, 0, 0, NULL, NULL),
('870679270', 'S77008447', 'S77008447', 'UT01', 'Kaysville Clinic', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', NULL, NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', NULL, '934 S Main ST', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870679577', 'S77008449', 'S77008449', 'UT01', '', 'David', 'M', 'Anderson', 'DDS MD', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '7390 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', '7390 S Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-11-15', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1619061546', 0, 'Y', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008450', 'S77008450', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Dann', 'C', 'Byck', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 2600', 'Ogden', 'Weber', 'UT', '84403', '8013872600', '8013872625', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '844033271', '8013872600', '8013872625', 'WiseOGORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-01', NULL, 0, NULL, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679565758', 0, 'N', 0, '2010-10-18', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008452', 'S77008452', 'UT01', 'Health Clinics Of Utah', 'Kathleen', '', 'Hogan', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215999578', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008453', 'S77008453', 'UT01', 'San Juan Clinic', 'Mahana', 'S', 'Fisher', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, 'Blue mountain hospital', '', '', '', 'HCFA|', '1700878949', 0, 'y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('900012698', 'S77008494', 'S77008494', 'UT01', '', 'Lorell', 'B', 'Fawson', 'DPM', 'Podiatry', '', '', NULL, 'O', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', '8016272125', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-09-13', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1144200155', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('912160693', 'S77008495', 'S77008495', 'UT01', 'Nephrology Medical Associates', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'B', 'PO Box 409137', 'Atlanta', 'Fulton', 'GA', '30384', '8003104872', NULL, 'PO Box 409137', 'Atlanta', 'Fulton', 'GA', '30384', '8003104872', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('870666061', 'S77008496', 'S77008496', 'UT01', 'Copperview Medical Center', 'Nicole', NULL, 'Girard', 'PA', 'Pediatrics', 'Pediatrics', NULL, NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S', 'South Jordan', '', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992791677', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77008497', 'S77008497', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Carl', 'A', 'Mattsson', 'MD', 'Orthopedic Surgery', 'Sports Medicine', NULL, NULL, 'B', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982696076', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77008499', 'S77008499', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Gregory', 'S', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992797492', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77008500', 'S77008500', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Robert', 'B', 'Bourne', 'MD', 'Sports Medicine', 'Orthopedic Surgery', NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487646998', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77008502', 'S77008502', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Harley', 'G', 'Morrell', 'PA', 'Family Practice', 'Orthopedic Surgery', NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831644', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870684599', 'S77008505', 'S77008505', 'UT01', 'Bountiful Eye Care', 'Gerald', 'O', 'Robinson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '140 S Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012952020', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833592', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'S77008506', 'S77008506', 'UT01', 'UNI Home Project', 'Bonnie', NULL, 'Anderson', 'APRN', 'Family Practice', 'Mental Health', '', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000951095', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'S77008507', 'S77008507', 'UT01', 'UNI Home Project', 'Deborah', 'A', 'Bilder', 'MD', 'Mental Health', 'Psychiatry', 'Pediatrics', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2007-01-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427084615', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('870686529', 'S77008508', 'S77008508', 'UT01', 'Pioneer Valley OBGYN', 'Spencer', 'N', 'Colby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-10-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144287699', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870686529', 'S77008509', 'S77008509', 'UT01', 'Pioneer Valley OBGYN', 'Scott', 'F', 'Epstein', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-10-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793339', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870477183', 'S77008530', 'S77008530', 'UT01', 'Emergency Medical Services', NULL, NULL, 'Emergency Medical Services', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8016754539', NULL, '750 W 800 N', 'Orem', '', 'UT', '840573660', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834829', 0, 'Y', 0, '2006-10-17', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('870477183', 'S77008531', 'S77008531', 'UT01', 'Emergency Medical Services', NULL, NULL, 'Emergency Medical Services', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1865', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8016754539', NULL, 'PO Box 1865', 'Salt Lake City', '', 'UT', '84110', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834829', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870478213', 'S77008533', 'S77008533', 'UT01', 'Eyre Dermatology Clinic', 'Steven', 'P', 'Eyre', 'MD', 'Dermatology', '', '', NULL, 'O', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', '486 W 800 N Ste 201', 'Orem', 'Utah', 'UT', '84057', '8014310300', '8014310312', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1174520597', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.3121, -111.708, NULL, NULL),
('942854057', 'S77008541', 'S77008541', 'UT02', 'Ihc Pulmonary Clinic', 'William', 'T', 'Alward', 'MD', 'Critical Care', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, 'Utah', NULL, NULL, '8013577291', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1609880939', 0, 'Y', 0, '2011-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008550', 'S77008550', 'UT01', 'Western Gyn & Ob Clinic', 'Jane', '', 'Bowman', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073621611', 0, 'Y', 0, '2008-07-29', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870686529', 'S77008552', 'S77008552', 'UT01', 'Pioneer Valley Ob/Gyn', 'Steven', 'M', 'Thackeray', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407813959', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77008556', 'S77008556', 'UT01', 'Western Neurological Associates', 'Michael', 'L', 'Goldstein', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', NULL, '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1962400580', 0, 'N', 0, '2011-08-01', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870687383', 'S77008557', 'S77008557', 'UT01', 'Western Neurological Associates', 'Gary', 'L', 'Halversen', 'MD', 'Diagnostic Radiology', 'Radiology', '', NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', NULL, '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2007-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286970', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77008559', 'S77008559', 'UT01', 'Western Neurological Assoc', 'Walter', 'H', 'Reichert', 'MD', 'Neurology', '', '', NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', NULL, '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1427055615', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('876000309', 'S77008564', 'S77008564', 'UT01', 'Orderville Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', NULL, '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', '2008-07-31', 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'N', 0, '2010-08-28', NULL, NULL, 0, 0, NULL, NULL),
('900012698', 'S77008577', 'S77008577', 'UT01', NULL, 'Lorell', 'B', 'Fawson', 'DPM', 'Podiatry', '', '', NULL, 'O', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '8016272125', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1144200155', 0, 'N', 0, '2014-06-30', NULL, NULL, 41.5107, -112.014, NULL, NULL),
('900012698', 'S77008578', 'S77008578', 'UT01', NULL, 'Lorell', 'B', 'Fawson', 'DPM', 'Podiatry', '', '', NULL, 'O', '3590 Harrison Blvd Ste G1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', '3590 Harrison Blvd Ste G1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1144200155', 0, 'N', 0, '2014-06-30', NULL, NULL, 41.1978, -111.949, NULL, NULL),
('870479370', 'S77008592', 'S77008592', 'UT01', 'Mountain West Cardiovascular Associates', 'Roger', 'L', 'Borchardt', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016763776', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016763776', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386637833', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008607', 'S77008607', 'UT01', 'Garfield Memorial Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77008608', 'S77008608', 'UT01', 'Garfield Memorial Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'N', 0, '2007-03-20', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('876000309', 'S77008611', 'S77008611', 'UT01', 'Kazan Memorial Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'S77008612', 'S77008612', 'UT01', 'University Hospital Physicians', NULL, '', 'University Hospital', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'S77008614', 'S77008614', 'UT01', 'University Hospital Physicians', NULL, '', 'University Hospital', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015717505', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008615', 'S77008615', 'UT01', 'Health Clinics Of Utah', 'Wayne', NULL, 'Crawford', 'PA', 'Family Practice', 'Family Practice', NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831609', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008616', 'S77008616', 'UT01', 'Health Clinics Of Utah', 'Richard', 'J', 'Gregoire', 'MD PHD', 'Family Practice', '', '', NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '3195 S Main St', 'Salt Lake City', 'Weber', 'UT', '84115', '8016263670', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-11-14', NULL, 0, NULL, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1528066149', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008618', 'S77008618', 'UT01', 'Health Clinics Of Utah', 'Joyce', 'D', 'Johnson', 'MD', 'Dermatology', 'Internal Medicine', NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649245705', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('900012698', 'S77008619', 'S77008619', 'UT01', NULL, 'Chantel', 'B', 'Murrah', 'DPM', 'Podiatry', '', '', NULL, 'O', '3590 Harrison Blvd Ste G1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', '3590 Harrison Blvd Ste G1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1093791311', 0, 'N', 0, '2014-05-20', NULL, NULL, 41.1978, -111.949, NULL, NULL),
