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
('261545953', 'W12031468', 'W12031468', 'UTDT01', 'Mountain High Dental', 'John', '', 'Coats', 'DDS', 'Endodontist', '', '', NULL, 'O', '1680 Ute Blvd Ste C', 'Park City', 'Summit', 'UT', '84098', '4356473012', NULL, '1680 Ute Blvd Ste C', 'Park City', 'Summit', 'UT', '84098', '4356473012', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010076', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031470', 'W12031470', 'WY01', 'Wyoming Medical Center ', '', '', 'Wyoming Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '0000000000', NULL, '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '0000000000', '          ', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332954', 0, 'N', 0, '2013-09-26', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031469', 'W12031469', 'WYT1', 'Wyoming Medical Center ', '', '', 'Wyoming Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '0000000000', NULL, '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '0000000000', '          ', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332954', 0, 'N', 0, '2013-09-26', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12031474', 'W12031474', 'UTDT01', 'All Around Dental Care', 'James', '', 'Fairbanks', 'DMD', 'Dentist', '', '', NULL, 'O', '1007 N Main', 'Nephi', 'Juab', 'UT', '84648', '4356230866', NULL, '1007 N Main', 'Nephi', 'Juab', 'UT', '84648', '4356230866', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010078', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12031475', 'W12031475', 'UTDT01', 'All Around Dental Care', 'James', '', 'Fairbanks', 'DMD', 'Dentist', '', '', NULL, 'O', '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', NULL, '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010078', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12031476', 'W12031476', 'UTDT01', 'Mountain View Dental', 'Devin', '', 'Walker', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001165', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('362970624', 'W12031481', 'W12031481', 'ILCHIGSTD', 'Illinois Retina Associates', 'Serge', '', 'DeBustros', 'MD', 'Ophthalmology', '', '', NULL, 'O', '19550 Governors Hwy Ste 3600', 'Flossmoor', 'Cook', 'IL', '60422', '7086479211', '0000000000', '19550 Governors Hwy Ste 3600', 'Flossmoor', 'Cook', 'IL', '60422', '7086479211', '0000000000', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962402685', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.534, -87.6952, NULL, NULL),
('362970624', 'W12031482', 'W12031482', 'ILCHIGSTD', 'Illinois Retina Associates', 'Serge', '', 'DeBustros', 'MD', 'Ophthalmology', '', '', NULL, 'O', '15300 W Ave Ste 212 West Building', 'Orland Park', 'Cook', 'IL', '60462', '7083643240', '0000000000', '15300 W Ave Ste 212 West Building', 'Orland Park', 'Cook', 'IL', '60462', '7083643240', '0000000000', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962402685', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.6121, -87.8629, NULL, NULL),
('362970624', 'W12031484', 'W12031484', 'ILCHIGSTD', 'Illinois Retina Associates', 'John', '', 'Pollack', 'MD', 'Ophthalmology', '', '', NULL, 'O', '300 Barney Dr', 'Joliet', 'Will', 'IL', '60435', '8157447515', '0000000000', '300 Barney Dr', 'Joliet', 'Will', 'IL', '60435', '8157447515', '0000000000', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1881694933', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.5281, -88.1434, NULL, NULL),
('362970624', 'W12031486', 'W12031486', 'ILCHIGSTD', 'Illinois Retina Associates', 'John', '', 'Pollack', 'MD', 'Ophthalmology', '', '', NULL, 'O', '12 Salt Creek Ste 110', 'Hinsdale', 'Dupage', 'IL', '60521', '6307895700', '0000000000', '12 Salt Creek Ste 110', 'Hinsdale', 'Dupage', 'IL', '60521', '6307895700', '0000000000', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1881694933', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.8208, -87.9213, NULL, NULL),
('820161600', 'W12031493', 'W12031493', 'IDBOISTD', 'St Lukes Elmore Physician Group', '', '', 'St Lukes Elmore Physician Group', '', 'Clinics', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326388737', 0, 'N', 0, '2013-07-11', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031495', 'W12031495', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Matthew', 'R', 'Black', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1437339900', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031496', 'W12031496', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Dennis', 'D', 'Crossley', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA', '1558341594', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031498', 'W12031498', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Robert', 'M', 'Jepsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1356385512', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031500', 'W12031500', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Marilee', 'J', 'Kuracina', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA', '1649216375', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031502', 'W12031502', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'David', 'C', 'McClain', 'MD', 'Family Practice', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', NULL, NULL, NULL, 'HCFA', '1851329767', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031503', 'W12031503', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Michael', 'R', 'Mercy', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA', '1689602336', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031504', 'W12031504', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Steven', 'Richard', 'Newman', 'MD', 'Family Practice', 'Sports Medicine', 'Occupational Therapy', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', '2014-01-31', 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA', '1134157613', 0, 'N', 0, '2014-02-05', NULL, NULL, 43.1388, -115.693, NULL, NULL),
('820161600', 'W12031505', 'W12031505', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Karl', 'H', 'Olson', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA', '1508846353', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031506', 'W12031506', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Janet', 'A', 'Rosenquist', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA', '1265468144', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031507', 'W12031507', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Michael', 'P', 'Garrett', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1083651665', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031509', 'W12031509', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Todd', 'K', 'Swanson', 'MD', 'Family Practice', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1871556514', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031511', 'W12031511', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Harold', 'K', 'Thompson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1336185073', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031513', 'W12031513', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Diane', 'K', 'Turner', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1467498196', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031515', 'W12031515', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Julie', 'M', 'Benzie', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1992819361', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031517', 'W12031517', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Krzysztof', '', 'Ziola', 'MD', 'Internal Medicine', '', '', NULL, 'O', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878401', '2085878406', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1073692166', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('800307419', 'W12031518', 'W12031518', 'WY01', 'Wyoming Health Medical Group', 'Matthew', 'T', 'Strand', 'PA', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1932456183', 1, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031519', 'W12031519', 'WYT1', 'Wyoming Health Medical Group', 'Matthew', 'T', 'Strand', 'PA', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1932456183', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031520', 'W12031520', 'WY01', 'Wyoming Health Medical Group', 'Anca', '', 'Voinov', 'MD', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1700099819', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031521', 'W12031521', 'WYT1', 'Wyoming Health Medical Group', 'Anca', '', 'Voinov', 'MD', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1700099819', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031522', 'W12031522', 'WYT1', 'Wyoming Health Medical Group', 'Jason', 'T', 'Strand', 'MD', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1285892232', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12031523', 'W12031523', 'WY01', 'Wyoming Health Medical Group', 'Jason', 'T', 'Strand', 'MD', 'Family Practice', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-01', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1285892232', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('461956684', 'W12031543', 'W12031543', 'UT01', 'On Call Medical ', 'Thomas', 'R', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'O', '125 E Main St Ste 135', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', '125 E Main St Ste 135', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1013923994', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.3768, -111.795, NULL, NULL),
