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
('204974140', 'W12023668', 'W12023668', 'WY01', 'Rocky Mountain Vein Clinic ', 'Jennifer', 'L', 'Williams', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1155', 'Billings', 'Yellowstone', 'MT', '59103', '4062528346', '4066568303', 'PO Box 1155', 'Billings', 'Yellowstone', 'MT', '59103', '4062528346', '4066568303', '', '', '', '0.00', '7.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679652010', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'W12023664', 'W12023664', 'WYT2', 'Rocky Mountain Vein Clinic ', 'Jennifer', 'L', 'Williams', 'PA', 'Internal Medicine', '', '', NULL, 'O', '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', '', '', '', '0.00', '7.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679652010', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'W12023666', 'W12023666', 'WYT2', 'Rocky Mountain Vein Clinic ', 'Jennifer', 'L', 'Williams', 'PA', 'Internal Medicine', '', '', NULL, 'O', '2820 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', '4066568303', '2820 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', '4066568303', '', '', '', '0.00', '7.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679652010', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'W12023667', 'W12023667', 'WYT2', 'Rocky Mountain Vein Clinic ', 'Jennifer', 'L', 'Williams', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1155', 'Billings', 'Yellowstone', 'MT', '59103', '4062528346', '4066568303', 'PO Box 1155', 'Billings', 'Yellowstone', 'MT', '59103', '4062528346', '4066568303', '', '', '', '0.00', '7.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679652010', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('742074876', 'W12027413', 'W12027413', 'TXHOUSTD', 'Rosewood ENT ', 'John', 'W', 'Craddock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '18400 Katy Fwy Ste 650', 'Houston', 'Harris', 'TX', '77094', '7137819660', '8327723125', '18400 Katy Fwy Ste 650', 'Houston', 'Harris', 'TX', '77094', '7137819660', '8327723125', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699752857', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('826041596', 'W12023670', 'W12023670', 'ID01', 'Gem State Radiology LLP', 'William', 'L', 'Taylor', 'MD', 'Radiologist', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415238137', '5415231788', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415238137', '5415231788', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1063469500', 0, 'Y', 0, '2014-06-02', NULL, NULL, 44.7961, -117.848, NULL, NULL),
('826041596', 'W12023671', 'W12023671', 'ID01', 'Gem State Radiology LLP', 'William', 'L', 'Taylor', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '0000000000', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '0000000000', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1063469500', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12023672', 'W12023672', 'ID02', 'Saint Alphonsus Medical Center Ontario ', 'Mark', 'D', 'Christenson', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817373', '5418817186', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817373', '5418817186', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-08-01', '2013-10-17', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1699883447', 0, 'Y', 0, '2014-06-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('200055625', 'W12023673', 'W12023673', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', '2013-05-23', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('200055625', 'W12023674', 'W12023674', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', '2013-05-23', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('200055625', 'W12023676', 'W12023676', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'John', 'H', 'Phillips', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1477567485', 0, 'N', 0, '2013-12-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('200055625', 'W12023677', 'W12023677', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'John', 'H', 'Phillips', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'B', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1477567485', 0, 'N', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('200055625', 'W12023679', 'W12023679', 'ID02', 'Saint Alphonsus Medical Center-Ontario (Apogee)(', 'Asad', '', 'Kizilbash', 'MD', 'Hospitalist', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-23', '2014-01-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861630907', 0, 'N', 0, '2014-02-07', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('200055625', 'W12023680', 'W12023680', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'Asad', '', 'Kizilbash', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-23', '2014-01-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861630907', 0, 'N', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('203942050', 'W12023683', 'W12023683', 'ID02', 'Saint Alphonsus Home Health & Home Infusion  (Amedisys, Inc)', '', '', 'Saint Alphonsus Home Health and Hospice, an Amedisys Partner', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'O', '9199 W Black Eagle Rd', 'Boise', 'Ada', 'ID', '83709', '2083218641', NULL, '9199 W Black Eagle Rd', 'Boise', 'Ada', 'ID', '83709', '2083218641', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', '2013-09-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518911890', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('203942050', 'W12023684', 'W12023684', 'ID02', 'Saint Alphonsus Home Health and Hospice  (Amedisys, Inc)', '', '', 'Four Rivers Hospice', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'O', '9199 W Black Eagle Rd', 'Boise', 'Ada', 'ID', '83709', '2083218641', NULL, '9199 W Black Eagle Rd', 'Boise', 'Ada', 'ID', '83709', '2083218641', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006290', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('363807485', 'W12043348', 'W12043348', 'ILCHIGSTD', '', 'David', '', 'Feerst', 'MD', 'Internal Medicine', '', '', NULL, 'O', '605 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8475908100', '8473948505', '605 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8475908100', '8473948505', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508931767', 0, 'N', 0, '2014-01-16', NULL, NULL, 42.0665, -87.9899, NULL, NULL),
('264814166', 'W12043337', 'W12043337', 'UT01', 'Hospice Care of Northern Utah', '', '', 'Hospice Care of Northern Utah', '', 'Hospice', '', '', NULL, 'O', '2721 N Hwy 89 Ste 200', 'Pleasant View', 'Weber', 'UT', '84414', '8016893049', '8016893045', '2721 N Hwy 89 Ste 200', 'Pleasant View', 'Weber', 'UT', '84414', '8016893049', '8016893045', '', '', '3', '0.00', '30.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659505501', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12043422', 'W12043422', 'UT01', 'Wasatch Pediatrics', 'Robert', '', 'Sylvester', 'NP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841628666', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('751365258', 'W12024175', 'W12024175', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Connie', '', 'Zhou', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 225', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2021 N MacArthur Blvd Ste 225', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447453055', 0, 'N', 1, '2012-10-24', NULL, NULL, 32.8355, -96.9602, NULL, NULL),
('820526861', 'W12023692', 'W12023692', 'IDBOISTD', 'Caldwell  Cancer Care Center  Radiation Oncology', '', '', 'Caldwell  Cancer Care Center - Radiation Oncology', 'Group', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 147', 'Caldwell', 'Canyon', 'ID', '83606', '2084551400', NULL, 'PO Box 147', 'Caldwell', 'Canyon', 'ID', '83606', '2084551400', '          ', 'IDHOSPOP', '', '', '0.00', '10.00', '0.00', 6, '2012-09-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053522961', 0, 'N', 0, '2012-10-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023693', 'W12023693', 'UTIHC01', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', NULL, '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023694', 'W12023694', 'UTIHC02', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', NULL, '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023695', 'W12023695', 'UTIHC03', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', NULL, '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023696', 'W12023696', 'UTIHC04', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', NULL, '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'N', 0, '2012-10-10', NULL, NULL, 40.2484, -111.667, NULL, NULL),
('203942050', 'W12023697', 'W12023697', 'ID02', 'Saint Alphonsus Home Health and Hospice  (Amedisys, Inc)', '', '', 'Four Rivers Hospice', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'O', '427 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673040', NULL, '427 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673040', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006290', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('203942050', 'W12023698', 'W12023698', 'ID02', 'Saint Alphonsus Home Health and Hospice', '', '', 'Four Rivers Hospice', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'B', 'Dept 115034', 'Hartford', 'Hartford', 'CT', '06115', '2083677305', NULL, 'Dept 115034', 'Hartford', 'Hartford', 'CT', '06115', '2083677305', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006290', 0, 'N', 0, '2012-10-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023701', 'W12023701', 'UTIHC01', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023702', 'W12023702', 'UTIHC02', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023703', 'W12023703', 'UTIHC03', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023704', 'W12023704', 'UTIHC04', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'B', '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '268 E 600 S ', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'Y', 0, '2012-10-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023705', 'W12023705', 'UTIHC01', 'IHC Hsp Div', '', '', 'IHC Hsp Div', '', 'Master', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009767', 0, 'Y', 1, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023706', 'W12023706', 'UTIHC02', 'IHC Hsp Div', '', '', 'IHC Hsp Div', '', 'Master', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009767', 0, 'Y', 1, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12023707', 'W12023707', 'UTIHC03', 'IHC Hsp Div', '', '', 'IHC Hsp Div', '', 'Master', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009767', 0, 'Y', 1, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