('900098068', 'S77008620', 'S77008620', 'UT01', '', 'Richard', 'G', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '620 Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012925070', '', '620 Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012925070', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-17', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1174539449', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL);
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
('900182518', 'S77008621', 'S77008621', 'UT01', 'Riverwoods Urgent Care LLC', NULL, NULL, 'Riverwoods Urgent Care LLC', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 120', 'Provo', 'Utah', 'UT', '84604', '8012292011', '8012240242', '280 W Riverpark Dr', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000912680', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('900182518', 'S77008622', 'S77008622', 'UT01', 'Riverwoods Urgent Care', 'Mark', NULL, 'Gardner', 'PA-C', 'Emergency Medicine', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 120', 'Provo', 'Utah', 'UT', '84604', '8012292011', '8012240242', '280 W Riverpark Dr', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891797247', 0, 'Y', 0, '2006-10-19', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('900188420', 'S77008623', 'S77008623', 'UT01', 'Gynecology Affiliates', 'Kristina', '', 'Hedin-Goldsmith', 'NP', 'Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1235279944', 0, 'N', 0, '2014-07-07', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('912160693', 'S77008625', 'S77008625', 'UT01', 'Nephrology Medical Assoc', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '880 E 3900 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012681296', NULL, '880 E 3900 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012681296', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('931182442', 'S77008628', 'S77008628', 'UT01', NULL, 'Justin', 'Forth', 'Thulin', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667325', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023057098', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('931239371', 'S77008629', 'S77008629', 'UT01', 'Peak Otolaryngology', 'Joanne', NULL, 'Abegglen', 'NP', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '8013566326', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832437', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942747377', 'S77008630', 'S77008630', 'UT01', 'Yeates, Henry M', 'Henry', NULL, 'Yeates', 'MD', 'Allergy', NULL, NULL, NULL, 'O', '159 N 400 W Ste B8', 'Orem', 'Utah', 'UT', '84057', '8012263600', '8012243811', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649204033', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77008633', 'S77008633', 'UT01', 'Mountain West Cardiovascular Associates', 'Edward', 'Wayne', 'Ganellen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164414017', 0, 'N', 0, '2014-04-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'S77008634', 'S77008634', 'UT01', 'Mountain West Cardiovascular Associates', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', NULL, '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870479370', 'S77008635', 'S77008635', 'UT01', 'Mountain West Cardiovascular Associates', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831138403', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77008638', 'S77008638', 'UT01', 'Mountain West Cardiovascular Assoc', 'Rex', 'A', 'Outtrim', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558355313', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77008639', 'S77008639', 'UT01', 'Mountain West Cardiovascular Associates', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Audiology', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012844512', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77008640', 'S77008640', 'UT01', 'Mountain West Cardiovascular Associates', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'S77008641', 'S77008641', 'UT01', 'Mountain West Cardiovascular Associates', 'Anabel', NULL, 'Tijerina', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832924', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77008654', 'S77008654', 'UT01', 'Health Clinics of Utah', 'Deborah', 'M', 'Judd', 'FNP-C', 'Family Practice', NULL, NULL, NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '          ', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790754760', 0, 'N', 0, '2014-07-15', NULL, NULL, 41.2198, -111.971, NULL, NULL),
('876000545', 'S77008655', 'S77008655', 'UT01', 'Health Clinics of Utah', 'Rhonda', 'G', 'Lee', 'PA', 'Obstetrics and Gynecology', 'Physician Assistant', '', NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174583793', 0, 'N', 0, '2012-09-18', NULL, NULL, 41.2198, -111.971, NULL, NULL),
('876000545', 'S77008656', 'S77008656', 'UT01', 'Health Clinics Of Utah', 'John', 'Edward', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669526950', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77008657', 'S77008657', 'UT01', 'San Juan Hospital Pro Fees', '', '', 'San Juan Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '380 W 100 N ', 'Monticello', 'San Juan', 'UT', '84535', NULL, NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', NULL, NULL, NULL, '0.00', '8.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1942251459', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008702', 'S77008702', 'UT02', 'Intermountain Health Care', 'Michael', 'J', 'Pearce', 'MD', 'Pulmonary', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568478832', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'S77008736', 'S77008736', 'UT01', 'Westside Medical Clinic', 'Corey', 'L', 'Ericksen', 'DO', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1912003922', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('870481325', 'S77008738', 'S77008738', 'UT01', 'Westside Medical Clinic', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1792 W 1800 N', 'Clinton', 'Davis', 'UT', '84015', '8017748888', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870481685', 'S77008739', 'S77008739', 'UT01', '', 'Kathryn', '', 'Allen', 'MD', 'Family Practice', 'Sports Medicine', NULL, NULL, 'O', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1023058278', 0, 'N', 0, '2013-01-22', NULL, NULL, 40.6955, -111.987, NULL, NULL),
('870481685', 'S77008740', 'S77008740', 'UT01', NULL, 'Steve', '', 'Nielsen', 'PAC', 'Emergency Medicine', '', '', NULL, 'O', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, '3540 S 4000 W', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1184623217', 0, 'N', 0, '2010-09-30', NULL, NULL, 40.6955, -111.987, NULL, NULL),
('870481685', 'S77008741', 'S77008741', 'UT01', 'Kathryn Allen, MD', 'Twana', 'M', 'Rigney', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908286', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870481685', 'S77008742', 'S77008742', 'UT01', NULL, 'Twana', 'M', 'Rigney', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3540 S 4000 W Ste 340', 'West Valley', 'Salt Lake', 'UT', '84120', '8019690200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908286', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008743', 'S77008743', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Derek', 'W', 'Anderson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821069485', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('942854057', 'S77008748', 'S77008748', 'UT02', 'Intermountain Health Care', 'Krishna', 'M', 'Sundar', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801802186', 0, 'Y', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('953750714', 'S77008751', 'S77008751', 'UT01', '', 'E Stanley', '', 'Rodier', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '15725 Pomerado Rd Ste 108', 'Poway', 'San Diego', 'CA', '92064', '8584858111', '8584859926', '15725 Pomerado Rd Ste 108', 'Poway', 'San Diego', 'CA', '92064', '8584858111', '8584859926', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134201312', 0, 'Y', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008774', 'S77008774', 'UT01', 'Millcreek Anesthesia', 'Derek', 'W', 'Anderson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821069485', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008775', 'S77008775', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Robert', 'L', 'Curtis', 'DO', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528166931', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008776', 'S77008776', 'UT01', 'Millcreek Anesthesia', 'John', NULL, 'English', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832098', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008777', 'S77008777', 'UT01', 'Millcreek Anesthesia', 'Kyle', 'R', 'Enslin', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134127202', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008778', 'S77008778', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Robert', 'S', 'Hibbard', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720185986', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008779', 'S77008779', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Douglas', NULL, 'Hill', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194723114', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008780', 'S77008780', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'James', NULL, 'Mackin', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841284635', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008781', 'S77008781', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Scott', NULL, 'Mears', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366440497', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008782', 'S77008782', 'UT01', 'Millcreek Anesthesia', 'Scott', NULL, 'Mears', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366440497', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008783', 'S77008783', 'UT01', 'Millcreek Anesthesia', 'Scott', 'W', 'Moss', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902906415', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008784', 'S77008784', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Bradley', '', 'Nielsen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457359317', 0, 'Y', 0, '2011-05-31', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008785', 'S77008785', 'UT01', 'Millcreek Anesthesia', 'Bradley', '', 'Nielsen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019939530', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457359317', 0, 'Y', 0, '2011-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008786', 'S77008786', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Teresa', '', 'Ota', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467450502', 0, 'Y', 0, '2011-05-31', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008787', 'S77008787', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Peggy', 