('461956684', 'W12031544', 'W12031544', 'UT01', 'On Call Medical ', 'Thomas', 'R', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'B', '5406 W 11000 N Ste 103-412', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', '5406 W 11000 N Ste 103-412', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1013923994', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
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('362704738', 'W12031559', 'W12031559', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Ommar', 'Tin', 'Hla', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942225511', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('271789847', 'W12041479', 'W12041479', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Guillermo', '', 'Guzman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881828010', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0258, -116.977, NULL, NULL),
('363395596', 'W12031562', 'W12031562', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Gordon', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1245291780', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('271789847', 'W12041491', 'W12041491', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Steven', '', 'Reich', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538144225', 0, 'N', 0, '2014-06-10', NULL, NULL, 44.0258, -116.977, NULL, NULL),
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('260557363', 'W12031588', 'W12031588', 'ILCHIGSTD', 'Presence Medical Group', 'Hernan', 'S', 'Reyes', 'MD', 'Family Practice', '', '', NULL, 'O', '1802 W Chicago Ave Ste 3', 'Chicago', 'Cook', 'IL', '60622', '7732277312', '0000000000', '1802 W Chicago Ave Ste 3', 'Chicago', 'Cook', 'IL', '60622', '7732277312', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386868826', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.896, -87.6723, NULL, NULL),
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('362985395', 'W12031628', 'W12031628', 'ILCHIGSTD', 'Advanced Urology Associates', 'Luke', 'S', 'Cho', 'MD', 'Urology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669400933', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('362985395', 'W12031629', 'W12031629', 'ILCHIGSTD', 'Advanced Urology Associates', 'Ernesto', '', 'Tan', 'MD', 'Urology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1699882084', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('362985395', 'W12031630', 'W12031630', 'ILCHIGSTD', 'Advanced Urology Associates', 'Constance', 'A', 'Marks', 'MD', 'Urology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1831398445', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('362985395', 'W12031631', 'W12031631', 'ILCHIGSTD', 'Advanced Urology Associates', 'Ryan', '', 'Manecke', 'MD', 'Urology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', '1890 Silver Cross Blvd Ste 430', 'New Lenox', 'Will', 'IL', '60451', '8157094930', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942289129', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('363283271', 'W12031632', 'W12031632', 'ILCHIGSTD', 'George Sosenko MD', 'George', 'R', 'Sosenko', 'MD', 'Urology', '', '', NULL, 'O', '836 N Wellington Ave', 'Chicago', 'Cook', 'IL', '60657', '7732967159', '0000000000', '836 N Wellington Ave', 'Chicago', 'Cook', 'IL', '60657', '7732967159', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881680411', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9363, -87.6526, NULL, NULL),
('363322419', 'W12031633', 'W12031633', 'ILCHIGSTD', 'Retina Consultants', 'Michael', 'P', 'Blair', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3100 Ogden Ave', 'Lisle', 'Dupage', 'IL', '60532', '8472990700', '8473900616', '3100 Ogden Ave', 'Lisle', 'Dupage', 'IL', '60532', '8472990700', '8473900616', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285645549', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.7982, -88.0985, NULL, NULL),
('363322419', 'W12031634', 'W12031634', 'ILCHIGSTD', 'Retina Consultants', 'Michael', 'P', 'Blair', 'MD', 'Ophthalmology', '', '', NULL, 'O', '755 S Milwaukee Ave', 'Libertyville', 'Lake', 'IL', '60048', '8472990700', '8473900616', '755 S Milwaukee Ave', 'Libertyville', 'Lake', 'IL', '60048', '8472990700', '8473900616', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285645549', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.275, -87.9518, NULL, NULL),
('363330928', 'W12031636', 'W12031636', 'ILCHIGSTD', '', 'Elizabeth', '', 'Anderson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2740 W Foster Ave Ste 113', 'Chicago', 'Cook', 'IL', '60625', '7737690575', NULL, '2740 W Foster Ave Ste 113', 'Chicago', 'Cook', 'IL', '60625', '7737690575', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1912940552', 0, 'N', 0, '2014-01-23', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('363330928', 'W12031637', 'W12031637', 'ILCHIGSTD', '', 'Krister', 'M', 'Johansson', 'MD', 'Family Practice', '', '', NULL, 'O', '3500 W Peterson Ave Ste 300', 'Chicago', 'Cook', 'IL', '60659', '7739613200', NULL, '3500 W Peterson Ave Ste 300', 'Chicago', 'Cook', 'IL', '60659', '7739613200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1831136027', 0, 'Y', 0, '2014-01-23', NULL, NULL, 41.9903, -87.7164, NULL, NULL),
('363330928', 'W12031638', 'W12031638', 'ILCHIGSTD', '', 'Andrew', NULL, 'Pavlatos', 'MD', 'Family Practice', '', '', NULL, 'O', '6974 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7735391331', NULL, '6974 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7735391331', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1679576201', 0, 'N', 0, '2014-01-23', NULL, NULL, 42.0083, -87.6738, NULL, NULL),
('363330928', 'W12031639', 'W12031639', 'ILCHIGSTD', '', 'Matthew', NULL, 'Pogodzinski', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '800 Austin Ave Ste 363 East Tower', 'Evanston', 'Cook', 'IL', '60202', '8473538802', NULL, '800 Austin Ave Ste 363 East Tower', 'Evanston', 'Cook', 'IL', '60202', '8473538802', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598755449', 0, 'N', 0, '2014-01-23', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363399794', 'W12031640', 'W12031640', 'ILCHIGSTD', 'WomanCare PC', 'Randall', 'Craig', 'Kahan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '0000000000', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '0000000000', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275522377', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363441544', 'W12031641', 'W12031641', 'ILCHIGSTD', 'Christoper M Guerrero MD', 'Christopher', 'M', 'Guerrero', 'MD', 'Family Practice', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '0000000000', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1376511345', 0, 'N', 0, '2014-06-25', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363915732', 'W12031642', 'W12031642', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Nafisa', 'D', 'Burhani', 'MD', 'Oncology', '', '', NULL, 'O', '1301 Copperfield Ave', 'Joliet', 'Will', 'IL', '60432', '8157407096', '0000000000', '1301 Copperfield Ave', 'Joliet', 'Will', 'IL', '60432', '8157407096', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-06-01', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1851386460', 0, 'N', 0, '2013-06-20', NULL, NULL, 41.5366, -88.05, NULL, NULL),
('363915732', 'W12031643', 'W12031643', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Nafisa', 'D', 'Burhani', 'MD', 'Oncology', '', '', NULL, 'O', '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '8159422791', '0000000000', '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '8159422791', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1851386460', 0, 'N', 0, '2013-06-20', NULL, NULL, 41.3669, -88.4239, NULL, NULL),
('363915732', 'W12031644', 'W12031644', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Arvind', '', 'Kumar', 'MD', 'Oncology', '', '', NULL, 'O', '1301 Copperfield Ave Ste 111', 'Joliet', 'Will', 'IL', '60432', '8157238939', '0000000000', '1301 Copperfield Ave Ste 111', 'Joliet', 'Will', 'IL', '60432', '8157238939', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1861590689', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5366, -88.0501, NULL, NULL),
('363915732', 'W12031645', 'W12031645', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Arvind', '', 'Kumar', 'MD', 'Oncology', '', '', NULL, 'O', '15720 S Route 59', 'Plainfield', 'Will', 'IL', '60544', '8157251355', '0000000000', '15720 S Route 59', 'Plainfield', 'Will', 'IL', '60544', '8157251355', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1861590689', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.596, -88.2017, NULL, NULL),
('363915732', 'W12031646', 'W12031646', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Arvind', '', 'Kumar', 'MD', 'Oncology', '', '', NULL, 'O', '420 Remington Blvd Ste 230', 'Bolingbrook', 'Will', 'IL', '60440', '6307597519', '0000000000', '420 Remington Blvd Ste 230', 'Bolingbrook', 'Will', 'IL', '60440', '6307597519', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1861590689', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.6814, -88.0822, NULL, NULL),
('363915732', 'W12031648', 'W12031648', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Sanjiv', 'S', 'Modi', 'MD', 'Oncology', '', '', NULL, 'O', '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '8159422791', '0000000000', '1600 W Route 6', 'Morris', 'Grundy', 'IL', '60450', '8159422791', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1396730909', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.3669, -88.4239, NULL, NULL),
('364030589', 'W12031649', 'W12031649', 'ILCHIGSTD', 'Fine Skin', 'Seema', 'Sahia', 'Sheth', 'MD', 'Dermatology', '', '', NULL, 'O', '10811 W 143rd St Ste 150', 'Orland Park', 'Cook', 'IL', '60467', '7082260044', '0000000000', '10811 W 143rd St Ste 150', 'Orland Park', 'Cook', 'IL', '60467', '7082260044', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-03', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1053519595', 0, 'N', 0, '2014-05-29', NULL, NULL, 41.6299, -87.883, NULL, NULL),