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('870212456', 'W12023850', 'W12023850', 'UT01', 'Gunnison Family Practice', 'Brady', 'C', 'Blackham', 'DO', 'Family Practice', '', '', NULL, 'O', '95 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84000', '4355287227', '4355287138', '95 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84000', '4355287227', '4355287138', 'WISESTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1679701197', 0, 'N', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870212456', 'W12023851', 'W12023851', 'UT01', 'Gunnison Valley Hospital', 'Brady', 'C', 'Blackham', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 163', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287291', '4355283844', 'PO Box 163', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287291', '4355283844', 'WISESTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1679701197', 0, 'N', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
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('200879366', 'W12023855', 'W12023855', 'ILCHIGSTD', 'Adil Pediatrics', 'Mohammed', 'M', 'Adil', 'MD', 'Pediatrics', '', '', NULL, 'B', '800 Shanahan Ct', 'Naperville', 'Dupage', 'IL', '60540', '8157293006', '8667576056', '800 Shanahan Ct', 'Naperville', 'Dupage', 'IL', '60540', '8157293006', '8667576056', 'CHIG11', '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|', '1972565679', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('453001737', 'W12023856', 'W12023856', 'TXHOUSTD', 'One Source Medic-Clinic', 'Mohammad', '', 'Ahmed', 'PA', 'Family Practice', '', '', NULL, 'O', '2802 Garth Rd Ste 211', 'Baytown', 'Harris', 'TX', '77521', '2818397244', '2818397374', '2802 Garth Rd Ste 211', 'Baytown', 'Harris', 'TX', '77521', '2818397244', '2818397374', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital ', NULL, '', '', 'HCFA|UB|', '1720368897', 0, 'N', 0, '2012-11-30', NULL, NULL, 29.7512, -94.9771, NULL, NULL),
('451118620', 'W12023857', 'W12023857', 'TXHOUSTD', 'Onyinye A Agim', 'Onyinye', 'A', 'Agim', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7330 Southwest Fwy Ste A', 'Houston', 'Harris', 'TX', '77074', '7135410095', '7135410091', '7330 Southwest Fwy Ste A', 'Houston', 'Harris', 'TX', '77074', '7135410095', '7135410091', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518121532', 0, 'N', 1, '2013-02-27', 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
('800701770', 'W12025506', 'W12025506', 'UT01', 'Coral Desert Spine Center', 'Ryan', 'D', 'Church', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1912909714', 0, 'N', 0, '2014-06-04', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('271790052', 'W12023901', 'W12023901', 'IDBOISTD', 'Saint Alphonsus Emergency Physicians Baker City', 'Steven', 'A', 'DeLashmutt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821030552', 0, 'Y', 0, '2012-10-12', NULL, NULL, 44.7961, -117.848, NULL, NULL),
('820200895', 'W12023891', 'W12023891', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jeremey', 'S', 'Cureton', 'NPC', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1053698167', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12023878', 'W12023878', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald', 'Susan', '', 'Paytash', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1912073370', 0, 'N', 0, '2012-10-12', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12023890', 'W12023890', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP', 'Susan', '', 'Paytash', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W. Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1912073370', 0, 'N', 0, '2012-10-12', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('271790052', 'W12023888', 'W12023888', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker Clinic', 'Elizabeth', '', 'Chattin', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821211277', 0, 'N', 0, '2014-03-18', NULL, NULL, 44.7961, -117.846, NULL, NULL),
('751365258', 'W12024179', 'W12024179', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Robert', 'R', 'Whittaker', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 425', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2001 N MacArthur Blvd Ste 425', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1368516585', 0, 'N', 1, '2012-10-24', NULL, NULL, 32.8354, -96.9606, NULL, NULL),
('271790052', 'W12023887', 'W12023887', 'IDBOISTD', 'Saint Alphonsus Emergency Physicians Baker City', 'Galen', '', 'Church', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467487868', 0, 'Y', 0, '2012-10-12', NULL, NULL, 44.7961, -117.848, NULL, NULL),
('820200895', 'W12023889', 'W12023889', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Jeffrey', 'L', 'Reimers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1952339434', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('271790052', 'W12023903', 'W12023903', 'IDBOISTD', 'Saint Alphonsus Emergency Physicians Baker City', 'Nancy', 'J', 'Hutnak', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Boise', 'Ada', 'ID', '87814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Boise', 'Ada', 'ID', '87814', '5415236461', '5415231709', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457405359', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('200860055', 'W12023905', 'W12023905', 'IDBOISTD', 'Saint Alphonsus Medical Center Baker City', 'Jesse', '', 'Jarnes', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415231797', '5415231799', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415231797', '5415231799', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215174669', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('271790052', 'W12023908', 'W12023908', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City', 'Eric', '', 'Sandefur', 'DO', 'Orthopedics', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346333721', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('271790052', 'W12023910', 'W12023910', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City', 'Barbara', '', 'Tylka', 'MD', 'General Surgery', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790878171', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('271790052', 'W12023912', 'W12023912', 'IDBOISTD', 'Saint Alphonsus Medical Center Baker City', 'Jon', 'T', 'Weakley', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415231797', '5415231799', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415231797', '5415231799', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255372835', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('271790052', 'W12023914', 'W12023914', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker Clinic', 'Bud', '', 'Zunino', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841253408', 0, 'Y', 0, '2014-07-09', NULL, NULL, 44.7961, -117.846, NULL, NULL),
('271790052', 'W12023916', 'W12023916', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City', 'Autumn', '', 'Swiger-Harrell', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205923208', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('820200895', 'W12023917', 'W12023917', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Robert', 'G', 'Ingram', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083760285', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427074384', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820477852', 'W12023918', 'W12023918', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Scott', 'N', 'Schwendiman', 'MD', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', '2012-12-25', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1538110234', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820200895', 'W12023919', 'W12023919', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Colette', 'D', 'Weber', 'PAC', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1922042464', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12023920', 'W12023920', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Travis', '', 'Smith', 'PA-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St  Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St  Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1376810689', 0, 'Y', 0, '2014-05-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('260553931', 'W12023921', 'W12023921', 'IDBOISTD', '', 'Michael', '', 'Hardesty', 'PAC', 'Family Practice', '', '', NULL, 'B', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-10', '2013-01-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912035999', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
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('870443687', 'W12029598', 'W12029598', 'UT01', 'UUHC Redstone Center', '', '', 'U-U Cardiology Division', 'MD', 'Cardiovascular Disease', 'Cardiology', '', NULL, 'O', '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003104', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7208, -111.543, NULL, NULL),
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('262617385', 'W12024000', 'W12024000', 'TXHOUSTD', 'Fairway Medical Clinic ', 'Murtaza', '', 'Mussaji', 'DO', 'Internal Medicine', '', '', NULL, 'O', '4910 Telephone Rd', 'Houston', 'Harris', 'TX', '77087', '7136413900', '7136413900', '4910 Telephone Rd', 'Houston', 'Harris', 'TX', '77087', '7136413900', '7136413900', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1487705034', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.6909, -95.2988, NULL, NULL),