'B', 'Petersen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245238104', 0, 'Y', 0, '2011-05-31', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('954893928', 'S77008788', 'S77008788', 'UT01', 'Magna Center For Family Medicine', 'Melissa', 'D', 'Lonnecker', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905063', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008789', 'S77008789', 'UT01', 'Exodus Healthcare Network', 'Aziza', 'O', 'Keval', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-09-01', NULL, 0, NULL, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790716439', 0, 'Y', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008790', 'S77008790', 'UT01', 'Exodus Healthcare Network', 'Steven', 'J', 'Spencer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2014-05-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356369938', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('900098068', 'S77008794', 'S77008794', 'UT01', '', 'Richard', 'G', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '1660 W Antelope Dr Ste 110', 'Layton', 'Davis', 'UT', '84041', '8018254709', '', '1660 W Antelope Dr Ste 110', 'Layton', 'Davis', 'UT', '84041', '8018254709', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-17', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1174539449', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('900188420', 'S77008795', 'S77008795', 'UT01', 'Gynecology Affiliates', 'Dan', 'L', 'Chichester', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194781633', 0, 'N', 0, '2013-07-22', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('900188420', 'S77008796', 'S77008796', 'UT01', 'Gynecology Affiliates', 'Robin', 'G', 'Mainwaring', 'MD', 'Gynecology', 'Gynecology', NULL, NULL, 'O', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043276033', 0, 'N', 0, '2013-09-13', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('930682553', 'S77008798', 'S77008798', 'UT01', '', 'John', 'Bingner', 'Lyman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '520 Medical Dr Ste 201', 'Bountiful', 'Davis', 'UT', '84010', '8012928878', NULL, '520 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012928878', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1538189402', 0, 'N', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('930682553', 'S77008799', 'S77008799', 'UT01', NULL, 'John', 'Bingner', 'Lyman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '520 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012928878', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538189402', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('931182442', 'S77008800', 'S77008800', 'UT01', NULL, 'Justin', 'F', 'Thulin', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B259', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667325', NULL, '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667325', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023057098', 0, 'N', 0, '2011-03-10', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('942854057', 'S77008808', 'S77008808', 'UT02', 'Ihc Pulmonary Clinic', 'Michael', 'J', 'Pearce', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568478832', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008813', 'S77008813', 'UT02', 'Ihc Pulmonary Clinic', 'Douglas', 'Scott', 'Ross', 'MD', 'Sleep Disorders', 'Pulmonary', NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780690198', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008814', 'S77008814', 'UT02', 'Ihc Legacy Ob/Gyn', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1159 E 200 N Ste 250', 'American Fork', 'Utah', 'UT', '84003', '8018552980', NULL, '1159 E 200 N Ste 250', 'American Fork', 'Utah', 'UT', '84003', '8018552980', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'Y', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008816', 'S77008816', 'UT01', 'Millcreek Anesthesia', 'Peggy', 'B', 'Petersen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019939530', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245238104', 0, 'Y', 0, '2011-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008817', 'S77008817', 'UT01', 'Millcreek Anesthesia', 'Mark', 'W', 'Rallison', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396743282', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008818', 'S77008818', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Terry', 'A', 'Smith', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114027877', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482642', 'S77008819', 'S77008819', 'UT01', 'Millcreek Anesthesia', 'Randall', '', 'Stockham', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376541268', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77008820', 'S77008820', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Randy', NULL, 'Thurgood', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245238146', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870482687', 'S77008821', 'S77008821', 'UT01', 'Bear River Eye Center', 'Lynn', 'R', 'Purcell', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', NULL, 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-06-30', 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1013910397', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008842', 'S77008842', 'UT02', 'IHC Pulmonary Clinic', 'Krishna', 'M', 'Sundar', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, 'Utah', NULL, NULL, '8013577291', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801802186', 0, 'Y', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('954659390', 'S77008848', 'S77008848', 'UT01', 'Whiting, Michael', 'Michael', 'D', 'Whiting', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '48 N 1100 E Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014924333', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548220148', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008872', 'S77008872', 'UT02', 'Intermountain Health Care', 'Tracy', 'Arnold', 'Hill', 'MD', 'Pulmonary', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992711253', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008873', 'S77008873', 'UT01', 'Magna Center For Family Medicine', 'Charles', 'O', 'Canfield', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023199825', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008875', 'S77008875', 'UT01', 'Exodus Healthcare Network', 'Steven', 'J', 'Spencer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-09-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356369938', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008892', 'S77008892', 'UT01', 'Ihc Legacy Ob/Gyn', 'Ryan', 'N', 'Jones', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1159 E 200 N Ste 250', 'American Fork', 'Utah', 'UT', '84003', '8018552980', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 8, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003872433', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008893', 'S77008893', 'UT01', 'Intermountain Health Care', 'Ryan', 'N', 'Jones', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 8, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003872433', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008898', 'S77008898', 'UT02', 'Ihc Legacy Ob/Gyn', 'Kari', 'F', 'Lawrence', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1159 E 200 N Ste 250', 'American Fork', 'Utah', 'UT', '84003', '8018552980', NULL, NULL, NULL, 'Utah', NULL, NULL, '8018552980', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1508827072', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870484194', 'S77008905', 'S77008905', 'UT01', 'Foot and Ankle Clinic', 'Max', 'E', 'Jones', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 115', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012689415', '8012680423', '3920 S 1100 E', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-07-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689611824', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870484194', 'S77008906', 'S77008906', 'UT01', 'Foot and Ankle Clinic', 'Max', 'E', 'Jones', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '508 E S Temple Ste 118', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013222727', '8015301542', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689611824', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77008907', 'S77008907', 'UT01', 'Oculoplastic Surgery', 'John', 'R', 'Burroughs', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', '8015339613', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905456', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77008908', 'S77008908', 'UT01', 'Oculoplastic Surgery', 'John', 'D', 'McCann', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', NULL, NULL, 'O', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', NULL, '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326006917', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7693, -111.862, NULL, NULL),
('942854057', 'S77008909', 'S77008909', 'UT02', 'Intermountain Health Care', 'Kari', 'F', 'Lawrence', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1508827072', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77008913', 'S77008913', 'UT02', 'Intermountain Health Care', 'Douglas', 'Scott', 'Ross', 'MD', 'Sleep Disorders', 'Pulmonary', NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780690198', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870486209', 'S77008914', 'S77008914', 'UT01', 'Berner Eye Clinic', 'Terry', 'H', 'Berner', 'OD', 'Optometry', '', '', NULL, 'B', '250 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', '250 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295716538', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870489599', 'S77008919', 'S77008919', 'UT01', 'Intermountain Pediatric Clinic', 'Rob', NULL, 'Lindsay', 'MD', 'Pediatrics', 'Pediatric Endocrinology', NULL, NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817761', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831328', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870489599', 'S77008920', 'S77008920', 'UT01', 'Intermountain Pediatric Clinic', 'Sandra', 'A', 'Phillips', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', NULL, '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205059458', 0, 'N', 0, '2013-11-19', NULL, NULL, 40.7693, -111.877, NULL, NULL),
('870489599', 'S77008921', 'S77008921', 'UT01', 'Intermountain Pediatric Clinic', 'Paul', 'H', 'Swensen', 'MD', 'Pediatrics', '', '', NULL, 'O', '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', NULL, '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477676112', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.7693, -111.877, NULL, NULL),