('364030589', 'W12031650', 'W12031650', 'ILCHIGSTD', 'Fine Skin', 'Renuka', 'H', 'Bhatt', 'MD', 'Dermatology', '', '', NULL, 'O', '10811 W 143rd St Ste 150', 'Orland Park', 'Cook', 'IL', '60467', '7082260044', '0000000000', '10811 W 143rd St Ste 150', 'Orland Park', 'Cook', 'IL', '60467', '7082260044', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1316128861', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.6299, -87.883, NULL, NULL),
('364088232', 'W12031651', 'W12031651', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Adam', 'D', 'Stein', 'MD', 'Endocrinology', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '0000000000', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '0000000000', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-01', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316003833', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364185473', 'W12031654', 'W12031654', 'ILCHIGSTD', 'Digestive Health Associates', 'Richard', 'M', 'Rotnicki', 'DO', 'Gastroenterology', '', '', NULL, 'O', '1715 N Division St Ste A', 'Morris', 'Grundy', 'IL', '60450', '8159421550', '8159428419', '1715 N Division St Ste A', 'Morris', 'Grundy', 'IL', '60450', '8159421550', '8159428419', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427062850', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.377, -88.422, NULL, NULL),
('364195126', 'W12031655', 'W12031655', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Pelagia', 'E', 'Kouloumberis', 'MD', 'Neurosurgery', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154625532', '8157253503', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154625532', '8157253503', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487804969', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('364210615', 'W12031656', 'W12031656', 'ILCHIGSTD', 'Lopez Marcos A MD', 'Marcos', 'A', 'Lopez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1431 N Wern Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '7733940400', '7084428009', '1431 N Wern Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '7733940400', '7084428009', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-01', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417967308', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12031657', 'W12031657', 'ILCHIGSTD', 'Provena Service Corporation', 'Christopher', NULL, 'Berry', 'MD', 'Cardiology', '', '', NULL, 'O', '5 Kish Hospital Dr Ste 203', 'Dekalb', 'Dekalb', 'IL', '60115', '8157488320', NULL, '5 Kish Hospital Dr Ste 203', 'Dekalb', 'Dekalb', 'IL', '60115', '8157488320', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1770668527', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.9565, -88.7217, NULL, NULL),
('364314354', 'W12031659', 'W12031659', 'ILCHIGSTD', 'Provena Service Corporation', 'James', NULL, 'Burks', 'MD', 'Cardiology', '', '', NULL, 'O', '2971 W Algonquin Rd Ste 106', 'Algonquin', 'Mchenry', 'IL', '60102', '8478641987', NULL, '2971 W Algonquin Rd Ste 106', 'Algonquin', 'Mchenry', 'IL', '60102', '8478641987', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821058819', 0, 'N', 0, '2013-04-04', NULL, NULL, 42.1757, -88.345, NULL, NULL),
('364314354', 'W12031660', 'W12031660', 'ILCHIGSTD', 'Provena Service Corporation', 'Neda', '', 'Zamani', 'MD', 'Cardiology', '', '', NULL, 'O', '5 Kish Hospital Dr Ste 203', 'Dekalb', 'Dekalb', 'IL', '60115', '8157488320', NULL, '5 Kish Hospital Dr Ste 203', 'Dekalb', 'Dekalb', 'IL', '60115', '8157488320', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1811935844', 0, 'N', 0, '2014-02-07', NULL, NULL, 41.9565, -88.7217, NULL, NULL),
('364362710', 'W12031661', 'W12031661', 'ILCHIGSTD', 'Retina Institute of Illinois PC', 'Stephen', 'M', 'Conti', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1585 N Barrington Rd Ste 504 Bldg 2', 'Schaumburg', 'Cook', 'IL', '60195', '8478434100', '0000000000', '1585 N Barrington Rd Ste 504 Bldg 2', 'Schaumburg', 'Cook', 'IL', '60195', '8478434100', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1215027115', 0, 'N', 0, '2013-04-04', NULL, NULL, 42.053, -88.1444, NULL, NULL),
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('364452578', 'W12031663', 'W12031663', 'ILCHIGSTD', 'Center for Neurological Diseases', 'Sreepathy', '', 'Kannan', 'MD', 'Neurology', '', '', NULL, 'O', '28369 Davis Pkwy Ste 403', 'Warrenville', 'Dupage', 'IL', '60555', '6304160301', '0000000000', '28369 Davis Pkwy Ste 403', 'Warrenville', 'Dupage', 'IL', '60555', '6304160301', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-01-12', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793529', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.8009, -88.1754, NULL, NULL),
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('383701260', 'W12031715', 'W12031715', 'ILCHIGSTD', 'Germane Nephrology Associates                                                         ', 'Mohammad', 'S', 'Shafi', 'MD', 'Nephrology', '', '', NULL, 'O', '95 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', NULL, '95 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528052792', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5232, -88.1506, NULL, NULL),
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('331082073', 'AETNA0063', 'AETNA0063', 'TXSATSTD', 'Baptist M and S Imaging Mission Trail', '', '', 'Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '3338 Oakwell Ct Ste 106', 'San Antonio', 'Bexar', 'TX', '78218', '2108249311', '2108249497', '3338 Oakwell Ct Ste 106', 'San Antonio', 'Bexar', 'TX', '78218', '2108249311', '2108249497', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005180', 0, 'N', 0, '2013-05-02', NULL, NULL, 29.507, -98.4311, NULL, NULL),
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('331082073', 'AETNA0069', 'AETNA0069', 'TXSATSTD', 'Baptist M and S Imaging Mission Trail', '', '', 'Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '8815 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2105905822', '2105905825', '8815 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2105905822', '2105905825', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005180', 0, 'N', 0, '2013-05-02', NULL, NULL, 29.5197, -98.4276, NULL, NULL),
('742743906', 'AETNA0614', 'AETNA0614', 'TXSATSTD', 'San Antonio Kidney Disease Center Physicians Group', 'Carl', 'J', 'Blond', 'MD', 'Nephrology', '', '', NULL, 'O', '2391 Northeast Loop 410 Ste 405', 'San Antonio', 'Bexar', 'TX', '78217', '2106547326', NULL, '2391 Northeast Loop 410 Ste 405', 'San Antonio', 'Bexar', 'TX', '78217', '2106547326', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174507776', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('850275777', 'W12032079', 'W12032079', 'NM01', 'Southwest Medical Associates', 'Aaron', 'W', 'Pfau', 'DO', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659683944', 0, 'N', 0, '2013-06-13', NULL, NULL, 35.1537, -106.587, NULL, NULL),
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('201428952', 'W12032075', 'W12032075', 'UT01', 'Western Anesthesia Associates', 'John', 'K', 'Zaugg', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1770698946', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('272559167', 'W12031838', 'W12031838', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78132', '8306099058', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78132', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.8496, -98.1705, NULL, NULL),
('271789847', 'W12032052', 'W12032052', 'IDBOISTD', 'Saint Alphonsus Medical Group Wound Ontario', 'Barry', 'L', 'Acor', 'MD', 'Family Practice', '', '', NULL, 'O', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1154633642', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('820200895', 'W12032051', 'W12032051', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics ', 'Todd', 'M', 'Otstot', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', '214 S Midland Blvd  ', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-03-25', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275523276', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('742719352', 'AETNA0384', 'AETNA0384', 'TXSATSTD', 'Urology of San Antonio', 'Patricia', 'P', 'Cecconi', 'MD', 'Urology', '', '', NULL, 'O', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2106144544', NULL, '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2106144544', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1558399816', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.3447, -98.4359, NULL, NULL),
('820312175', 'W12032049', 'W12032049', 'ID01', 'Idaho Emergency Physicians PA', 'Santina', 'M', 'Ellison', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2013-03-25', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932376936', 0, 'N', 0, '2013-04-11', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('870550275', 'W12032474', 'W12032474', 'UT01', 'Wasatch Pediatrics', 'Alison', '', 'Delgado', 'MD', 'Pediatrics', '', '', NULL, 'O', '750 Round Valley Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356550926', '4356493748', '750 Round Valley Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356550926', '4356493748', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1649413212', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870550275', 'W12032475', 'W12032475', 'UT01', 'Wasatch Pediatrics', 'Alison', '', 'Delgado', 'MD', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1649413212', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12032476', 'W12032476', 'UT01', 'Wasatch Pediatrics', 'Alison', '', 'Delgado', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1649413212', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'W12032477', 'W12032477', 'ILCHIGSTD', '', 'Andrew', 'Warren', 'Wunderlich', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-13', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275528341', 0, 'N', 0, '2014-02-12', NULL, NULL, 41.5298, -88.1298, NULL, NULL),