('830219655', 'W12030770', 'W12030770', 'Sinclair', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', NULL, '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('202489484', 'W12024012', 'W12024012', 'UT01', 'Salt Lake Wound Care', 'Randolph', 'K', 'Cribbs', 'MD', 'Wound Care', '', '', NULL, 'O', '3949 S 700 E Ste 180', 'Murray', 'Salt Lake', 'UT', '84107', '8012882273', '8012880211', '3949 S 700 E Ste 180', 'Murray', 'Salt Lake', 'UT', '84107', '8012882273', '8012880211', 'WUWOUND5', 'WUSTDER5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770675563', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('455628804', 'W12020912', 'W12020912', 'UT01', '', 'Joanne', 'S', 'Hinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-10-31', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1881789212', 0, 'N', 0, '2012-12-12', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12024294', 'W12024294', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', 'R', 'Luna', 'MD', 'Family Practice', '', '', NULL, 'O', '8038 Wurzbach Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2109491568', '2109491570', '8038 Wurzbach Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2109491568', '2109491570', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-12-01', '2012-12-23', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023127255', 0, 'N', 0, '2013-02-01', NULL, NULL, 29.5144, -98.5772, NULL, NULL),
('202630141', 'W12024021', 'W12024021', 'ID02', 'Primary Health Medical Group', 'Michael ', '', 'Graff', 'MD', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', NULL, '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-12-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689603219', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6356, -116.647, NULL, NULL),
('202630141', 'W12024022', 'W12024022', 'ID02', 'Primary Health Medical Group', 'Michael ', '', 'Graff', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-12-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689603219', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12024023', 'W12024023', 'UT01', 'St. Marks Gynecology Oncology Care', 'Patricia', '', 'Bearnson', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '4465 S 900 E Ste 275 & 224', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', '4465 S 900 E Ste 275 & 224', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-11-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013920677', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.6753, -111.866, 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
('450579013', 'W12024025', 'W12024025', 'UT01', 'St. Marks Gynecology Oncology Care', 'Patricia', '', 'Bearnson', 'MD', 'Gynecology', NULL, NULL, NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013920677', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12024027', 'W12024027', 'UT01', 'South Jordan Family Medicine ', 'Erin', '', 'Kimball', 'PA', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790034916', 0, 'N', 0, '2012-11-12', NULL, NULL, 40.5582, -111.939, NULL, NULL),
('770701557', 'W12024028', 'W12024028', 'UT01', 'South Jordan Family Medicine ', 'Erin', '', 'Kimball', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790034916', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12024029', 'W12024029', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'David', '', 'Tranter', 'PA-C', 'General Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932458619', 0, 'N', 0, '2012-10-19', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12024031', 'W12024031', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'David', '', 'Tranter', 'PA-C', 'General Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932458619', 0, 'N', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12024032', 'W12024032', 'UT01', 'Central Utah Clinic PC', 'William', 'E', 'Barager', 'DO', 'Nephrology', '', '', NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8014180810', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8014180810', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962444638', 0, 'N', 0, '2014-06-12', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12024033', 'W12024033', 'UT01', 'Central Utah Clinic PC', 'William', 'E', 'Barager', 'DO', 'Nephrology', '', '', NULL, 'O', '910 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014654813', '8014657207', '910 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014654813', '8014657207', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962444638', 0, 'N', 0, '2013-03-14', NULL, NULL, 40.0445, -111.717, NULL, NULL),
('870281028', 'W12024034', 'W12024034', 'UT01', 'Central Utah Clinic PC', 'William', 'E', 'Barager', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962444638', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('363799822', 'W12024035', 'W12024035', 'ILCHIGSTD', 'Dupage Internist Associate', 'Manvinder', '', 'Singh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6319 S Fairview Ste 101', 'Westmont', 'Dupage', 'IL', '60559', '6308525017', '6308521474', '6319 S Fairview Ste 101', 'Westmont', 'Dupage', 'IL', '60559', '6308525017', '6308521474', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, 'Edward Hospital', '', '', 'HCFA|UB|', '1992987697', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.772, -87.9892, NULL, NULL),
('010885716', 'W12024037', 'W12024037', 'UTMH1', 'Riley Individual, Family and Marriage Counseling', 'William', 'R', 'Kastner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMD', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982906616', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('010885716', 'W12024038', 'W12024038', 'UTMH1', 'Riley Individual, Family and Marriage Counseling', 'William', 'R', 'Kastner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'UTMD', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982906616', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12024040', 'W12024040', 'UT01', 'Standard Optical', 'Rodney', 'N', 'Gilliland', 'OD', 'Optometry', '', '', NULL, 'O', '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '0000000000', '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801800016', 0, 'N', 0, '2013-03-04', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W12024039', 'W12024039', 'UT01', 'Standard Optical', 'Rodney', 'N', 'Gilliland', 'OD', 'Optometry', '', '', NULL, 'O', '3754 W 5400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019649911', '0000000000', '3754 W 5400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019649911', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801800016', 0, 'N', 0, '2013-03-04', NULL, NULL, 40.6532, -111.98, NULL, NULL),
('460752191', 'W12024042', 'W12024042', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'Christopher', 'J', 'Morgan', 'NP', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1201 S Main St Ste 1', 'Logan', 'Cache', 'UT', '84321', '4357878504', '4357878509', '1201 S Main St Ste 1', 'Logan', 'Cache', 'UT', '84321', '4357878504', '4357878509', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801144480', 0, 'Y', 0, '2014-02-21', NULL, NULL, 41.7102, -111.835, NULL, NULL),
('460752191', 'W12024043', 'W12024043', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'Christopher', 'J', 'Morgan', 'NP', 'Urgent Care', 'Family Practice', '', NULL, 'B', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4357878504', '4357878509', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4357878504', '4357878509', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801144480', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('751836764', 'W12024044', 'W12024044', 'TXDALSTD', 'Shu Ying Turng', 'Shu Ying', '', 'Turng', 'MD', 'Pediatrics', '', '', NULL, 'O', '315 S Cockrell Hill Rd Ste 206', 'Duncanville', 'Dallas', 'TX', '75116', '9722961412', '9722961440', '315 S Cockrell Hill Rd Ste 206', 'Duncanville', 'Dallas', 'TX', '75116', '9722961412', '9722961440', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770679961', 0, 'N', 1, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('202785622', 'W12024045', 'W12024045', 'ILCHIGSTD', 'Anthony Martino MD', 'Anthony', 'J', 'Martino', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1419 W Lake St Ste D', 'Melrose Park', 'Cook', 'IL', '60160', '7083458255', '7083450534', '1419 W Lake St Ste D', 'Melrose Park', 'Cook', 'IL', '60160', '7083458255', '7083450534', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1457319337', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.8921, -87.8506, NULL, NULL),
('203193817', 'W12026059', 'W12026059', 'ILCHIGSTD', 'Broadway Medical Group', '', '', 'Broadway Medical Group', '', 'Family Practice', '', '', NULL, 'O', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306952858', 0, 'Y', 0, '2013-09-27', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('262478258', 'W12024047', 'W12024047', 'TXDALSTD', 'Carrollton Medical Center', 'Hardeep', 'S', 'Rai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1913 Walnut Plaza', 'Carrollton', 'Dallas', 'TX', '75006', '9724165902', '9724182214', '1913 Walnut Plaza', 'Carrollton', 'Dallas', 'TX', '75006', '9724165902', '9724182214', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043324098', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9561, -96.8891, NULL, NULL),
('362844357', 'W12024048', 'W12024048', 'ILCHIGSTD', 'Minal Giri MD', 'Minal', '', 'Giri', 'MD', 'Pediatrics', '', '', NULL, 'O', '8319 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7084509700', '7084509978', '8319 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7084509700', '7084509978', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1164471124', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.9085, -87.8264, NULL, NULL),