('870489599', 'S77008922', 'S77008922', 'UT01', 'Intermountain Pediatric Clinic', 'Mark', 'C', 'Templeman', 'MD', 'Pediatrics', '', '', NULL, 'O', '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', NULL, '508 E S Temple Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013554316', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922120468', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'S77008923', 'S77008923', 'UT01', 'Millcreek Womens Center', 'Susan', 'T', 'Horvath', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023086444', 0, 'N', 0, '2011-08-23', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870489979', 'S77008924', 'S77008924', 'UT01', 'Millcreek Womens Center', 'Jennifer', 'C', 'Kinghorn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1750359170', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870489979', 'S77008925', 'S77008925', 'UT01', 'Millcreek Womens Center', 'Lisa', 'A', 'Morgan', 'MD', 'Gynecology', 'Obstetrics and Gynecology', '', NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-12-31', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1215904685', 0, 'N', 0, '2011-03-23', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'S77008926', 'S77008926', 'UT01', 'Millcreek Womens Center', 'Catherine', 'J', 'Wheeler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-05-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720055742', 0, 'N', 0, '2012-12-07', NULL, NULL, 0, 0, NULL, NULL),
('870490351', 'S77008935', 'S77008935', 'UT01', NULL, 'R', 'Dirk', 'Noyes', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '324 10th Ave Ste 249', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083555', '8014083565', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124107792', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008958', 'S77008958', 'UT01', 'Exodus Healthcare Network', 'Kevin', '', 'MacFarlane', 'PA', 'Family Practice', '', '', NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-08-31', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1922163401', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77008959', 'S77008959', 'UT01', 'Exodus Healthcare Network', 'Aziza', 'O', 'Keval', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2014-05-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790716439', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'S77008960', 'S77008960', 'UT01', 'Exodus Healthcare Network', 'Brian', 'K', 'Zehnder', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-09-01', NULL, 0, NULL, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447278023', 0, 'N', 0, '2011-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870491699', 'S77008964', 'S77008964', 'UT01', '', 'Robert', 'F', 'Miller', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1002 E S Temple Ste 412', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013550465', NULL, '1002 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013550465', '          ', 'WiseSTD15', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1306925433', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77008966', 'S77008966', 'UT01', 'Utah Cardiology', 'Michael', 'C', 'Cody', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', NULL, '520 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8017760174', '          ', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', '2011-09-09', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1629063755', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77008967', 'S77008967', 'UT01', 'Utah Cardiology', 'Michael', 'E', 'Crawford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', 'Lakeview Hospital', '', 'HCFA|UB|', '1699760397', 0, 'Y', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77008969', 'S77008969', 'UT01', 'Utah Cardiology', 'Daniel', 'J', 'Humiston', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780679829', 0, 'N', 0, '2006-12-15', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870494130', 'S77008977', 'S77008977', 'UT01', 'Salt Lake Womens Center', 'Michael', 'L', 'Twede', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy Ste 350', 'Sandy', 'Salt Lake', 'UT', '84070', '8015613922', '8015698710', '10011 Centennial Pkwy Ste 350', 'Sandy', 'Salt Lake', 'UT', '84070', '8015613922', '8015698710', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-08-31', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1861450140', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870495119', 'S77008978', 'S77008978', 'UT01', 'Barton, Scott', 'Scott', 'R', 'Barton', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', '8012613605', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235108861', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870495119', 'S77008979', 'S77008979', 'UT01', 'Old Farm OBGYN', 'Scott', 'R', 'Barton', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', '8012629142', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', '8012629142', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108861', 0, 'N', 0, '2013-05-22', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870498345', 'S77008980', 'S77008980', 'UT01', '', 'Leonard', 'J', 'Swinyer', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-01-02', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538153234', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870498921', 'S77008982', 'S77008982', 'UT01', NULL, 'Duane', 'E', 'Townsend', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '6339 Starview Dr', 'Park City', 'Summit', 'UT', '84098', '4359018123', NULL, '112 Ryans Lane', 'Midway', '', 'UT', '84049', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114986502', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870500176', 'S77008983', 'S77008983', 'UT01', NULL, 'Jeffery', 'R', 'Oka', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '425 Medical Dr Ste 108', 'Bountiful', 'Davis', 'UT', '84010', '8012922500', NULL, '425 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012922500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528194826', 0, 'N', 0, '2011-08-22', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870503202', 'S77008992', 'S77008992', 'UT01', 'Mountain West Ear Nose and Throat', 'Curt', 'R', 'Stock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', NULL, '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Star Valley Medical Center', 'HCFA|UB|', '1275681686', 0, 'N', 0, '2013-08-16', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870503286', 'S77008993', 'S77008993', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '8014440300', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 41.0609, -111.945, NULL, NULL),
('870503286', 'S77008994', 'S77008994', 'UT01', 'Hearing Zone', '', '', 'Hearing Zone', 'GROUP', '', NULL, NULL, NULL, 'O', '973 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232727', NULL, '70 S Fairfield', 'Layton', 'Cache', 'UT', '84041', '4357232727', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006643', 0, 'Y', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77008995', 'S77008995', 'UT01', 'Hearing Zone', 'Garr', NULL, 'Crookston', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield', 'Layton', '', 'UT', '84041', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104999200', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77008996', 'S77008996', 'UT01', 'Hearing Zone', 'Kent', 'J', 'Nielsen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', NULL, '70 S Fairfield', 'Layton', 'Weber', 'UT', '84041', '8016120202', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1689744138', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77008997', 'S77008997', 'UT01', 'Hearing Zone', 'Orvil', 'J', 'Stokes', 'AUD', 'Speech Therapy', NULL, NULL, NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '70 S Fairfield', 'Layton', '', 'UT', '84041', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154489896', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503286', 'S77008998', 'S77008998', 'UT01', 'Hearing Zone', 'Orvil', 'J', 'Stokes', 'AUD', 'Speech Therapy', NULL, NULL, NULL, 'O', '973 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232727', NULL, '70 S Fairfield', 'Layton', 'Box Elder', 'UT', '84041', '4357232727', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-01-01', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154489896', 0, 'N', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870503931', 'S77008999', 'S77008999', 'UT01', 'Southwestern OBGYN', 'Steven ', 'J', 'Dewey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013758889', '', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013758889', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1356358147', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'S77009001', 'S77009001', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'S77009002', 'S77009002', 'UT01', 'Neurological Associates', 'Christopher', 'Jay', 'Reynolds', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'S77009003', 'S77009003', 'UT01', 'Neurological Associates', 'Mohammad', 'Entezari', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870509414', 'S77009005', 'S77009005', 'UT01', 'Mountain Utah Family Medicine', 'Dixie', '', 'Rasmussen', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', '850 N Main St Ste 3', 'Richfield', 'Sevier', 'UT', '84701', '4358969561', '4358969564', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1740385046', 0, 'N', 0, '2013-07-08', NULL, NULL, 38.781, -112.085, NULL, NULL),
('870516264', 'S77009024', 'S77009024', 'UT01', 'Utah County Surgical Associates', 'Craig', 'S', 'Cook', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851347090', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'S77009025', 'S77009025', 'UT01', 'Utah County Surgical Associates', 'Lee', 'M', 'Peterson', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316987613', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870517201', 'S77009027', 'S77009027', 'UT01', 'Central Utah Radiology', 'Connie', NULL, 'Vail', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 908', 'Bountiful', 'Davis', 'UT', '84011', '4356231242', '4355287358', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689675076', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'S77009032', 'S77009032', 'UT01', 'Basin Anesthesia Associates', NULL, NULL, 'Basin Anesthesia Associates', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 90164', 'Vernal', 'Uintah', 'UT', '84079', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833027', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870518863', 'S77009040', 'S77009040', 'UT01', 'Jordan Meadows Medical Center', NULL, NULL, 'Jordan Meadows Medical Center', 'GROUP', 'Primary Care with Extended Hours', NULL, NULL, NULL, 'O', '3354 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012822677', NULL, '3534 S 6000 W', 'West Valley', '', 'UT', '84128', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194860569', 0, 'N', 0, '2006-10-17', NULL, NULL, 40.6095, -111.971, NULL, NULL),