('900406130', 'W12032480', 'W12032480', 'SACN', '', 'John', 'C', 'Preece', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083452212', '2083452282', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083452212', '2083452282', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093871436', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'AETNA0060', 'AETNA0060', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Madhu', 'B', 'Challapalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '12701 IH 35 N', 'San Antonio', 'Bexar', 'TX', '78233', '2109670096', NULL, '12701 IH 35 N', 'San Antonio', 'Bexar', 'TX', '78233', '2109670096', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1609847029', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'AETNA0044', 'AETNA0044', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Anna', 'L', 'Chavana', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', NULL, '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1689683039', 0, 'N', 0, '2014-05-01', NULL, NULL, 29.5641, -98.2617, NULL, NULL),
('113676182', 'AETNA0004', 'AETNA0004', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Elias', 'R', 'Cheleuitte', 'DPM', 'Podiatry', '', '', NULL, 'O', '1303 McCullough Ave Ste 348', 'San Antonio', 'Bexar', 'TX', '78212', '2102274164', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1972594455', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('205805198', 'AETNA0007', 'AETNA0007', 'TXSATSTD', 'Concentra Health Services Inc', '', '', 'Concentra Health Services', '', 'Urgent Care', '', '', NULL, 'O', '12702 Toepperwein Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78233', '2106534420', NULL, '12702 Toepperwein Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78233', '2106534420', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010079', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('205805198', 'AETNA0010', 'AETNA0010', 'TXSATSTD', 'Concentra Health Services Inc', '', '', 'Concentra Health Services', '', 'Urgent Care', '', '', NULL, 'O', '400 E Quincy St', 'San Antonio', 'Bexar', 'TX', '78215', '2104720211', NULL, '400 E Quincy St', 'San Antonio', 'Bexar', 'TX', '78215', '2104720211', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010079', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'AETNA0684', 'AETNA0684', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Ronald', 'W', 'Connor', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811939820', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('454732418', 'W12032040', 'W12032040', 'UTDT01', 'Brush Dental', 'Jason', '', 'Teerlink', 'DMD', 'Dentist', '', '', NULL, 'O', '2633 W 6200 S Ste A-6', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551112', NULL, '2633 W 6200 S Ste A-6', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010110', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('741850643', 'AETNA0118', 'AETNA0118', 'TXSATSTD', 'General Surgical Associates', 'Bruce', 'E', 'Conway', 'MD', 'General Surgery', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1629005996', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6164, -98.492, NULL, NULL),
('742143569', 'AETNA0132', 'AETNA0132', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Jorge', 'A', 'De La Chapa', 'DO', 'Ophthalmology', '', '', NULL, 'O', '11212 State Hwy151  Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2106972020', NULL, '11212 State Hwy151  Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-09-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710026596', 0, 'N', 0, '2014-01-31', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('742143569', 'AETNA0133', 'AETNA0133', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Jorge', 'A', 'De La Chapa', 'DO', 'Ophthalmology', '', '', NULL, 'O', '11900 Crownpoint Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', NULL, '11900 Crownpoint Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-09-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710026596', 0, 'N', 0, '2014-01-31', NULL, NULL, 29.5494, -98.3646, NULL, NULL),
('742143569', 'AETNA0134', 'AETNA0134', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Jorge', 'A', 'De La Chapa', 'DO', 'Ophthalmology', '', '', NULL, 'O', '315 S  San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 S  San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710026596', 0, 'N', 0, '2014-01-31', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('741850643', 'AETNA0123', 'AETNA0123', 'TXSATSTD', 'General Surgical Associates', 'Brittany', 'B', 'DeBerry', 'MD', 'General Surgery', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1891722179', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6164, -98.492, NULL, NULL),
('274069975', 'W12032036', 'W12032036', 'UTDT01', 'Utah Orthodontic Care', 'Brian', '', 'Randle', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1140 E Brickyard Rd Ste 32', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019994431', NULL, '1140 E Brickyard Rd Ste 32', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019994431', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010108', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'AETNA0203', 'AETNA0203', 'TXSATSTD', 'South Texas Spinal Clinic', 'Jerjis', 'J', 'Denno', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1303 Hospital Blvd Ste 200', 'Floresville', 'Wilson', 'TX', '78114', '2106146432', NULL, '1303 Hospital Blvd Ste 200', 'Floresville', 'Wilson', 'TX', '78114', '2106146432', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1033186515', 0, 'Y', 0, '2013-07-10', NULL, NULL, 29.114, -98.1697, NULL, NULL),
('742503534', 'AETNA0204', 'AETNA0204', 'TXSATSTD', 'South Texas Spinal Clinic', 'Jerjis', 'J', 'Denno', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '18600 N  Hardy Oak Blvd', 'San Antonio', 'Bexar', 'TX', '78258', '2104040800', NULL, '18600 N  Hardy Oak Blvd', 'San Antonio', 'Bexar', 'TX', '78258', '2104040800', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1033186515', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'AETNA0205', 'AETNA0205', 'TXSATSTD', 'South Texas Spinal Clinic', 'Jerjis', 'J', 'Denno', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', NULL, '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1033186515', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.6137, -98.4785, NULL, NULL),
('742503534', 'AETNA0206', 'AETNA0206', 'TXSATSTD', 'South Texas Spinal Clinic', 'Jerjis', 'J', 'Denno', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', NULL, '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1033186515', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.6992, -98.1487, NULL, NULL),
('743003947', 'AETNA0643', 'AETNA0643', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Marc', 'F', 'Deschaine', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931480', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931480', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124061544', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('274069975', 'W12032035', 'W12032035', 'UTDT01', 'Utah Orthodontic Care', 'Brian', '', 'Randle', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1231 W 9000 S Ste D', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019994431', NULL, '1231 W 9000 S Ste D', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019994431', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010108', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12032033', 'W12032033', 'UTDT01', 'All Around Dental Care', 'Stephen', '', 'Pratt', 'DDS', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', NULL, '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010107', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870414734', 'W12032031', 'W12032031', 'UTDT01', 'Peery Family Dentistry', 'Samuel', '', 'Peery', 'DMD', 'Dentist', '', '', NULL, 'O', '30 N 100 E', 'Logan', 'Cache', 'UT', '84321', '4357521362', NULL, '30 N 100 E', 'Logan', 'Cache', 'UT', '84321', '4357521362', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010106', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('753051218', 'W12032029', 'W12032029', 'UTDT01', 'A Kids Place Dentistry', 'Rodney', '', 'Slater', 'DDS', 'Pedodontist', '', '', NULL, 'O', '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478000', NULL, '292 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8017478000', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004126', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('753051218', 'W12032028', 'W12032028', 'UTDT01', 'A Kids Place Dentistry', 'Rodney', '', 'Slater', 'DDS', 'Pedodontist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004126', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('721543665', 'W12032027', 'W12032027', 'UTDT01', 'Baer Canyon Dental', 'Mckay', '', 'Packer', 'DDS', 'Dentist', '', '', NULL, 'O', '275 N 300 W Ste 404', 'Kaysville', 'Davis', 'UT', '84037', '8015449444', NULL, '275 N 300 W Ste 404', 'Kaysville', 'Davis', 'UT', '84037', '8015449444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008029', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742246239', 'AETNA0139', 'AETNA0139', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Leonard', '', 'Duran', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2105452555', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144224809', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('742246239', 