('208407632', 'W12024051', 'W12024051', 'WY01', 'Big Horn Basin Mental Health Group', 'Gibson', '', 'Condie', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1054 Vali Rd', 'Powell', 'Park', 'WY', '82435', '3072540000', NULL, '1054 Vali Rd', 'Powell', 'Park', 'WY', '82435', '3072540000', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366658601', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('208407632', 'W12024052', 'W12024052', 'WYT1', 'Big Horn Basin Mental Health Group', 'Gibson', '', 'Condie', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1054 Vali Rd', 'Powell', 'Park', 'WY', '82435', '3072540000', NULL, '1054 Vali Rd', 'Powell', 'Park', 'WY', '82435', '3072540000', '          ', 'phd', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366658601', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'W12024054', 'W12024054', 'UT01', 'Mountain View Anesthesia', 'Shane', 'Verl', 'Theobald', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322648', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322648', '8014322668', '', '', '', '0.00', '23.00', '0.00', 3, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174783492', 0, 'N', 0, '2013-01-04', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12024053', 'W12024053', 'UT01', 'Pinnacle Anesthesia Associates', 'Pauline', '', 'Frome', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', '', '', '', '0.00', '20.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336268655', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('454027358', 'W12024055', 'W12024055', 'UTMH1', 'Psychiatric & Behavioral Solutions', 'Tammy', '', 'Steans', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1522 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014671200', '8014671210', '1522 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014671200', '8014671210', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952600819', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('364452461', 'W12024056', 'W12024056', 'ILCHIGSTD', 'Atkinson Clinic ', 'Sergei', '', 'Shevlyagin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '100 N Atkinson Rd', 'Grayslake', 'Lake', 'IL', '60030', '8475489777', '8475489797', '100 N Atkinson Rd', 'Grayslake', 'Lake', 'IL', '60030', '8475489777', '8475489797', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235123589', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.3447, -88.0241, NULL, NULL),
('263720511', 'W12029173', 'W12029173', 'UT01', 'John B Fassio, MD', 'John', 'B', 'Fassio', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1548 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', '1548 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-12-26', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1689671638', 0, 'N', 0, '2013-07-11', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('273507603', 'W12024057', 'W12024057', 'UT01', 'K2 Foot and Ankle ', 'Stanton', 'M', 'Smith', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013145400', '8013145409', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013145400', '8013145409', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043283856', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12024058', 'W12024058', 'UT01', 'Granger Medical Clinic', 'Valerie', '', 'Oquendo', 'NP', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912270497', 0, 'N', 0, '2012-12-11', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12024059', 'W12024059', 'UT01', 'Granger Medical Clinic', 'Valerie', '', 'Oquendo', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912270497', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('364409884', 'W12024067', 'W12024067', 'ILCHIGSTD', 'Donte Medical', 'Ronald', '', 'Sam', 'DO', 'Internal Medicine', '', '', NULL, 'O', '11540 W 183rd Unit NE', 'Orland Park', 'Cook', 'IL', '60467', '7084227758', '7084228154', '11540 W 183rd Unit NE', 'Orland Park', 'Cook', 'IL', '60467', '7084227758', '7084228154', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073537643', 0, 'N', 0, '2013-10-03', NULL, NULL, 41.557, -87.8975, NULL, NULL),
('364409884', 'W12024066', 'W12024066', 'ILCHIGSTD', 'Donte Medical', 'Ronald', '', 'Sam', 'DO', 'Internal Medicine', '', '', NULL, 'O', '4400 W 95th St Ste 106', 'Oak Lawn', 'Cook', 'IL', '60453', '7084227758', '7084228154', '4400 W 95th St Ste 106', 'Oak Lawn', 'Cook', 'IL', '60453', '7084227758', '7084228154', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073537643', 0, 'N', 0, '2013-10-03', NULL, NULL, 41.7203, -87.7311, NULL, NULL),
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('364122551', 'W12025989', 'W12025989', 'ILCHIGSTD', 'West Suburban Eye Associates', '', '', 'West Suburban Eye Associates', '', 'Ophthalmology', '', '', NULL, 'O', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255354601', 0, 'Y', 0, '2012-12-05', NULL, NULL, 41.8919, -87.775, NULL, NULL),
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('751365258', 'W12024083', 'W12024083', 'TXDALSTD', 'The Medical & Surgical Clinic of Irvin', 'Renuka', '', 'Basavaraju', 'MD', 'Rheumatology', 'Allergy and Immunology', '', NULL, 'O', '2021 N MacArthur Blvd Ste 325', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2021 N MacArthur Blvd Ste 325', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982720199', 0, 'N', 1, '2012-12-27', NULL, NULL, 32.8355, -96.9602, NULL, NULL),
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('751365258', 'W12024093', 'W12024093', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', '', '', 'The Medical & Surgical Clinic of Irving', '', 'Clinics', '', '', NULL, 'O', '6750 N MacArthur Blvd Ste 250 and 255', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '6750 N MacArthur Blvd Ste 250 and 255', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932273141', 0, 'N', 1, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
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('751365258', 'W12024101', 'W12024101', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Gerald', '', 'Edelman', 'MD', 'Oncology', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 350', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2021 N MacArthur Blvd Ste 350', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831131739', 0, 'N', 1, '2012-10-22', NULL, NULL, 32.8355, -96.9602, NULL, NULL),
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('751365258', 'W12024105', 'W12024105', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Allan', 'J', 'Furman', 'MD', 'Family Practice', '', '', NULL, 'O', '6750 N MacArthur Blvd Ste 250', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '6750 N MacArthur Ste 250', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689748873', 0, 'N', 1, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
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('870371964', 'W12024108', 'W12024108', 'UT01', 'Cache Valley Ear Nose and Throat', 'James', 'W', 'Blotter', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', NULL, 'O', '451 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352570822', '0000000000', '451 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352570822', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-18', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962499673', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.7188, -112.174, NULL, NULL),
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('870281028', 'W12024110', 'W12024110', 'UT01', 'Central Utah Clinic PC', 'Lawrence', 'J', 'Chase', 'MD', 'Plastic Surgery', 'Hand Surgery', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-12-01', '2013-03-13', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1538232863', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'W12024112', 'W12024112', 'UT01', 'Granger Medical Clinic', 'Kathryn', '', 'Schneider', 'MD', 'Family Practice', '', '', NULL, 'O', '3725 W 400 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 400 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1457589640', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12024113', 'W12024113', 'UT01', 'Granger Medical Clinic', 'Kathryn', '', 'Schneider', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1457589640', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870371964', 'W12024114', 'W12024114', 'UT01', 'Cache Valley Ear Nose and Throat', 'Jeffrey', 'G', 'Bennion', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', NULL, 'O', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '2088520137', '0000000000', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '2088520137', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-18', NULL, 0, 0, 0, 'Franklin County Medical Center ', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396731469', 0, 'N', 0, '2012-10-23', NULL, NULL, 42.0971, -111.874, NULL, NULL),
('870371964', 'W12024115', 'W12024115', 'UT01', 'Cache Valley Ear Nose and Throat', 'Jeffrey', 'G', 'Bennion', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', NULL, 'O', '164 S 5th', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471630', '0000000000', '164 S 5th', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471630', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-18', NULL, 0, 0, 0, 'Franklin County Medical Center ', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396731469', 0, 'N', 0, '2012-10-23', NULL, NULL, 42.3165, -111.301, NULL, NULL),
('204043287', 'W12024116', 'W12024116', 'NM01', 'ABQ Health Partners Radiology and Imaging', '', '', 'ABQ Health Partners Radiology and Imaging', '', 'Radiology', 'Imaging Center', '', NULL, 'O', '5150 Journal Ctr Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052321500', '5052321584', '5150 Journal Ctr Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052321500', '5052321584', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245494723', 0, 'N', 0, '2013-11-04', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12024117', 'W12024117', 'NM01', 'ABQ Health Partners Radiology and Imaging', '', '', 'ABQ Health Partners Radiology and Imaging', '', 'Radiology', 'Imaging Center', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052321500', '5052321584', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052321500', '5052321584', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245494723', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
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('263553949', 'W12024220', 'W12024220', 'TXDALSTD', 'Total Family Footcare div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '2625 Matlock Rd Ste 103', 'Arlington', 'Tarrant', 'TX', '76015', '8174668514', '8174668473', '2625 Matlock Rd Ste 103', 'Arlington', 'Tarrant', 'TX', '76015', '8174668514', '8174668473', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 32.7014, -97.1147, NULL, NULL),
('263553949', 'W12024221', 'W12024221', 'TXDALSTD', 'Total Family Footcare div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '3020 Race St', 'Fort Worth', 'Tarrant', 'TX', '76111', '8178389424', '8178389425', '3020 Race St', 'Fort Worth', 'Tarrant', 'TX', '76111', '8178389424', '8178389425', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 32.7731, -97.3039, NULL, NULL),