('870519172', 'S77009041', 'S77009041', 'UT01', 'Utah Heart Clinic', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009042', 'S77009042', 'UT01', 'Utah Heart Clinic', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669440269', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009044', 'S77009044', 'UT01', 'Utah Heart Clinic', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043288640', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009045', 'S77009045', 'UT01', 'Utah Heart Clinic', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009046', 'S77009046', 'UT01', 'Utah Heart Clinic', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669440277', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009047', 'S77009047', 'UT01', 'Utah Heart Clinic', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '5169 S Cottonwood', 'Murray', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', NULL, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009049', 'S77009049', 'UT01', 'Utah Heart Clinic', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'S77009050', 'S77009050', 'UT01', 'Utah Heart Clinic', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014083900', '8014083909', '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-11-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316915952', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009053', 'S77009053', 'UT01', 'Utah Cancer Specialists', 'Vilija', '', 'Avizonis', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003865932', 0, 'Y', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009054', 'S77009054', 'UT01', 'Utah Cancer Specialists', 'Anna', '', 'Beck', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-02', NULL, 0, NULL, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1719036265', 0, 'N', 0, '2012-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009055', 'S77009055', 'UT01', 'Utah Cancer Specialists', 'Nitin', 'B', 'Chandramouli', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1801845730', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009058', 'S77009058', 'UT01', 'Utah Cancer Specialists', 'Melissa', 'C', 'Corcoran', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', NULL, '1121 S 3900 E', 'Salt Lake City', 'Utah', 'UT', '84124', '8013578200', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-02', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114976032', 0, 'N', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009059', 'S77009059', 'UT01', 'Utah Cancer Specialists', 'Ann', 'J', 'Eisenbraun', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832028', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009062', 'S77009062', 'UT01', 'Utah Cancer Specialists', 'A Jennifer', '', 'Fischbach', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1528017456', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'S77009065', 'S77009065', 'UT01', 'Utah Cancer Specialists', 'Richard', 'N', 'Frame', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336070', NULL, '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019336070', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073563516', 0, 'N', 0, '2011-09-02', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('870519691', 'S77009066', 'S77009066', 'UT01', 'Utah Cancer Specialists', 'W', 'G', 'Harker', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1679522569', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009067', 'S77009067', 'UT01', 'Utah Cancer Specialists', 'W', 'G', 'Harker', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '4052 Pioneer Pkwy Ste 101', 'West Valley', 'Salt Lake', 'UT', '84120', '8019671000', '', '4052 Pioneer Pkwy Ste 101', 'West Valley', 'Salt Lake', 'UT', '84120', '8019671000', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-02', 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1679522569', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009071', 'S77009071', 'UT01', 'Utah Cancer Specialists', 'Rosemary', NULL, 'McGee-Conder', 'APRN', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '1121 S 3900 E', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-23', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699724500', 0, 'N', 0, '2009-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009072', 'S77009072', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Miller', 'MD', 'Hematology and Oncology', 'Oncology', 'Pain Management', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012633428', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012633428', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225089790', 0, 'N', 0, '2012-05-04', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('870519691', 'S77009075', 'S77009075', 'UT01', 'Utah Cancer Specialists', 'Jonathan', 'R', 'Whisenant', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861441974', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77009076', 'S77009076', 'UT01', 'Utah Cancer Specialists', 'Jonathan', 'R', 'Whisenant', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012625679', '8012702242', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861441974', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77009077', 'S77009077', 'UT01', 'Nephrology Associates', 'Jeff', 'A', 'Barklow', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538166640', 0, 'N', 0, '2014-07-16', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77009078', 'S77009078', 'UT01', 'Nephrology Associates', 'Richard', 'G', 'Lambert', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043217847', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77009079', 'S77009079', 'UT01', 'Nephrology Associates', 'Shital', 'R', 'Shah', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '926196', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77009080', 'S77009080', 'UT01', 'Nephrology Associates', 'Sheetal', 'R', 'Shah', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1841271491', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870523626', 'S77009081', 'S77009081', 'UT01', 'Blake O Zobell DPM', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358966497', '4358930227', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525465', 'S77009083', 'S77009083', 'UT01', 'Bookcliffs Pathology', NULL, NULL, 'Bookcliffs', 'GROUP', 'Pathology', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4357349471', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '913009', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77009085', 'S77009085', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1250 E 3900 S', 'Salt Lake City', 'Davis', 'UT', '84124', '8017758222', '8017758223', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77009089', 'S77009089', 'UT01', 'Retina Associates Of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77009090', 'S77009090', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009091', 'S77009091', 'UT01', 'Mountain View Anesthesia', NULL, NULL, 'Mountain View Anesth', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832168', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009092', 'S77009092', 'UT01', 'Mountain View Anesthesia', NULL, NULL, 'Mountain View Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '23.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832168', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870525882', 'S77009094', 'S77009094', 'UT01', 'Mountain View Anesthesia', 'Janie', 'S', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834373', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009095', 'S77009095', 'UT01', 'Mountain View Anesthesia', 'Richard', 'B', 'Riddle', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832112', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009096', 'S77009096', 'UT01', 'Mountain View Anesthesia', 'Richard', 'B', 'Riddle', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832112', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009097', 'S77009097', 'UT01', 'Mountain View Anesthesia', 'Wayne', 'R', 'Riding', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972608495', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77009098', 'S77009098', 'UT01', 'Mountain View Anesthesia', 'Jed', 'T', 'Widdison', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832846', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870526286', 'S77009099', 'S77009099', 'UT01', 'Wasatch Internal Medicine', 'Thomas', 'R', 'Cate', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1275643611', 0, 'N', 0, '2011-12-14', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'S77009100', 'S77009100', 'UT01', 'Wasatch Internal Medicine', 'Jennifer', 'L', 'Norris', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932210895', 0, 'N', 0, '2012-06-22', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870527703', 'S77009106', 'S77009106', 'UT01', 'HealthSouth Rehabilitation Hospital', 'Joseph', 'W', 'VickRoy', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '          ', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-05-19', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1104818442', 0, 'Y', 0, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('870530876', 'S77009107', 'S77009107', 'UT01', 'Castle Country Clinic', 'Connie', 'K', 'Quinton', 'FNP', 'Family Practice', '', '', NULL, 'O', '590 E 100 N Ste 6', 'Price', 'Carbon', 'UT', '84501', '4356139466', NULL, '590 E 100 N Ste 6', 'Price', 'Carbon', 'UT', '84501', '4356139466', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2013-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346233996', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870532396', 'S77009108', 'S77009108', 'UT01', 'Pioneer Anesthesia Group Inc', NULL, NULL, 'Pioneer Anesthesia Group Inc', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 108', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939526', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834808', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870532396', 'S77009109', 'S77009109', 'UT01', 'Pioneer Anesthesia Group', 'Robert', 'L', 'Langston', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366557407', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532396', 'S77009110', 'S77009110', 'UT01', 'Pioneer Anesthesia Group', 'David', 'D', 'Miller', 'CRNA', 'Anesthesiology', 'Nurse Anesthetist', NULL, NULL, 'O', '3460 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205838745', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77009112', 'S77009112', 'UT01', 'Davis Family Physicians', 'Zachary', 'M', 'Campbell', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-02-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905569', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77009113', 'S77009113', 'UT01', 'Davis Family Physicians', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'O', '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-12', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2012-05-24', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77009114', 'S77009114', 'UT01', 'Davis Family Physicians', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.0747, -112.027, NULL, NULL),