'AETNA0140', 'AETNA0140', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Leonard', '', 'Duran', 'MD', 'Gastroenterology', '', '', NULL, 'O', '215 E Quincy St Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2104263994', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144224809', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('742246239', 'AETNA0141', 'AETNA0141', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Leonard', '', 'Duran', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2829 Babcock Rd Ste 525', 'San Antonio', 'Bexar', 'TX', '78229', '2106158201', NULL, '2829 Babcock Rd Ste 525', 'San Antonio', 'Bexar', 'TX', '78229', '2106158201', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144224809', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('742246239', 'AETNA0142', 'AETNA0142', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Leonard', '', 'Duran', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', NULL, '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144224809', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('742246239', 'AETNA0143', 'AETNA0143', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Leonard', '', 'Duran', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', NULL, '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144224809', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('742246239', 'AETNA0158', 'AETNA0158', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Joseph', 'E', 'Johnson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', NULL, '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1477557072', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.3557, -98.5463, NULL, NULL),
('742743906', 'AETNA0612', 'AETNA0612', 'TXSATSTD', 'San Antonio Kidney Disease Center Physicians Group', 'Lin', 'Z', 'Johnson', 'MD', 'Nephrology', '', '', NULL, 'O', '1528 E Common St Ste 1', 'New Braunfels', 'Comal', 'TX', '78130', '8306204650', NULL, '1528 E Common St Ste 1', 'New Braunfels', 'Comal', 'TX', '78130', '8306204650', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104801737', 0, 'N', 0, '2013-05-02', NULL, NULL, 0, 0, NULL, NULL),
('461088078', 'W12031922', 'W12031922', 'UTDT01', 'Parleys Creek Dental', 'Daniel', '', 'Linford', '', 'Dentist', '', '', NULL, 'O', '2725 E Parleys Way Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8018750570', NULL, '2725 E Parleys Way Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8018750570', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013228709', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('741654878', 'AETNA0109', 'AETNA0109', 'TXSATSTD', 'Neurosurgical Associates of San Antonio', 'Robert', 'G', 'Johnson', 'MD', 'Neurosurgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2106142453', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, NULL, '', '', '', 'HCFA|UB|', '1689675142', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6137, -98.4785, NULL, NULL),
('741850643', 'AETNA0121', 'AETNA0121', 'TXSATSTD', 'General Surgical Associates', 'Joe', 'E', 'Johnston', 'MD', 'General Surgery', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1679507123', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.6164, -98.492, NULL, NULL),
('202126685', 'W12031921', 'W12031921', 'UTDT01', 'City Creek Dental', 'Steven', '', 'Lambourne', 'DDS', 'Dentist', '', '', NULL, 'O', '175 S W Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8013647943', NULL, '175 S W Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8013647943', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009826', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('452403034', 'W12031919', 'W12031919', 'UTDT01', 'Stonehaven Dental', 'Angela', '', 'Kerr', 'DDS', 'Dentist', '', '', NULL, 'O', '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', NULL, '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010085', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('461026587', 'W12031914', 'W12031914', 'UTDT01', 'Blue Mountain Family Dental', 'Justin', '', 'Hilmo', 'DDS', 'Dentist', '', '', NULL, 'O', '1675 N 200 W Ste 8A', 'Provo', 'Utah', 'UT', '84604', '8013567329', NULL, '1675 N 200 W Ste 8A', 'Provo', 'Utah', 'UT', '84604', '8013567329', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006719', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('201951989', 'W12031913', 'W12031913', 'UTDT01', 'Lonepeak Pediatric Dentistry', 'Jeanne', '', 'Hibler', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1030 E 11400 S Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015538882', NULL, '1030 E 11400 S Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015538882', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004190', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('752780597', 'W12031910', 'W12031910', 'UTDT01', 'Canyon View Dental Care', 'Daniel', '', 'Ellingson', 'DMD', 'Dentist', '', '', NULL, 'O', '1844 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8018169366', NULL, '1844 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8018169366', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010083', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'AETNA0375', 'AETNA0375', 'TXSATSTD', 'Urology of San Antonio', 'LeRoy', 'A', 'Jones', 'MD', 'Urology', '', '', NULL, 'O', '7909 Fredericksburg Rd Ste 125', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', NULL, '7909 Fredericksburg Rd Ste 125', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518947613', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
('752780597', 'W12031909', 'W12031909', 'UTDT01', 'Snow Country Dental Care', 'Daniel', '', 'Ellingson', 'DMD', 'Dentist', '', '', NULL, 'O', '1729 Sidewinder Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356499492', NULL, '1729 Sidewinder Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356499492', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010083', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('752780597', 'W12031911', 'W12031911', 'UTDT01', 'Wasatch Dental Care', 'Daniel', '', 'Ellingson', 'DMD', 'Dentist', '', '', NULL, 'O', '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', NULL, '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010083', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('741654878', 'AETNA0102', 'AETNA0102', 'TXSATSTD', 'Neurosurgical Associates of San Antonio', 'Jordan', 'J', 'Jude', 'MD', 'Neurosurgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2106142453', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1255533451', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6137, -98.4785, NULL, NULL),
('264333033', 'AETNA0033', 'AETNA0033', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Elizabeth', 'A', 'King', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', NULL, '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184643769', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5641, -98.2617, NULL, NULL),
('264333033', 'AETNA0034', 'AETNA0034', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Elizabeth', 'A', 'King', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2014951900', NULL, '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2014951900', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184643769', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('742763430', 'AETNA0615', 'AETNA0615', 'TXSATSTD', 'Allergy Asthma and Immunology Associates of South Texas', 'William', 'T', 'Kniker', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', NULL, '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-09-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710978663', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.3515, -98.5457, NULL, NULL),
('710938777', 'W12031908', 'W12031908', 'UTDT01', 'Lakeview Dental ', 'Daniel', '', 'Ellingson', 'DMD', 'Dentist', '', '', NULL, 'O', '3626 W 5600 S Ste D', 'Roy', 'Weber', 'UT', '84067', '8019852273', NULL, '3626 W 5600 S Ste D', 'Roy', 'Weber', 'UT', '84067', '8019852273', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010083', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('742246239', 'AETNA0182', 'AETNA0182', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '215 E Quincy St Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2104263994', NULL, '215 E Quincy St Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2104263994', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('742246239', 'AETNA0183', 'AETNA0183', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', NULL, '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('742246239', 'AETNA0184', 'AETNA0184', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', NULL, '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
('742246239', 'AETNA0185', 'AETNA0185', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', NULL, '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.3557, -98.5463, NULL, NULL),
('742796322', 'AETNA0620', 'AETNA0620', 'TXSATSTD', 'Southwest Allergy and Asthma Center PA', 'Bruce', 'G', 'Martin', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '7711 Louis Pasteur Dr Ste 905', 'San Antonio', 'Bexar', 'TX', '78229', '2106160690', NULL, '7711 Louis Pasteur Dr Ste 905', 'San Antonio', 'Bexar', 'TX', '78229', '2106160690', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1326087081', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5088, -98.5702, NULL, NULL),
('742503534', 'AETNA0193', 'AETNA0193', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gilbert', 'R', 'Meadows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '12709 Toepperwein Rd Ste 302', 'San Antonio', 'Bexar', 'TX', '78233', '2106576948', NULL, '12709 Toepperwein Rd Ste 302', 'San Antonio', 'Bexar', 'TX', '78233', '2106576948', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174522536', 0, 'N', 0, '2014-03-21', NULL, NULL, 29.5535, -98.3472, NULL, NULL),