('263553949', 'W12024222', 'W12024222', 'TXDALSTD', 'Wylie Foot and Ankle Specialist div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '600 Cooper Dr Ste 100', 'Wylie', 'Collin', 'TX', '75098', '9722889034', '9722898025', '600 Cooper Dr Ste 100', 'Wylie', 'Collin', 'TX', '75098', '9722889034', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 33.0092, -96.5443, NULL, NULL),
('263553949', 'W12024223', 'W12024223', 'TXDALSTD', 'Gene G Reister DPM div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '2001 N Collins Blvd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9726905374', '9726906446', '2001 N Collins Blvd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9726905374', '9726906446', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 32.9755, -96.7237, NULL, NULL),
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('263553949', 'W12024227', 'W12024227', 'TXDALSTD', 'Lewis Podiatry Group PA div of PMPT', 'Brandon', 'J', 'Lewis', 'DPM', 'Podiatry', '', '', NULL, 'O', '504 N Carrier Pkwy', 'Grand Prairie', 'Dallas', 'TX', '75050', '9722637042', '9722637046', '504 N Carrier Pkwy', 'Grand Prairie', 'Dallas', 'TX', '75050', '9722637042', '9722637046', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487654489', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.7457, -97.0168, NULL, NULL),
('263553949', 'W12024229', 'W12024229', 'TXDALSTD', 'Southwest Podiatry div of PMPT', 'Catherine', '', 'Casteel', 'DPM', 'Podiatry', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 300', 'Irving', 'Dallas', 'TX', '75061', '9722540680', '9722540683', '2001 N MacArthur Blvd Ste 300', 'Irving', 'Dallas', 'TX', '75061', '9722540680', '9722540683', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831419423', 0, 'N', 0, '2013-05-21', NULL, NULL, 32.8354, -96.9606, NULL, NULL),
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('263553949', 'W12024231', 'W12024231', 'TXDALSTD', 'Southwest Podiatry div of PMPT', 'Catherine', '', 'Casteel', 'DPM', 'Podiatry', '', '', NULL, 'O', '701 Tuscan Dr Ste 220', 'Irving', 'Dallas', 'TX', '75039', '9724329191', '9724320538', '701 Tuscan Dr Ste 220', 'Irving', 'Dallas', 'TX', '75039', '9724329191', '9724320538', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831419423', 0, 'N', 0, '2013-05-21', NULL, NULL, 32.8987, -96.9572, NULL, NULL),
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('263553949', 'W12024259', 'W12024259', 'TXDALSTD', 'Complete Foot and Ankle div of PMPT', 'Matthew', '', 'Babich', 'DPM', 'Podiatry', '', '', NULL, 'O', '1151 N Buckner Blvd Ste 304 Bldg 1', 'Dallas', 'Dallas', 'TX', '75218', '2146600777', '8776311566', '1151 N Buckner Blvd Ste 304 Bldg 1', 'Dallas', 'Dallas', 'TX', '75218', '2146600777', '8776311566', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659436632', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.8347, -96.7036, NULL, NULL),
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('263553949', 'W12024275', 'W12024275', 'TXDALSTD', 'Southwest Podiatry div of PMPT', 'Samuel', '', 'Nava', 'DPM', 'Podiatry', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 300', 'Irving', 'Dallas', 'TX', '75061', '9722540680', '9722540683', '2001 N MacArthur Blvd Ste 300', 'Irving', 'Dallas', 'TX', '75061', '9722540680', '9722540683', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1033199963', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.8349, -96.9592, NULL, NULL),
('263553949', 'W12024276', 'W12024276', 'TXDALSTD', 'Southwest Podiatry div of PMPT', 'Samuel', '', 'Nava', 'DPM', 'Podiatry', '', '', NULL, 'O', '4333 N Josey Ln Ste 102', 'Carrollton', 'Denton', 'TX', '75010', '9723940825', '9723940853', '4333 N Josey Ln Ste 102', 'Carrollton', 'Denton', 'TX', '75010', '9723940825', '9723940853', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1033199963', 0, 'N', 0, '2013-02-21', NULL, NULL, 33.0278, -96.8847, NULL, NULL),
('263553949', 'W12024277', 'W12024277', 'TXDALSTD', 'Southwest Podiatry div of PMPT', 'Samuel', '', 'Nava', 'DPM', 'Podiatry', '', '', NULL, 'O', '701 Tuscan Dr Ste 220', 'Irving', 'Dallas', 'TX', '75039', '9724329191', '9724320538', '701 Tuscan Dr Ste 220', 'Irving', 'Dallas', 'TX', '75039', '9724329191', '9724320538', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1033199963', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.8979, -96.9587, NULL, NULL),
('263553949', 'W12024279', 'W12024279', 'TXDALSTD', 'Total Family Footcare div of PMPT', 'Terry', '', 'Wright', 'DPM', 'Podiatry', '', '', NULL, 'O', '2625 Matlock Rd Ste 103', 'Arlington', 'Tarrant', 'TX', '76015', '8174668514', '8174668473', '2625 Matlock Rd Ste 103', 'Arlington', 'Tarrant', 'TX', '76015', '8174668514', '8174668473', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922068220', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.7014, -97.1147, NULL, NULL),
('263553949', 'W12024280', 'W12024280', 'TXDALSTD', 'Total Family Footcare div of PMPT', 'Terry', '', 'Wright', 'DPM', 'Podiatry', '', '', NULL, 'O', '3020 Race St', 'Fort Worth', 'Tarrant', 'TX', '76111', '8178389424', '8178389425', '3020 Race St', 'Fort Worth', 'Tarrant', 'TX', '76111', '8178389424', '8178389425', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922068220', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.7731, -97.3039, NULL, NULL),
('263553949', 'W12024282', 'W12024282', 'TXDALSTD', 'Victor A Schechter DPM div of PMPT', 'Victor', 'A', 'Schechter', 'DPM', 'Podiatry', '', '', NULL, 'O', '1105 Central Expwy N Ste 2300', 'Allen', 'Collin', 'TX', '75013', '9723969101', '9723969105', '1105 Central Expwy N Ste 2300', 'Allen', 'Collin', 'TX', '75013', '9723969101', '9723969105', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891747994', 0, 'N', 0, '2013-02-21', NULL, NULL, 33.1161, -96.6711, NULL, NULL),
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('263553949', 'W12024286', 'W12024286', 'TXDALSTD', 'Wylie Foot and Ankle Specialist div of PMPT', 'William', '', 'Arrington', 'DPM', 'Podiatry', '', '', NULL, 'O', '600 Cooper Dr Ste 100', 'Wylie', 'Collin', 'TX', '75098', '9722889034', '9722898025', '600 Cooper Dr Ste 100', 'Wylie', 'Collin', 'TX', '75098', '9722889034', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134213812', 0, 'N', 0, '2014-06-17', NULL, NULL, 33.0099, -96.5452, NULL, NULL),
('263553949', 'W12024285', 'W12024285', 'TXDALSTD', 'Beltline Foot and Ankle Specialist div of PMPT', 'William', '', 'Arrington', 'DPM', 'Podiatry', '', '', NULL, 'O', '763 E US Hwy 80 Ste 100', 'Forney', 'Kaufman', 'TX', '75126', '9722887441', '9722898025', '763 E US Hwy 80 Ste 100', 'Forney', 'Kaufman', 'TX', '75126', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134213812', 0, 'N', 0, '2014-06-17', NULL, NULL, 32.7511, -96.4662, NULL, NULL),
('870639098', 'W12024287', 'W12024287', 'UT01', 'After Hours Urgent Care', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 15161', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', 'PO Box 15161', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12024297', 'W12024297', 'UTMH1', 'The Counseling Center', 'Paul', 'J', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528114667', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12024298', 'W12024298', 'UTMH1', 'The Counseling Center', 'Paul', 'J', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528114667', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12024299', 'W12024299', 'UT01', 'St. Marks Primary Care at West Valley', 'Randall', '', 'Archibald', 'PA', 'Family Practice', '', '', NULL, 'O', '3540 S 4000 W Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019690200', '8019690393', '3540 S 4000 W Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019690200', '8019690393', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396752119', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.6955, -111.987, NULL, NULL),
('770701557', 'W12024301', 'W12024301', 'UT01', 'MountainStar Medical Group-St. Marks Hospital', 'Randall', '', 'Archibald', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396752119', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12024302', 'W12024302', 'UT01', 'Lone Peak Family Care', 'Teri', '', 'Lund', 'RD', 'Dietician', '', '', NULL, 'O', '74 Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', '74 Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346521986', 0, 'Y', 0, '2013-05-07', NULL, NULL, 40.537, -111.889, NULL, NULL),
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('760586609', 'W12024325', 'W12024325', 'TXHOUSTD', 'Schaeffer, Luis', 'Luis', 'G', 'Schaeffer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 328', 'Cleveland', 'Liberty', 'TX', '77328', '2815930485', '2814320563', 'PO Box 328', 'Cleveland', 'Liberty', 'TX', '77328', '2815930485', '2814320563', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376586230', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12024380', 'W12024380', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Heather', '', 'Johnson', 'NP', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-25', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518214154', 0, 'N', 0, '2013-06-10', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'W12024381', 'W12024381', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Heather', '', 'Johnson', 'NP', 'Pediatrics', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '0000000000', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-25', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518214154', 0, 'Y', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12024435', 'W12024435', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', '1512 12th Ave Rd   ', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134296106', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('742129954', 'TEMP00028', 'TEMP00028', 'TEMPSTD', 'Cypress Fairbanks Medical Center', NULL, NULL, 'Cypress Fairbanks Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '10655 Steepletop Dr', 'Houston', 'Harris', 'TX', '77065', '2818904285', NULL, 'P.O. Box 849762', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', '2012-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477583334', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('261512163', 