('870532738', 'S77009115', 'S77009115', 'UT01', 'Davis Family Physicians', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'O', '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-08-12', NULL, 0, NULL, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77009117', 'S77009117', 'UT01', 'Davis Family Physicians', 'Craig', 'K', 'Julien', 'MD', 'Family Practice', '', '', NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-06-01', NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245340173', 0, 'N', 0, '2011-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S77009120', 'S77009120', 'UT01', 'North Davis Anesthesiology', 'Mark', 'R', 'Gillis', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', NULL, 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154390177', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S77009121', 'S77009121', 'UT01', 'North Davis Anesthesiology', 'Mark', 'E', 'Rush', 'MD', 'Pain Management', 'Anesthesiology', NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801840806', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870535611', 'S77009122', 'S77009122', 'UT01', NULL, 'Tyler', 'L', 'Collins', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1377 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012730100', NULL, '1377 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012730100', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1376617563', 0, 'N', 0, '2013-01-17', NULL, NULL, 40.6871, -111.852, NULL, NULL),
('870535901', 'S77009123', 'S77009123', 'UT01', 'Childrens Evening Clinic (Appts Required)', NULL, NULL, 'Children''s Evening Clinic (Appt''s Required)', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8014798444', NULL, '5495 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833840', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77009124', 'S77009124', 'UT01', 'Jordan Valley Family Health', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77009125', 'S77009125', 'UT01', 'Jordan Valley Family Health', 'Amy', NULL, 'Ladue', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-05-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922034222', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870541126', 'S77009132', 'S77009132', 'UT01', 'Evergreen Medical', 'Michael', 'T', 'Giovanniello', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', NULL, '10011 Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285604462', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870541126', 'S77009133', 'S77009133', 'UT01', 'Evergreen Medical', 'Christopher', 'P', 'Patton', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy Ste 500', 'Sandy', 'Salt Lake', 'UT', '84070', '8016767627', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832889', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870542236', 'S77009139', 'S77009139', 'UT01', 'Alpine Plastic & Reconstructive Surgery', 'Randall', 'D', 'Barnett', 'MD', 'Hand Surgery', 'Plastic Surgery', '', NULL, 'O', '4403 Harrison Blvd Ste 3680', 'Ogden', 'Weber', 'UT', '84403', '8013873900', NULL, '4403 Harrison Blvd Ste 3680', 'Ogden', 'Weber', 'UT', '84403', '8013873900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-12-22', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700883600', 0, 'N', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'S77009140', 'S77009140', 'UT01', 'Intermountain Anesthesia', 'Max', NULL, 'Shurtliff', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '40.60', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851484489', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'S77009141', 'S77009141', 'UT01', 'Intermountain Anesthesia', 'Mike', NULL, 'Tyler', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '40.60', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832033', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543090', 'S77009153', 'S77009153', 'UT01', 'Ogden Ear Nose & Throat', 'Douglas', 'K', 'Anderson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014753072', '8014753071', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014753072', '8014753071', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790898807', 0, 'N', 0, '2013-01-23', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870543318', 'S77009155', 'S77009155', 'UT01', 'Mountain West Gastroenterology', 'Randall', 'J', 'Ryser', 'MD', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1528071156', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77009156', 'S77009156', 'UT01', 'Mountain West Gastroenterology', 'I', 'R', 'Thomason', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1649282542', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77009171', 'S77009171', 'UT01', 'Central Utah Clinic PC', 'Kent', 'M', 'Gledhill', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '          ', NULL, 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '          ', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871539833', 0, 'Y', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77009173', 'S77009173', 'UT01', 'Woodland Hills Radiology', 'Brent', 'T', 'Layton', 'MD', 'Radiologist', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012219154', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012219154', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1346286317', 0, 'Y', 0, '2014-01-17', NULL, NULL, 40.0446, -111.716, NULL, NULL),
('870545911', 'S77009174', 'S77009174', 'UT01', 'Woodland Hills Radiology', 'Brent', 'T', 'Layton', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', NULL, NULL, 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1346286317', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77009175', 'S77009175', 'UT01', 'Woodland Hills Radiology', 'Ryan', 'B', 'Nielsen', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146524', '8012219154', '750 W 800 N', 'Orem', 'Utah', 'UT', '840573660', '8017146524', '8012219154', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1821032863', 0, 'Y', 0, '2011-11-18', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('870546501', 'S77009179', 'S77009179', 'UT01', 'Alpine Pediatrics', 'Bradley', 'C', 'Arnold', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1912 W 930 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417995671', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77009181', 'S77009181', 'UT01', 'Alpine Pediatrics', 'Heather', 'N', 'Benally', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1659327153', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77009183', 'S77009183', 'UT01', 'Alpine Pediatrics', 'Catherine', 'G', 'Caldwell', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8019229222', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1639118375', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77009185', 'S77009185', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77009191', 'S77009191', 'UT01', 'Alpine Pediatrics', 'Beverly', 'L', 'Vargo', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-02-21', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316991565', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870547294', 'S77009194', 'S77009194', 'UT01', 'Salt Lake Senior Clinic', 'John', 'C', 'Luras', 'MD', 'Internal Medicine', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619084928', 0, 'N', 0, '2014-06-26', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('870548726', 'S77009195', 'S77009195', 'UT01', 'Snow Creek Emergency Center (Mtn Family Health)', 'Peter', 'J', 'Deweerd', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134166259', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870548726', 'S77009196', 'S77009196', 'UT01', 'Snow Creek Emergency Center (Mtn Family Health)', 'Peter', 'J', 'Deweerd', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356550055', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134166259', 0, 'Y', 0, NULL, 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
('870548726', 'S77009197', 'S77009197', 'UT01', 'Snow Creek Emergency Center (Mtn Family Health)', 'Julie', 'Ann', 'Dolan', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477501252', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009198', 'S77009198', 'UT01', 'Utah Valley Pediatrics', 'Bradley', 'W', 'Anderson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1124086186', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009199', 'S77009199', 'UT01', 'Utah Valley Pediatrics', 'Ernest', '', 'Bailey', 'MD', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1114985314', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009200', 'S77009200', 'UT01', 'Utah Valley Pediatrics', 'Lynn', 'B', 'Barlow', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831357', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009201', 'S77009201', 'UT01', 'Utah Valley Pediatrics', 'Melissa', 'A', 'Kendall', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '716 W 800 N Ste 300', 'Orem', 'Utah', 'UT', '84057', '8012240421', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598772089', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009202', 'S77009202', 'UT01', 'Utah Valley Pediatrics', 'Scott', 'H', 'Mumford', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275561391', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009203', 'S77009203', 'UT01', 'Utah Valley Pediatrics', 'Gregory', 'W', 'Nielsen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012254197', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012254197', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427025378', 0, 'N', 0, '2012-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009205', 'S77009205', 'UT01', 'Utah Valley Pediatrics', 'Daniel', 'G', 'Simmons', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134196900', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009206', 'S77009206', 'UT01', 'Utah Valley Pediatrics', 'Daniel', 'G', 'Simmons', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012254197', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134196900', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77009207', 'S77009207', 'UT01', 'Utah Valley Pediatrics', 'Ryan', 'B', 'Wilcox', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679501720', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77009208', 'S77009208', 'UT01', 'Utah Physicians Care Center', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.5523, -111.891, NULL, NULL),