('742503534', 'AETNA0194', 'AETNA0194', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gilbert', 'R', 'Meadows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1303 Hospital Blvd Ste 200', 'Floresville', 'Wilson', 'TX', '78114', '2106146432', NULL, '1303 Hospital Blvd Ste 200', 'Floresville', 'Wilson', 'TX', '78114', '2106146432', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174522536', 0, 'Y', 0, '2014-03-21', NULL, NULL, 29.114, -98.1697, NULL, NULL),
('742503534', 'AETNA0195', 'AETNA0195', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gilbert', 'R', 'Meadows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5282 Medical Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78229', '8009241455', NULL, '5282 Medical Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78229', '8009241455', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174522536', 0, 'N', 0, '2014-03-21', NULL, NULL, 29.5095, -98.5891, NULL, NULL),
('742503534', 'AETNA0196', 'AETNA0196', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gilbert', 'R', 'Meadows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', NULL, '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174522536', 0, 'N', 0, '2014-03-21', NULL, NULL, 29.6992, -98.1487, NULL, NULL),
('272482029', 'W12031814', 'W12031814', 'TXDALSTD', 'Dallas Orthopedic and Shoulder Institute', 'Jeff', 'X', 'Zhao', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2704 N Galloway Ave Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '2142563778', NULL, '2704 N Galloway Ave Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '2142563778', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598828758', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.8016, -96.6112, NULL, NULL),
('870617733', 'W12031816', 'W12031816', 'UT01', 'Utah Eye Centers', 'Scott', 'D', 'Farrell', 'OD', 'Optometry', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306096979', 0, 'N', 0, '2013-07-23', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870617733', 'W12031815', 'W12031815', 'UT01', 'Utah Eye Centers', 'Scott', 'D', 'Farrell', 'OD', 'Optometry', '', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014099901', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014099901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306096979', 0, 'N', 0, '2013-07-23', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870617733', 'W12031817', 'W12031817', 'UT01', 'Utah Eye Centers', 'Scott', 'D', 'Farrell', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 30015 Dept 93', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014760494', '8014099901', 'PO Box 30015 Dept 93', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014760494', '8014099901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306096979', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('202344885', 'W12031818', 'W12031818', 'NM01', 'New Mexico Chiropractic Center', 'Rion', '', 'Marcus', 'DC', 'Chiropractic', '', '', NULL, 'O', '10555 Montgomery Blvd NE Bldg 1 Ste 30', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', '10555 Montgomery Blvd NE Bldg 1 Ste 30', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124369947', 0, 'N', 0, '2013-07-15', NULL, NULL, 35.1307, -106.522, NULL, NULL),
('870576522', 'W12031819', 'W12031819', 'UT01', 'Brigham Anesthesia LLC', 'Derek', '', 'Lish', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015946399', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015946399', '8014322601', '', '', '', '0.00', '25.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699914044', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('272559167', 'W12031862', 'W12031862', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3349 S Hwy 181 Ste A', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', NULL, '3349 S Hwy 181 Ste A', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2013-04-17', NULL, NULL, 28.8037, -97.8566, NULL, NULL),
('272559167', 'W12031861', 'W12031861', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5164, -98.4324, NULL, NULL),
('272559167', 'W12031860', 'W12031860', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-23', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('272559167', 'W12031859', 'W12031859', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12031858', 'W12031858', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5267, -98.5922, NULL, NULL),
('272559167', 'W12031857', 'W12031857', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5164, -98.4324, NULL, NULL),
('742246239', 'AETNA0163', 'AETNA0163', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2105452555', NULL, '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2105452555', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('742246239', 'AETNA0164', 'AETNA0164', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2829 Babcock Rd Ste 525', 'San Antonio', 'Bexar', 'TX', '78229', '2106158201', NULL, '2829 Babcock Rd Ste 525', 'San Antonio', 'Bexar', 'TX', '78229', '2106158201', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('742246239', 'AETNA0165', 'AETNA0165', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', NULL, '3903 Wiseman Blvd Ste 313', 'San Antonio', 'Bexar', 'TX', '78251', '2102710606', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('742246239', 'AETNA0166', 'AETNA0166', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', NULL, '4212 E Southcross Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78222', '2103596446', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
('742246239', 'AETNA0167', 'AETNA0167', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', NULL, '7333 Barlite Blvd Ste 320', 'San Antonio', 'Bexar', 'TX', '78224', '2109236238', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.3557, -98.5463, NULL, NULL),
('760467095', 'AETNA0694', 'AETNA0694', 'TXBEAUSTD', 'Southeast Texas Medical Assoc LLP', 'James', '', 'Shepherd', 'MD', 'Internal Medicine', '', '', NULL, 'O', '610 Strickland Dr Ste 140', 'Orange', 'Orange', 'TX', '77630', '4098339797', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'BEAUMONT4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-04', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1174896575', 0, 'N', 0, '2013-04-04', NULL, NULL, 30.0978, -93.7662, NULL, NULL),
('262427082', 'AETNA0027', 'AETNA0027', 'TXSATSTD', 'San Antonio Premier Internal Medicine', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'O', '559 10th St Ste 1', 'Floresville', 'Wilson', 'TX', '78114', '8303939152', NULL, '559 10th St Ste 1', 'Floresville', 'Wilson', 'TX', '78114', '8303939152', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871557454', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.153, -98.1661, NULL, NULL),
('272559167', 'W12031856', 'W12031856', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'AETNA0215', 'AETNA0215', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Alan', 'K', 'Silverman', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316039811', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('742143569', 'AETNA0137', 'AETNA0137', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Michael', 'A', 'Singer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '11900 Crownpoint Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', NULL, '11900 Crownpoint Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912902651', 0, 'N', 0, '2013-06-21', NULL, NULL, 29.5494, -98.3646, NULL, NULL),
('742143569', 'AETNA0138', 'AETNA0138', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Michael', 'A', 'Singer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '315 S  San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 S  San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912902651', 0, 'N', 0, '2013-06-21', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('272559167', 'W12031855', 'W12031855', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-15', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('272559167', 'W12031854', 'W12031854', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', NULL, '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('272559167', 'W12031853', 'W12031853', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('272559167', 'W12031852', 'W12031852', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-05-05', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('272559167', 'W12031851', 'W12031851', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', NULL, '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.3526, -98.883, NULL, NULL),
('272559167', 'W12031850', 'W12031850', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kevin', 'F', 'James', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063432938', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'AETNA0035', 'AETNA0035', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Ingrid', 'P', 'Skop', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', NULL, '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275542698', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5641, -98.2617, NULL, NULL),