'TEMP00029', 'TEMP00029', 'TEMPSTD', 'Houston Northwest Medical Center', NULL, NULL, 'Houston Northwest Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '710 FM 1960 West', 'Houston', 'Harris', 'TX', '77090', '2814401000', NULL, 'P.O. Box 849762', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', '2012-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1831112895', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('262792136', 'W12024432', 'W12024432', 'ID02', 'Advanced Therapy Care', 'Cebu', '', 'Maybury', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E  ', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', '2014-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184984932', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('0', 'TEMP00035', 'TEMP00035', 'TEMPSTD', 'Baptist Hospitals of Southeast Texas - Beaumont', NULL, NULL, 'Baptist Hospitals of Southeast Texas - Beaumont', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '3080 College Street', 'Beaumont', 'Jefferson', 'TX', '77701', '4092125000', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1093744187', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00036', 'TEMP00036', 'TEMPSTD', 'Baptist Hospitals of Southeast Texas - Orange Campus', NULL, NULL, 'Baptist Hospitals of Southeast Texas - Orange Campus', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '608 Strickland Drive', 'Orange', 'Orange', 'TX', '77630', '4098839361', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1295764330', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00037', 'TEMP00037', 'TEMPSTD', 'Baptist Convenient Care Clinic', NULL, NULL, 'Baptist Convenient Care Clinic', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '3025 Dowlen Rd', 'Beaumont', 'Jefferson', 'TX', '77706', '4093478277', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('751037591', 'TEMP00038', 'TEMP00038', 'TEMPSTD', 'Baylor Medical Center at McKinney', NULL, NULL, 'Baylor Medical Center at McKinney', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '5252 W University Drive', 'McKinney', 'Collin', 'TX', '75071', '4697641000', NULL, 'P.O. Box 847051', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1124305065', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752865177', 'TEMP00039', 'TEMP00039', 'TEMPSTD', 'Frisco Medical Center', NULL, NULL, 'Frisco Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '5601 Warren Pkwy', 'Frisco', 'Denton', 'TX', '75034', '2146182000', NULL, '5601 Warren Parkway', 'Frisco', NULL, 'TX', '75034', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1922002674', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752658178', 'TEMP00040', 'TEMP00040', 'TEMPSTD', 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, 'Baylor Surgical Hospital at Fort Worth', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '750 12th Avenue', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173345050', NULL, 'P.O. Box 849050', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1871599183', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('542086863', 'TEMP00041', 'TEMP00041', 'TEMPSTD', 'Irving-Coppell Surgical Hospital', NULL, NULL, 'Irving-Coppell Surgical Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '400 W I-635', 'Irving', 'Dallas', 'TX', '75063', '9728684000', NULL, 'P.O. Box 841158', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1669569984', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('201508140', 'TEMP00043', 'TEMP00043', 'TEMPSTD', 'North Central Surgical Center', NULL, NULL, 'North Central Surgical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '9301 N Central Expwy Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2142652810', NULL, 'P.O. Box 840494', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1548236524', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('752813815', 'TEMP00047', 'TEMP00047', 'TEMPSTD', 'Baylor SurgiCare', NULL, NULL, 'Baylor SurgiCare', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '3920 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148202581', NULL, '3920 Worth St.', 'Dallas', NULL, 'TX', '75246', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1811995913', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('752854711', 'TEMP00050', 'TEMP00050', 'TEMPSTD', 'Baylor Surgicare at Grapevine', NULL, NULL, 'Baylor Surgicare at Grapevine', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2040 SW Hwy 114', 'Grapevine', 'Tarrant', 'TX', '76051', '8174104300', NULL, 'P.O. Box 849145', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1295702942', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('752764855', 'TEMP00054', 'TEMP00054', 'TEMPSTD', 'Baylor Surgicare at Garland', NULL, NULL, 'Baylor Surgicare at Garland', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '530 Clara Barton Blvd Ste 100', 'Garland', 'Dallas', 'TX', '75042', '9724942400', NULL, '530 Clara Barton, Suite 100', 'Garland', NULL, 'TX', '75042', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1396742029', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('200334166', 'TEMP00055', 'TEMP00055', 'TEMPSTD', 'Baylor Surgicare at Heath', NULL, NULL, 'Baylor Surgicare at Heath', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '6435 S FM 549 Ste 101', 'Heath', 'Rockwall', 'TX', '75032', '9727229003', NULL, '6435 S FM 549, Suite 101', 'Heath', NULL, 'TX', '75032', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1891788584', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752748040', 'TEMP00056', 'TEMP00056', 'TEMPSTD', 'Baylor Surgicare at Arlington', NULL, NULL, 'Baylor Surgicare at Arlington', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2400 Matlock', 'Arlington', 'Tarrant', 'TX', '76015', '8178606800', NULL, 'P.O. Box 849047', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752862263', 'TEMP00057', 'TEMP00057', 'TEMPSTD', 'Surgery Center of Lewisville', NULL, NULL, 'Surgery Center of Lewisville', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1854 Lake Pointe Drive', 'Lewisville', 'Denton', 'TX', '75057', '9723151401', NULL, 'P.O. Box 841145', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1326042300', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752900902', 'TEMP00058', 'TEMP00058', 'TEMPSTD', 'Baylor Surgicare at Valley View', NULL, NULL, 'Baylor Surgicare at Valley View', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '5744 LBJ Freeway Ste 200', 'Dallas', 'Dallas', 'TX', '75240', '9724904333', NULL, 'P.O. Box 849160', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1750347472', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('205506447', 'TEMP00059', 'TEMP00059', 'TEMPSTD', 'Rockwall Surgery Center', NULL, NULL, 'Rockwall Surgery Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '825 W Yellowjacket Ln', 'Rockwall', 'Rockwall', 'TX', '75087', '9727726166', NULL, '825 W. Yellowjacket Ln.', 'Rockwall', NULL, 'TX', '75087', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1073694550', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('260308454', 'TEMP00060', 'TEMP00060', 'TEMPSTD', 'Baylor Surgicare at Plano', NULL, NULL, 'Baylor Surgicare at Plano', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1701 Ohio Drive', 'Plano', 'Collin', 'TX', '75093', '2142913000', NULL, 'P.O. Box 841191', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1992721591', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('263896477', 'TEMP00061', 'TEMP00061', 'TEMPSTD', 'Baylor Surgicare at Granbury, LLC ', NULL, NULL, 'Baylor Surgicare at Granbury, LLC ', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1717 Paluxy Rd', 'Granbury', 'Hood', 'TX', '76048', '8175798863', NULL, '1717 Paluxy Road', 'Granbury', NULL, 'TX', '76048', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1386882587', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('208303422', 'TEMP00062', 'TEMP00062', 'TEMPSTD', 'Baylor Surgicare at Fort Worth I', NULL, NULL, 'Baylor Surgicare at Fort Worth I', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '975 Haskell Street', 'Fort Worth', 'Tarrant', 'TX', '76107', '8175700200', NULL, '975 Haskell Street', 'Fort Worth', NULL, 'TX', '76107', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1578530226', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('208303422', 'TEMP00063', 'TEMP00063', 'TEMPSTD', 'Baylor Surgicare at Fort Worth II', NULL, NULL, 'Baylor Surgicare at Fort Worth II', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2001 Cooper Street', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178771291', NULL, '975 Haskell Street', 'Fort Worth', NULL, 'TX', '76107', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1992901847', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('752592508', 'TEMP00064', 'TEMP00064', 'TEMPSTD', 'North Texas Surgery Center', NULL, NULL, 'North Texas Surgery Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7992 West Virginia Drive', 'Dallas', 'Dallas', 'TX', '75237', '9722832400', NULL, 'P.O. Box 849049', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1609870336', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('271835675', 'TEMP00065', 'TEMP00065', 'TEMPSTD', 'Baylor Surgicare at Mansfield', NULL, NULL, 'Baylor Surgicare at Mansfield', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '280 Regency Pkwy', 'Mansfield', 'Tarrant', 'TX', '76063', '8174532744', NULL, '280 Regency Parkway', 'Mansfield', NULL, 'TX', '76063', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1790945145', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('30380493', 'TEMP00066', 'TEMP00066', 'TEMPSTD', 'Baylor Surgicare at Carrollton', NULL, NULL, 'Baylor Surgicare at Carrollton', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '4780 North Josey Lane', 'Carrollton', 'Denton', 'TX', '75010', '9723950440', NULL, 'P.O. Box 844511', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1780683490', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('273583837', 'TEMP00067', 'TEMP00067', 'TEMPSTD', 'Baylor Surgicare at Duncanville', NULL, NULL, 'Baylor Surgicare at Duncanville', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1018 East Wheatland Rd ', 'Duncanville', 'Dallas', 'TX', '75116', '9722966912', NULL, '1018 East