('870550021', 'S77009209', 'S77009209', 'UT01', 'Utah Physicians Care Center', 'Alireza', '', 'Falahati-Nini', 'MD', 'Endocrinology', '', '', NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-04-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417989971', 0, 'N', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77009210', 'S77009210', 'UT01', 'Utah Physicians Care Center', 'David', 'Brent', 'Gubler', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797595', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870550021', 'S77009211', 'S77009211', 'UT01', 'Utah Physicians Care Center', 'Thomas', 'Anton', 'Kurrus', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831120567', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77009212', 'S77009212', 'UT01', 'Utah Physicians Care Center', 'Margaret', 'Sydnie', 'Lunt', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326070731', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77009213', 'S77009213', 'UT01', 'Utah Physicians Care Center', 'Venkatesh', 'Babu', 'Segu', 'MD', 'Internal Medicine', 'Endocrinology', NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834577', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77009214', 'S77009214', 'UT01', 'Utah Physicians Care Center', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009215', 'S77009215', 'UT01', 'Cottonwood Pediatrics', 'R Dennis', '', 'Ashton', 'MD', 'Pediatrics', NULL, NULL, 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, '2006-06-01', '2012-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760464580', 0, 'Y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009216', 'S77009216', 'UT01', 'Cottonwood Pediatrics', 'Kenneth', 'R', 'Broadbent', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447232285', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009217', 'S77009217', 'UT01', 'Wasatch Pediatrics at St Marks', 'Kenneth', 'R', 'Broadbent', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447232285', 0, 'N', 0, '2014-03-06', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'S77009218', 'S77009218', 'UT01', 'Cottonwood Pediatrics', 'Julia', 'C', 'Brogli', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1336121177', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009219', 'S77009219', 'UT01', 'Grow Up Great', 'Kara', 'F', 'Burnett', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669454401', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009220', 'S77009220', 'UT01', 'Cottonwood Pediatrics', 'Joseph', 'G', 'Cramer', 'MD', 'Pediatrics', NULL, NULL, 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, '2006-06-01', '2011-06-30', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477535169', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009221', 'S77009221', 'UT01', 'Cottonwood Pediatrics', 'Leslie', '', 'Goodwin', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184606782', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009222', 'S77009222', 'UT01', 'Cottonwood Pediatrics', 'Kimberly', '', 'Hansen', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427030030', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009223', 'S77009223', 'UT01', 'Cottonwood Pediatrics', 'Galina', 'R', 'Hornyik', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962484576', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009224', 'S77009224', 'UT01', 'Willow Creek Pediatrics', 'Galina', 'R', 'Hornyik', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962484576', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'S77009225', 'S77009225', 'UT01', 'Cottonwood Pediatrics', 'Edward', 'G', 'Jenkins', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1265414882', 0, 'Y', 0, '2011-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009226', 'S77009226', 'UT01', 'Willow Creek Pediatrics', 'R Joe', '', 'Jopling', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992788152', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'S77009227', 'S77009227', 'UT01', 'Cottonwood Pediatrics', 'Steven', 'M', 'Lynch', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275515892', 0, 'Y', 0, '2013-12-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009228', 'S77009228', 'UT01', 'Willow Creek Pediatrics', 'Steven', 'M', 'Lynch', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275515892', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'S77009229', 'S77009229', 'UT01', 'Cottonwood Pediatrics', 'Terry', 'H', 'Omura', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1417939117', 0, 'N', 0, '2011-06-23', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'S77009230', 'S77009230', 'UT01', 'Cottonwood Pediatrics', 'Cynthia', 'S', 'Owens', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972586329', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009231', 'S77009231', 'UT01', 'Wasatch Pediatrics at St Marks', 'Cynthia', 'S', 'Owens', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972586329', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'S77009232', 'S77009232', 'UT01', 'Cottonwood Pediatrics', 'Charles', 'W', 'Ralston', 'MD', 'Pediatric Cardiology', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1588647978', 0, 'Y', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77009233', 'S77009233', 'UT01', 'Cottonwood Pediatrics', 'Shellie', 'J', 'Ring', '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, '2006-06-01', '2011-10-24', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1316920770', 0, 'Y', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('870550841', 'S77009234', 'S77009234', 'UT01', NULL, 'Peter', 'W', 'Bossart', 'MD', 'Colon and Rectal Surgery', NULL, NULL, NULL, 'O', '324 10th Ave Ste 280', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085930', '8014085259', '324 10th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085930', '8014085259', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477647246', 0, 'N', 0, '2011-07-20', NULL, NULL, 40.7808, -111.88, NULL, NULL),
('870550968', 'S77009235', 'S77009235', 'UT01', NULL, 'Timothy', 'S', 'Houden', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, '4335 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255339552', 0, 'Y', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870555165', 'S77009256', 'S77009256', 'UT01', 'Pediatric Care of Ogden', 'Anne', 'G', 'Baranko', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', NULL, '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962595256', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870555521', 'S77009257', 'S77009257', 'UT01', 'Box Elder Family Vision Clinic', 'Larry', 'D', 'Terry', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 447', 'Brigham City', 'Box Elder', 'UT', '84302', NULL, NULL, 'PO Box 447', 'Brigham City', 'Box Elder', 'UT', '84302', '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437137379', 0, 'Y', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870556330', 'S77009258', 'S77009258', 'UT01', '', 'Danee', 'S', 'Young', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '920 N 200 W Ste A', 'Logan', 'Cache', 'UT', '84321', '4357500366', NULL, '920 N 200 W Ste A', 'Logan', 'Cache', 'UT', '84321', '4357500366', '          ', 'WUSTDOBG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-03-01', '2011-09-13', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1417953662', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870556715', 'S77009259', 'S77009259', 'UT01', 'Comprehensive Orthopedic Specialists', 'Leland', 'R', 'Chick', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912023383', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009261', 'S77009261', 'UT01', 'Utah Navajo Health System PT', 'Utah Navajo Health System', '', NULL, 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', '57.75', 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009262', 'S77009262', 'UT01', 'Montezuma Creek Community Clinic', 'Terry', 'R', 'Cook', NULL, 'Podiatry', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009263', 'S77009263', 'UT01', 'Utah Navajo Health System', 'Terry', 'R', 'Cook', NULL, 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009264', 'S77009264', 'UT01', 'Utah Navajo Health System', 'Michele', 'M', 'Lyman', NULL, NULL, NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447253091', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009265', 'S77009265', 'UT01', 'Blanding Family Practice', 'Kevin', 'M', 'Matteson', 'MD', 'General Surgery', '', '', NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2010-01-14', NULL, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407853013', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009266', 'S77009266', 'UT01', 'Montezuma Creek Community Clinic', 'Martin', 'G', 'Neubert', NULL, NULL, NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649273921', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009267', 'S77009267', 'UT01', 'Blanding Family Practice', 'Norman', 'S', 'Nielson', NULL, 'Family Practice', NULL, NULL, NULL, 'O', '799 S 200 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558364125', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009268', 'S77009268', 'UT01', 'Montezuma Creek Community Clinic', 'Norman', 'S', 'Nielson', NULL, 'Family Practice', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558364125', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009269', 'S77009269', 'UT01', 'Utah Navajo Health System', 'Earl', 'K', 'Plunkett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, 'San Juan', NULL, NULL, '4356513291', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1225031792', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009271', 'S77009271', 'UT01', 'Montezuma Creek Community Clinic', 'Tanya', 'D', 'Richey', NULL, '', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009272', 'S77009272', 'UT01', 'Blanding Family Practice', 'Christopher', '', 'Singer', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-05-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1073517991', 0, 'N', 0, '2011-01-31', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77009273', 'S77009273', 'UT01', 'Utah Navajo Health System', 'Christopher', '', 'Singer', NULL, '', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073517991', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870562898', 'S77009274', 'S77009274', 'UT01', 'Spine & Sports Medicine', 'John', 'Howard', 'Loomis', 'DO', 'Pain Management', 'Sports Medicine', 'Physical Medicine and Rehabilitation', NULL, 'O', '3336 Pioneer Pkwy Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643249', NULL, '3336 Pioneer Pkwy Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643249', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-02-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598820318', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77009275', 'S77009275', 'UT01', 'Layton Family Practice', 'Corey', 'L', 'Ericksen', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-01-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912003922', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77009276', 'S77009276', 'UT01', 'Layton Family Practice', 'Casey', 'L', 'Stelter', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '8015462422', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '8015462422', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073607222', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77009277', 'S77009277', 'UT01', NULL, 'Paul', 'Ray', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912091422', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870565773', 'S77009301', 'S77009301', 'UT01', 'Mountain Medical Vascular Specialists', 'Steven', 'W', 'Merrell', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8017131010', NULL, '5323 S Woodrow St Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8017131010', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1063452050', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870565773', 'S77009302', 'S77009302', 'UT01', 'Mountain Medical Vascular Specialists', 'Douglas', 'J', 'Wirthlin', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '5323 S Woodrow St Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8017131010', NULL, '5323 S Woodrow St Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8017131010', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609816602', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870566781', 'S77009304', 'S77009304', 'UT01', 'Benita Medical', 'Ray', NULL, 'Morris', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3465 Pioneer Pkwy Ste 2', 'West Valley', 'Salt Lake', 'UT', '84120', '8019637636', '8019638130', NULL, 'West Valley', '', 'UT', '84120', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023171014', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870569293', 'S77009330', 'S77009330', 'UT01', NULL, 'Christopher', 'K', 'Anderson', 'MD', 'Pulmonary', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1497794150', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870569381', 'S77009331', 'S77009331', 'UT01', 'Cache Valley Cardiology', 'Rudolf', '', 'Otrusinik', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', NULL, '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-01', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1003922394', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870569381', 'S77009332', 'S77009332', 'UT01', 'Cache Valley Cardiology', 'William', 'L', 'Saul', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255447538', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870569543', 'S77009333', 'S77009333', 'UT01', 'Basin Clinic', 'Rodney', 'S', 'Anderson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', '379 N 500 W', 'Vernal', '', 'UT', '84078', '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952495582', 0, 'N', 0, '2006-12-11', NULL, NULL, 40.4616, -109.538, NULL, NULL),