('264333033', 'AETNA0036', 'AETNA0036', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Ingrid', 'P', 'Skop', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', NULL, '502 Madison Oak Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275542698', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('742625722', 'AETNA0220', 'AETNA0220', 'TXSATSTD', 'Alamo Ent Associates', 'William', 'C', 'Smith', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '8715 Village Dr Ste 618', 'San Antonio', 'Bexar', 'TX', '78217', '2109677377', NULL, '8715 Village Dr Ste 618', 'San Antonio', 'Bexar', 'TX', '78217', '2109677377', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336140680', 0, 'N', 0, '2013-05-28', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('272559167', 'W12031848', 'W12031848', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 330', 'New Braunfels', 'Comal', 'TX', '78130', '2102972240', NULL, '1583 E Common Ste 330', 'New Braunfels', 'Comal', 'TX', '78130', '2102972240', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.7251, -98.0961, NULL, NULL),
('272559167', 'W12031846', 'W12031846', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-04', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('272559167', 'W12031845', 'W12031845', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12031844', 'W12031844', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5267, -98.5922, NULL, NULL),
('272559167', 'W12031842', 'W12031842', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', NULL, '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12031841', 'W12031841', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('272559167', 'W12031837', 'W12031837', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12031831', 'W12031831', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'David', 'T', 'Schroder', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2102819595', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2102819595', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710935853', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
('870427760', 'W12031830', 'W12031830', 'NA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 161020', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8008770618', '0000000000', 'PO Box 161020', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8008770618', '0000000000', 'DEPOTDRUG', '', '', '0.00', '100.00', '0.00', 3, '2013-05-01', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870427760', 'W12031954', 'W12031954', 'NA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8008770618', '0000000000', 'Phone Number Only', '', '', '', '', '8008770618', '0000000000', 'DEPOTDRUG', '', '', '0.00', '100.00', '0.00', 3, '2013-04-01', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'AETNA0048', 'AETNA0048', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Mark', 'E', 'Thompson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', NULL, '5000 Schertz Pkwy Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2106535501', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821017484', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5641, -98.2617, NULL, NULL),
('271670329', 'W12031822', 'W12031822', 'UT01', 'Alpine Center Medical Services', 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2013-07-23', NULL, NULL, 40.6479, -111.939, NULL, NULL),
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('752919329', 'W12031802', 'W12031802', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Robert', 'F', 'Ulrich', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1215982699', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8724, -96.7711, NULL, NULL),
('752919329', 'W12031801', 'W12031801', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Nicole', '', 'Simpkins', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1396940532', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8724, -96.7711, NULL, NULL),
('741654878', 'AETNA0103', 'AETNA0103', 'TXSATSTD', 'Neurosurgical Associates of San Antonio', 'Arnold', 'B', 'Vardiman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2106142453', NULL, '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2106142453', '          ', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', 'North Central Baptist Hospital', '', '', 'HCFA|UB|', '1346241817', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6139, -98.4774, NULL, NULL),
('742719352', 'AETNA0567', 'AETNA0567', 'TXSATSTD', 'Urology of San Antonio', 'George', 'J', 'Vassar', 'MD', 'Urology', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', NULL, '255 E Sonterra Blvd Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932297157', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('752919329', 'W12031799', 'W12031799', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Ziad', '', 'Blaik', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1912013756', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8724, -96.7711, NULL, NULL),
('205934739', 'W12031797', 'W12031797', 'ID02', 'Family Medicine Health Center', 'Susan', 'M', 'Marzolf', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568440719', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('364351282', 'W12031796', 'W12031796', 'ILCHIGSTD', 'Mathew Chelich MD', 'Mathew', '', 'Chelich', 'DO', 'Family Practice', '', '', NULL, 'O', '16240 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083310011', '7083310008', '16240 Prince Dr', 'South Holland', 'Cook', 'IL', '60473', '7083310011', '7083310008', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1558349514', 0, 'N', 0, '2014-05-16', NULL, NULL, 41.6005, -87.5871, NULL, NULL),
('743003947', 'AETNA0680', 'AETNA0680', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Sergio', '', 'Viroslav', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2103375785', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2103375785', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1760424790', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('364351282', 'W12031795', 'W12031795', 'ILCHIGSTD', '', 'Mathew', '', 'Chelich', 'DO', 'Family Practice', '', '', NULL, 'B', '1600 Torrence Ave Ste B', 'Calumet City', 'Cook', 'IL', '60409', '7089152099', NULL, '1600 Torrence Ave Ste B', 'Calumet City', 'Cook', 'IL', '60409', '7089152099', '', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-06-14', 0, 0, 0, 'Ingalls Memorial Hospital', '', '', '', 'HCFA|UB|', '1558349514', 0, 'Y', 0, '2014-05-16', NULL, NULL, 41.588, -87.5596, NULL, NULL),
('621801973', 'W12031792', 'W12031792', 'UT01', 'Davis Internal Medicine', 'Heather', '', 'Berkel', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '1493 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1493 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-09', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326372764', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12031791', 'W12031791', 'UT01', 'Davis Urgent Care ', 'Heather', '', 'Berkel', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273099', '8019273088', '124 S Fairfield Rd  ', 'Layton', 'Davis', 'UT', '84041', '8019273099', '8019273088', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-09', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326372764', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.0604, -111.945, NULL, NULL),
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('742939835', 'AETNA0630', 'AETNA0630', 'TXSATSTD', 'John P Huff MD PHD PA', 'James', '', 'Wild', 'MD', 'Rheumatology', '', '', NULL, 'O', '102 Palo Alto Dr Ste 320', 'San Antonio', 'Bexar', 'TX', '78211', '2104040020', NULL, '102 Palo Alto Dr Ste 320', 'San Antonio', 'Bexar', 'TX', '78211', '2104040020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-04', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659343291', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
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('900406130', 'W12032479', 'W12032479', 'ID01', '', 'John', 'C', 'Preece', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083452212', '2083452282', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083452212', '2083452282', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093871436', 0, 'N', 0, '2013-04-23', NULL, NULL, 43.6239, -116.206, NULL, NULL),
('621801973', 'W12031793', 'W12031793', 'UT01', '', 'Heather', '', 'Berkel', 'FNP-C', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-09', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326372764', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('264147290', 'W12031989', 'W12031989', 'UTDT01', 'Mount Ogden Dental', 'Derald', '', 'Geddes', 'DDS', 'Dentist', '', '', NULL, 'O', '1220 33rd St Ste D', 'Ogden', 'Weber', 'UT', '84403', '8013945554', NULL, '1220 33rd St Ste D', 'Ogden', 'Weber', 'UT', '84403', '8013945554', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006389', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
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('272559167', 'W12031843', 'W12031843', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12031953', 'W12031953', 'UT01', 'Central Utah Clinic PC', 'Brad', 'A', 'Mangum', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', NULL, '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316992548', 0, 'N', 0, '2013-04-16', NULL, NULL, 40.248, -111.667, NULL, NULL),