Wheatland Rd. ', 'Duncanville', NULL, 'TX', '75116', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1871803999', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('273635726', 'TEMP00068', 'TEMP00068', 'TEMPSTD', 'Lone Star Endoscopy', NULL, NULL, 'Lone Star Endoscopy', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '180 Bear Creek Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8173376371', NULL, 'PO Box 277417', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1336459353', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('273578014', 'TEMP00069', 'TEMP00069', 'TEMPSTD', 'Tuscan Surgery Center at Las Colinas', NULL, NULL, 'Tuscan Surgery Center at Las Colinas', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '701 Tuscan Ste 100', 'Irving', 'Dallas', 'TX', '75039', '2144421900', NULL, '701 Tuscan Ste. 100', 'Irving', NULL, 'TX', '75039', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1013227248', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('274202856', 'TEMP00070', 'TEMP00070', 'TEMPSTD', 'Baylor Surgicare at Ennis', NULL, NULL, 'Baylor Surgicare at Ennis', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2200 Physicians Blvd Ste A', 'Ennis', 'Ellis', 'TX', '75119', '9728755538', NULL, '2200 Physicians Blvd, Ste. A', 'Ennis', NULL, 'TX', '75119', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1992008965', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('274282604', 'TEMP00071', 'TEMP00071', 'TEMPSTD', 'Baylor Surgicare at Plano Parkway', NULL, NULL, 'Baylor Surgicare at Plano Parkway', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '4031 Plano Pkwy Ste 100', 'Plano', 'Collin', 'TX', '75093', '9729851072', NULL, '4031 Plano Parkway, Ste 100 ', 'Plano', NULL, 'TX', '75093', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1609179415', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('562357079', 'TEMP00072', 'TEMP00072', 'TEMPSTD', 'Park Cities Surgery Center', NULL, NULL, 'Park Cities Surgery Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '6901 Snider Plaza Ste 300', 'University Park', 'Dallas', 'TX', '75205', '2147066901', NULL, '4031 Plano Parkway, Suite 100', 'Plano', NULL, 'TX', '75093', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1184689010', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00073', 'TEMP00073', 'TEMPSTD', 'Edward Hospital', NULL, NULL, 'Edward Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '801 South Washington Street', 'Naperville', 'Dupage', 'IL', '60540', '6305273000', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1427069632', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00074', 'TEMP00074', 'TEMPSTD', 'Edward Immediate Care and Edward Healthcare Center', NULL, NULL, 'Edward Immediate Care and Edward Healthcare Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '6701 US Hwy 34 ', 'Oswego', 'Kendall', 'IL', '60543', '6306464200', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', 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
('0', 'TEMP00075', 'TEMP00075', 'TEMPSTD', 'Edward Immediate Care', NULL, NULL, 'Edward Immediate Care', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '130 N Weber Rd', 'Bolingbrook', 'Will', 'IL', '60440', '6306465770', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00076', 'TEMP00076', 'TEMPSTD', 'Ingalls Memorial Hospital ', NULL, NULL, 'Ingalls Memorial Hospital ', 'Group', 'Hospital', NULL, NULL, NULL, 'O', 'One Ingalls Drive', 'Harvey', 'Cook', 'IL', '60426', '7083332300', NULL, 'P.O. Box 75608', 'Chicago', NULL, 'IL', '60675', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00077', 'TEMP00077', 'TEMPSTD', 'Ingalls Flossmoor Family Care Center ', NULL, NULL, 'Ingalls Flossmoor Family Care Center ', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '19550 Governors Hwy', 'Flossmoor', 'Cook', 'IL', '60422', '7087998400', NULL, 'P.O. Box 75608', 'Chicago', NULL, 'IL', '60675', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00078', 'TEMP00078', 'TEMPSTD', 'Ingalls Tinley Park Family Care Center', NULL, NULL, 'Ingalls Tinley Park Family Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '6701 West 159th Street', 'Tinley Park', 'Cook', 'IL', '60477', '7084293300', NULL, 'P.O. Box 75608', 'Chicago', NULL, 'IL', '60675', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00079', 'TEMP00079', 'TEMPSTD', 'Ingalls Calumet City Family Care Center', NULL, NULL, 'Ingalls Calumet City Family Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '1600 Torrence Avenue', 'Calumet City', 'Cook', 'IL', '60409', '7087301300', NULL, 'P.O. Box 75608', 'Chicago', NULL, 'IL', '60675', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00080', 'TEMP00080', 'TEMPSTD', 'Ingalls Matteson Family Care Center', NULL, NULL, 'Ingalls Matteson Family Care Center', 'Group', 'Family Care', NULL, NULL, NULL, 'O', '4647 W Lincoln Hwy ', 'Matteson', 'Cook', 'IL', '60443', '7087477720', NULL, 'P.O. Box 75608', 'Chicago', NULL, 'IL', '60675', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362170866', 'TEMP00081', 'TEMP00081', 'TEMPSTD', 'Ingalls Center For Outpatient Rehabilitation', NULL, NULL, 'Ingalls Center For Outpatient Rehabilitation', 'Group', 'PT', NULL, NULL, NULL, 'O', '1551 Huntington Drive ', 'Calumet City', 'Cook', 'IL', '60409', '7088625500', NULL, 'One Ingalls Drive ', 'Harvey', NULL, 'IL', '60426', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598756686', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00082', 'TEMP00082', 'TEMPSTD', 'Little Company of Mary', NULL, NULL, 'Little Company of Mary', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '2800 West 95th Street', 'Evergreen Park', 'Cook', 'IL', '60805', '7084226200', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1598768780', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'TEMP00083', 'TEMP00083', 'TEMPSTD', 'Northwest Community Hospital', NULL, NULL, 'Northwest Community Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1770531600', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363540436', 'TEMP00084', 'TEMP00084', 'TEMPSTD', 'Northwest Community Day Surgery Center', NULL, NULL, 'Northwest Community Day Surgery Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '675 W Kirchoff', 'Arlington Heights', 'Cook', 'IL', '60005', '8476187000', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'TEMP00085', 'TEMP00085', 'TEMPSTD', 'NCH Immediate Care Center', NULL, NULL, 'NCH Immediate Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '15 South McHenry Road', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474596100', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'TEMP00086', 'TEMP00086', 'TEMPSTD', 'NCH Immediate Care Center', NULL, NULL, 'NCH Immediate Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '1201 South Rand Road', 'Lake Zurich', 'Lake', 'IL', '60047', '8475408088', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'TEMP00087', 'TEMP00087', 'TEMPSTD', 'NCH Immediate Care Center', NULL, NULL, 'NCH Immediate Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '199 West Rand Road', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185400', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'TEMP00088', 'TEMP00088', 'TEMPSTD', 'NCH Immediate Care Center', NULL, NULL, 'NCH Immediate Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '519 South Roselle Road', 'Schaumburg', 'Cook', 'IL', '60193', '8479850600', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00089', 'TEMP00089', 'TEMPSTD', 'Northwestern Ambulatory Surgical Center', NULL, NULL, 'Northwestern Ambulatory Surgical Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '710 North Fairbanks 6th Fl', 'Chicago', 'Cook', 'IL', '60611', '3129265450', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00090', 'TEMP00090', 'TEMPSTD', 'Northwestern Lake Forest Hospital', NULL, NULL, 'Northwestern Lake Forest Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '660 North Westmoreland Road', 'Lake Forest', 'Lake', 'IL', '60045', '8472345600', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1124025176', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00091', 'TEMP00091', 'TEMPSTD', 'Northwestern Memorial Hospital', NULL, NULL, 'Northwestern Memorial Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '251 East Huron Street', 'Chicago', 'Cook', 'IL', '60611', '3129262000', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1497859649', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('0', 'TEMP00092', 'TEMP00092', 'TEMPSTD', 'Convenient Care Clinic', NULL, NULL, 'Convenient Care Clinic', 'Group', 'Urgent Cares', NULL, NULL, NULL, 'O', '150 E Huron St Ste 1100', 'Chicago', 'Cook', 'IL', '60611', '3129263627', NULL, '0', '0', NULL, '0', '0', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00093', 'TEMP00093', 'TEMPSTD', 'Provena Mercy Medical Center', NULL, NULL, 'Provena Mercy Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '1325 North Highland Avenue', 'Aurora', 'Kane', 'IL', '60506', '6308592222', NULL, '2667 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00094', 'TEMP00094', 'TEMPSTD', 'Provena Saint Joseph Hospital', NULL, NULL, 'Provena Saint Joseph Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '77 North Airlite Street', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '2669 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00095', 'TEMP00095', 'TEMPSTD', 'Provena Saint Joseph Medical Center', NULL, NULL, 'Provena Saint Joseph Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '2668 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1487715645', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362439318', 'TEMP00096', 'TEMP00096', 'TEMPSTD', 'Holy Family Medical Center', NULL, NULL, 'Holy Family Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '100 North River Road', 'Des Plaines', 'Cook', 'IL', '60016', '8472971800', NULL, '2097 Paysphere Circle ', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1689775736', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362644178', 'TEMP00097', 'TEMP00097', 'TEMPSTD', 'Our Lady Of The Resurrection Medical Center', NULL, NULL, 'Our Lady Of The Resurrection Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '5645 W Addison St ', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '6921 Collection Center