('870569774', 'S77009334', 'S77009334', 'UT01', 'Welling, Blake G', 'Blake', NULL, 'Welling', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'B', '425 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014799119', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770627234', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870570082', 'S77009337', 'S77009337', 'UT01', 'Intermountain Stroke Center', 'Nancy', 'N', 'Futrell', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '5292 College Dr Ste 204', 'Murray', 'Salt Lake', 'UT', '84123', '8012630611', NULL, '5292 College', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012630611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, NULL, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1699791095', 0, 'N', 0, '2011-09-02', NULL, NULL, 40.6557, -111.905, NULL, NULL),
('870570144', 'S77009338', 'S77009338', 'UT01', '', 'Daniel', 'B', 'Vine', 'MD', 'Neurology', '', '', NULL, 'O', '1002 E S Temple Ste 407', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282788', NULL, '1002 E S Temple Ste 407', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282788', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-04-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1841219375', 0, 'N', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('870571315', 'S77009339', 'S77009339', 'UT01', NULL, 'Max', 'K', 'Cannon', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 508', 'Payson', 'Utah', 'UT', '84651', '8014651701', NULL, 'PO Box 508', 'Payson', '', 'UT', '84651', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-01-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124036231', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77009340', 'S77009340', 'UT01', 'Layton Ambulatory Anesthesia', 'Earl', 'K', 'Leeman', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831174333', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77009341', 'S77009341', 'UT01', 'Layton Ambulatory Anesthesia', 'Clark', 'E', 'Petersen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519894', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77009342', 'S77009342', 'UT01', 'Layton Ambulatory Anesthesia', 'Christopher', 'G', 'Reveley', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144206723', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'S77009344', 'S77009344', 'UT01', 'Holladay Family Practice', 'Randall', 'P', 'Daynes', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1811962939', 0, 'N', 0, '2012-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77009361', 'S77009361', 'UT01', 'The Er Group', 'William', 'P', 'Durant', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma City', 'Oklahoma', 'OK', '73143', '4357893342', NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851303721', 0, 'Y', 0, '2007-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77009362', 'S77009362', 'UT01', 'The Er Group', 'Paul', 'J', 'Ebbert', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma City', 'Oklahoma', 'OK', '73143', NULL, NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1235243650', 0, 'Y', 0, '2007-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77009363', 'S77009363', 'UT01', 'The Er Group', 'Steve', 'E', 'Pehrson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma City', 'Oklahoma', 'OK', '73143', NULL, NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164531968', 0, 'Y', 0, '2007-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77009364', 'S77009364', 'UT01', 'The Er Group', 'Larry', NULL, 'Wilcken', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '8002250953', NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790817013', 0, 'Y', 0, '2007-01-05', NULL, NULL, 40.4585, -109.531, NULL, NULL),
('870574277', 'S77009365', 'S77009365', 'UT01', 'James  T Roth MD', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', '8012613605', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870575989', 'S77009366', 'S77009366', 'UT01', 'Country Hills Eye Center', 'Douglas', 'P', 'Felt', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1831171446', 0, 'N', 0, '2013-11-11', NULL, NULL, 41.1889, -111.958, NULL, NULL),
('870575989', 'S77009367', 'S77009367', 'UT01', 'Country Hills Eye Center', 'Bradley', 'W', 'Richards', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1457333064', 0, 'N', 0, '2013-11-05', NULL, NULL, 41.1889, -111.958, NULL, NULL),
('870576428', 'S77009368', 'S77009368', 'UT01', NULL, 'Kenneth', 'N', 'Buchi', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 300', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338233', NULL, '3584 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338233', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1518985696', 0, 'N', 0, '2011-05-09', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870576522', 'S77009369', 'S77009369', 'UT01', 'Brigham Anesthesia', 'Kent', 'G', 'Johnson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '950 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357344144', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '841216800', '', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-03-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639163413', 0, 'Y', 0, '2007-01-10', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('870576522', 'S77009370', 'S77009370', 'UT01', 'Brigham Anesthesia', 'Penny', 'J', 'Ogden', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8005946399', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '841216800', '', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265453088', 0, 'Y', 0, '2007-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870576522', 'S77009371', 'S77009371', 'UT01', 'Brigham Anesthesia', 'Penny', 'J', 'Ogden', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '950 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349471', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '841216800', '', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265453088', 0, 'Y', 0, '2007-04-11', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('870577952', 'S77009372', 'S77009372', 'UT01', 'Western Newborn Specialists', 'Ellen', '', 'Liu', 'MD', 'Neonatology', NULL, NULL, NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', NULL, NULL, 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790784965', 0, 'Y', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870577952', 'S77009373', 'S77009373', 'UT01', 'Western Newborn Specialists', 'Robin', 'S', 'Smith', 'MD', 'Neonatology', NULL, NULL, NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', NULL, NULL, 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245239649', 0, 'Y', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870580379', 'S77009377', 'S77009377', 'UT01', 'Summit View Medical', 'David', 'B', 'Douglas', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015768988', '8015769396', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908303', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870580379', 'S77009378', 'S77009378', 'UT01', 'Summit View Medical', 'Vernon', 'D', 'Potter', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015768988', '8015769396', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801937263', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870583479', 'S77009380', 'S77009380', 'UT01', 'Phase II Center For Womens Health', 'Shelly', 'E', 'Kirk', 'FNP', 'Obstetrics and Gynecology', 'Gynecology', NULL, NULL, 'O', '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012629800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932229259', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870583479', 'S77009381', 'S77009381', 'UT01', 'Phase II Center For Womens Health', 'Ronda', NULL, 'Lucey', 'NP', NULL, NULL, NULL, NULL, 'O', '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012629800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306902101', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870603341', 'S77009384', 'S77009384', 'UT01', NULL, 'Ivan', 'D', 'Flint', 'MD', 'Dermatology', '', '', NULL, 'O', '1250 E 3900 S Ste 450', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623600', '8012622555', '1250 E 3900 S Ste 450', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623600', '8012622555', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962484485', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('202499373', 'S77009385', 'S77009385', 'UT01', 'South Valley Ob/Gyn', 'Cameron', 'D', 'Anderson', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654899', '8014653267', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841415338', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870615760', 'S77009388', 'S77009388', 'UT01', 'Urology Clinic of Logan', 'Michael', 'Scott', 'Callister', 'MD', 'Urology', NULL, NULL, NULL, 'O', '550 E 1400 N Ste J', 'Logan', 'Cache', 'UT', '84341', '4357531171', NULL, '550 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811038060', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870615760', 'S77009389', 'S77009389', 'UT01', 'Urology Clinic Of Logan', 'Ryan', 'H', 'Larsen', 'MD', 'Urology', NULL, NULL, NULL, 'O', '950 Medical Dr Ste 103', 'Brigham City', 'Box Elder', 'UT', '84302', '4357344242', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235224932', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616000', 'S77009391', 'S77009391', 'UT01', 'Salt Lake Podiatry', 'Mark', 'E', 'Moritz', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245297688', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616000', 'S77009393', 'S77009393', 'UT01', 'Salt Lake Podiatry', 'Mark', 'E', 'Moritz', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245297688', 0, 'Y', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL);