('201951870', 'W12031912', 'W12031912', 'UTDT01', 'Eastgate Pediatric Dentistry', 'Jeanne', '', 'Hibler', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1580 E 3900 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012728555', NULL, '1580 E 3900 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012728555', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004190', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('205497151', 'W12032078', 'W12032078', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'Michael', '', 'Boothby', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '6049 S Hulen St Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', '6049 S Hulen St Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 6, '2013-05-22', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, NULL, 'HCFA|UB', '1669419743', 0, 'N', 0, '2014-03-05', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('452958326', 'W12031970', 'W12031970', 'UTDT01', 'Experienced Dental', 'Blake', '', 'Cameron', '', 'Dentist', '', '', NULL, 'O', '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', NULL, '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009928', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('452958326', 'W12031969', 'W12031969', 'UTDT01', 'Ridge View Dental', 'Blake', '', 'Cameron', '', 'Dentist', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009928', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('460740417', 'W12031972', 'W12031972', 'UTDT01', 'Genesis Dental of Magna', 'David', '', 'Cannon', 'DDS', 'Dentist', '', '', NULL, 'O', '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', NULL, '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005555', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12031839', 'W12031839', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12034145', 'W12034145', 'TXDALSTD', 'Health Texas Provider Network', 'Osman', '', 'Mir', 'MD', 'Neurology', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 1155', 'Dallas', 'Dallas', 'TX', '75246', '2148204561', '2148204562', '3600 Gaston Ave Wadley Tower Ste 1155', 'Dallas', 'Dallas', 'TX', '75246', '2148204561', '2148204562', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1821273590', 0, 'N', 0, '2013-06-10', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('272559167', 'W12031868', 'W12031868', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.7251, -98.0961, NULL, NULL),
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('752780597', 'W12031935', 'W12031935', 'UTDT01', 'Wasatch Dental Care', 'Joseph', '', 'Peck', 'DMD', 'Dentist', '', '', NULL, 'O', '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', NULL, '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010088', 0, 'N', 0, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
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('752919329', 'W12031803', 'W12031803', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Maureen', 'P', 'Wooten Watts', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1750497434', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('621801973', 'W12031781', 'W12031781', 'UT01', 'Physician Group of Utah Inc', '', '', 'Physician Group of Utah Inc', '', 'Clinic', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8012147650', '8012147651', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477676930', 0, 'Y', 0, '2014-04-29', 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
('460703284', 'W12032093', 'W12032093', 'ID02', 'JC Hospitalists', 'Hernan', 'M', 'Macias', 'MD', 'Hospitalist', '', '', NULL, 'O', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073736302', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12032094', 'W12032094', 'ID02', 'JC Hospitalists', 'Hernan', 'M', 'Macias', 'MD', 'Hospitalist', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073736302', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12032095', 'W12032095', 'ID02', 'JC Hospitalists PLLC', 'Hernan', 'M', 'Macias', 'MD', 'Hospitalist', '', '', NULL, 'M', 'PO Box 4477', 'Boise', 'Ada', 'ID', '83711', '0000000000', '0000000000', 'PO Box 4477', 'Boise', 'Ada', 'ID', '83711', '0000000000', '0000000000', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073736302', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12032096', 'W12032096', 'ID02', 'Family Medicine Health Center', 'Suzanne', 'M', 'Anstine', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790770246', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12032097', 'W12032097', 'ID02', 'Family Medicine Health Center', 'Suzanne', 'M', 'Anstine', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790770246', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12032098', 'W12032098', 'UT01', 'Utah Eye Centers', 'Jed', 'T', 'Poll', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', NULL, '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376656124', 0, 'N', 0, '2013-07-26', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870622942', 'W12032099', 'W12032099', 'UT01', 'Utah Imaging Associates ', 'Lauren', 'V', 'Zollinger', 'MD', 'Radiology', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548443716', 0, 'N', 0, '2013-04-12', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870622942', 'W12032100', 'W12032100', 'UT01', 'Utah Imaging Associates', 'Lauren', 'V', 'Zollinger', 'MD', 'Radiology', '', '', NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548443716', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032101', 'W12032101', 'UT01', 'Utah Imaging Associates', 'Lauren', 'V', 'Zollinger', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548443716', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032102', 'W12032102', 'UT01', 'Utah Imaging Associates', 'Gregory', 'B', 'Martin', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457529927', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032104', 'W12032104', 'UT01', 'Utah Imaging Associates ', 'Gregory', 'B', 'Martin', 'MD', 'Radiologist', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457529927', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870622942', 'W12032103', 'W12032103', 'UT01', 'Utah Imaging Associates', 'Gregory', 'B', 'Martin', 'MD', 'Radiologist', '', '', NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457529927', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032106', 'W12032106', 'UT01', 'Utah Imaging Associates', 'Mark', 'F', 'Abbott', 'MD', 'Radiologist', '', '', NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295993871', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032107', 'W12032107', 'UT01', 'Utah Imaging Associates', 'Mark', 'F', 'Abbott', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295993871', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'W12032108', 'W12032108', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Colleen', '', 'Heniff', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 W 95th St Ste 205', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 205', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972509594', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'W12032109', 'W12032109', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Colleen', '', 'Heniff', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972509594', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('364364574', 'W12032111', 'W12032111', 'ILCHIGSTD', 'Primary Healthcare Associates', 'Sherry', '', 'Fishkin', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '71 W 156th St Ste 107', 'Harvey', 'Cook', 'IL', '60426', '7083330730', '7087980205', '71 W 156th St Ste 107', 'Harvey', 'Cook', 'IL', '60426', '7083330730', '7087980205', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568647196', 0, 'N', 0, '2013-04-15', NULL, NULL, 41.6063, -87.6604, NULL, NULL),
('061506129', 'W12032112', 'W12032112', 'UT01', 'Wee Care Pediatrics ', '', '', 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', NULL, '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', '          ', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009555', 0, 'Y', 0, '2013-06-26', NULL, NULL, 41.1899, -112.049, NULL, NULL),
('061506129', 'W12032113', 'W12032113', 'UT01', 'Wee Care Pediatrics 24 hours 7 days a week', '', '', 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '0000000000', '0000000000', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-06-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009555', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032114', 'W12032114', 'UT01', 'Wee Care Pediatrics', '', '', 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009555', 0, 'Y', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032115', 'W12032115', 'UT01', 'Wee Care Pediatrics', 'Priscilla', 'Aye', 'Chen', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750346599', 0, 'Y', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032116', 'W12032116', 'UT01', 'Wee Care Pediatrics', 'James', 'A', 'Fennell', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912905035', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032118', 'W12032118', 'UT01', 'Wee Care Pediatrics', 'Alvin', 'A', 'Gabrielsen', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992703029', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032119', 'W12032119', 'UT01', 'Wee Care Pediatrics', 'Jennifer', 'M', 'Gilsoul', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164402202', 0, 'Y', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032120', 'W12032120', 'UT01', 'Wee Care Pediatrics', 'Cody', 'J', 'Hawkes', 'DO', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457535114', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032121', 'W12032121', 'UT01', 'Wee Care Pediatrics', 'Michael', 'P', 'Husseman', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1053319186', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032122', 'W12032122', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12032123', 'W12032123', 'UT01', 'Wee Care Pediatrics', 'Anthony', 'G', 'Pruitt', 'MD', 'Pediatrics', '', '', NULL, 'O', '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', NULL, '4040 Midland Dr Ste 2', 'Roy', 'Weber', 'UT', '84067', '8017738644', '          ', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700884848', 0, 'N', 0, '2013-04-15', NULL, NULL, 41.1899, -112.049, NULL, NULL),
('061506129', 'W12032124', 'W12032124', 'UT01', 'Wee Care Pediatrics', 'Anthony', 'G', 'Pruitt', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700884848', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
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