Drive', 'Chicago', NULL, 'IL', '60693', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1033214416', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363330926', 'TEMP00098', 'TEMP00098', 'TEMPSTD', 'Resurrection Medical Center', NULL, NULL, 'Resurrection Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', NULL, '62415 Collection Center Drive', 'Chicago', NULL, 'IL', '60693', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'TEMP00099', 'TEMP00099', 'TEMPSTD', 'Saints Mary and Elizabeth Medical Center - Saint Elizabeth Campus', NULL, NULL, 'Saints Mary and Elizabeth Medical Center - Saint Elizabeth Campus', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '1431 North Claremont Avenue', 'Chicago', 'Cook', 'IL', '60622', '7732782000', NULL, '1117 Paysphere Circle ', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'TEMP00100', 'TEMP00100', 'TEMPSTD', 'Saints Mary and Elizabeth Medical Center - Saint Mary Campus', NULL, NULL, 'Saints Mary and Elizabeth Medical Center - Saint Mary Campus', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '2233 West Division Street', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '1117 Paysphere Circle ', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'TEMP00101', 'TEMP00101', 'TEMPSTD', 'Saint Joseph Hospital', NULL, NULL, 'Saint Joseph Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', NULL, '4588 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362167800', 'TEMP00102', 'TEMP00102', 'TEMPSTD', 'Saint Francis Hospital', NULL, NULL, 'Saint Francis Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '355 Ridge Avenue', 'Evanston', 'Cook', 'IL', '60202', '8473164000', NULL, '62243 Collection Center Drive', 'Chicago', NULL, 'IL', '60693', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1033210166', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00103', 'TEMP00103', 'TEMPSTD', 'Resurrection  Immediate Care  -  Des Plaines', NULL, NULL, 'Resurrection  Immediate Care  -  Des Plaines', 'Group', 'IC', NULL, NULL, NULL, 'O', '150 N River Rd Ste 110', 'Des Plaines', 'Cook', 'IL', '60016', '8478133510', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1124355904', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00104', 'TEMP00104', 'TEMPSTD', 'Resurrection  Immediate Care -  Norridge', NULL, NULL, 'Resurrection  Immediate Care -  Norridge', 'Group', 'IC', NULL, NULL, NULL, 'O', '4900 North Cumberland Avenue', 'Norridge', 'Cook', 'IL', '60706', '7084561600', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1114253812', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00105', 'TEMP00105', 'TEMPSTD', 'Resurrection  Immediate Care  -  Elmwood Park', NULL, NULL, 'Resurrection  Immediate Care  -  Elmwood Park', 'Group', 'IC', NULL, NULL, NULL, 'O', '7230 W North Ave Ste 107', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1407182108', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00106', 'TEMP00106', 'TEMPSTD', 'Resurrection Express Care', NULL, NULL, 'Resurrection Express Care', 'Group', 'Express Care', NULL, NULL, NULL, 'O', '2940 North Ashland Avenue', 'Chicago', 'Cook', 'IL', '60657', '7735254440', NULL, '62311 Collections Center Drive', 'Chicago', NULL, 'IL', '60693', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1235411703', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00107', 'TEMP00107', 'TEMPSTD', 'Provena Mercy Medical Centers Behavioral Health', NULL, NULL, 'Provena Mercy Medical Centers Behavioral Health', 'Group', 'BH', NULL, NULL, NULL, 'O', '1325 North Highland Avenue', 'Aurora', 'Kane', 'IL', '60506', '6308012657', NULL, '2667 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00108', 'TEMP00108', 'TEMPSTD', 'Provena Convenient Care Center - Carpentersville', NULL, NULL, 'Provena Convenient Care Center - Carpentersville', 'Group', 'PT', NULL, NULL, NULL, 'O', '2201 Randall Road ', 'Carpenternsville', 'Kane', 'IL', '60110', '8478447800', NULL, '2669 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00109', 'TEMP00109', 'TEMPSTD', 'Provena Convenient Care Center - Huntley', NULL, NULL, 'Provena Convenient Care Center - Huntley', 'Group', 'PT', NULL, NULL, NULL, 'O', '12155 Regency Square Parkway', 'Huntley', 'McHenry', 'IL', '60142', '8475152100', NULL, '2669 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00110', 'TEMP00110', 'TEMPSTD', 'Provena Acute Care', NULL, NULL, 'Provena Acute Care', 'Group', 'ES', NULL, NULL, NULL, 'O', '2250 W Algonquin Road', 'Lake in the Hills', 'McHenry', 'IL', '60102', '8478545511', NULL, '2669 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00111', 'TEMP00111', 'TEMPSTD', 'Provena Outpatient Rehabilitation', NULL, NULL, 'Provena Outpatient Rehabilitation', 'Group', 'Rehab', NULL, NULL, NULL, 'O', '87 North Airlite Street', 'Elgin', 'Kane', 'IL', '60123', '8476955904', NULL, '2669 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801360', 'TEMP00012', 'TEMP00012', 'TEMPSTD', 'Clear Lake Regional Medical Center', NULL, NULL, 'Clear Lake Regional Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '500 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813592511', NULL, 'P.O. Box 406795', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1063466035', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801360', 'TEMP00013', 'TEMP00013', 'TEMPSTD', 'Mainland Medical Center', NULL, NULL, 'Mainland Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '6801 E F Lowry Expressway', 'Texas City', 'Galveston', 'TX', '77591', '4099385000', NULL, 'P.O. Box 406795', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1063466035', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801359', 'TEMP00014', 'TEMP00014', 'TEMPSTD', 'Bayshore Medical Center', NULL, NULL, 'Bayshore Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '4000 Spencer Hwy', 'Pasadena', 'Harris', 'TX', '77504', '7133592000', NULL, 'P.O Box 406787', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1174576698', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801359', 'TEMP00015', 'TEMP00015', 'TEMPSTD', 'East Houston Regional Medical Center', NULL, NULL, 'East Houston Regional Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '13111 East Freeway', 'Houston', 'Harris', 'TX', '77015', '7133592000', NULL, 'P.O Box 406787', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1174576698', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801363', 'TEMP00016', 'TEMP00016', 'TEMPSTD', 'West Houston Medical Center', NULL, NULL, 'West Houston Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '12141 Richmond Ave', 'Houston', 'Harris', 'TX', '77082', '2815583444', NULL, 'P.O. Box 406325', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1275580938', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12024431', 'W12024431', 'ID02', 'Advanced Therapy Care', 'Cebu', '', 'Maybury', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', '2014-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184984932', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00160', 'TEMP00160', 'TEMPSTD', 'Resurrection Behavioral Health - Respite', NULL, NULL, 'Resurrection Behavioral Health - Respite', 'Group', 'BH', NULL, NULL, NULL, 'O', '117 S 6th Ave', 'Maywood', 'Cook', 'IL', '60153', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60161', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00159', 'TEMP00159', 'TEMPSTD', 'Resurrection Behavioral Health at Our Lady of the Resurrection Medical Center', NULL, NULL, 'Resurrection Behavioral Health at Our Lady of the Resurrection Medical Center', 'Group', 'BH', NULL, NULL, NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60160', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00158', 'TEMP00158', 'TEMPSTD', 'Resurrection Behavioral Health at Resurrection Medical Center', NULL, NULL, 'Resurrection Behavioral Health at Resurrection Medical Center', 'Group', 'BH', NULL, NULL, NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60159', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'TEMP00025', 'TEMP00025', 'TEMPSTD', 'Methodist Willowbrook Hospital', NULL, NULL, 'Methodist Willowbrook Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '18220 Tomball Pkwy', 'Houston', 'Harris', 'TX', '77070', '2814771000', NULL, 'P.O. Box 4755', 'Houston', NULL, 'TX', '77210', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1083937593', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362439318', 'TEMP00144', 'TEMP00144', 'TEMPSTD', 'Holy Family Medical Center/ Keys to Recovery', NULL, NULL, 'Holy Family Medical Center/ Keys to Recovery', 'Group', 'IP BH', NULL, NULL, NULL, 'O', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8473163600', NULL, '2097 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1689775736', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'TEMP00145', 'TEMP00145', 'TEMPSTD', 'Saint Joseph Behavioral Health/ Outpatient Psych Services', NULL, NULL, 'Saint Joseph Behavioral Health/ Outpatient Psych Services', 'Group', 'OP BH', NULL, NULL, NULL, 'O', '2913 N Commonwealth Dr          ', 'Chicago', 'Cook', 'IL', '60657', '8473163600', NULL, '4588 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'TEMP00146', 'TEMP00146', 'TEMPSTD', 'Saint Joseph Behavioral Health / Psych Unit', NULL, NULL, 'Saint Joseph Behavioral Health / Psych Unit', 'Group', 'IP BH', NULL, NULL, NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '8473163600', NULL, '4588 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'TEMP00147', 'TEMP00147', 'TEMPSTD', 'Saint Joseph Behavioral Health / Addiction Services, Harborview Recovery Center', NULL, NULL, 'Saint Joseph Behavioral Health / Addiction Services, Harborview Recovery Center', 'Group', 'OP BH', NULL, NULL, NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '8473163600', NULL, '4588 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'TEMP00148', 'TEMP00148', 'TEMPSTD', 'Saint Joseph Behavioral Health / Addiction Services, Harborview Recovery Center', NULL, NULL, 'Saint Joseph Behavioral Health / Addiction Services, Harborview Recovery Center', 'Group', 'IP BH', NULL, NULL, NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '8473163600', NULL, '4588 Paysphere Circle', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00156', 'TEMP00156', 'TEMPSTD', 'Resurrection Behavioral Health at Procare ', NULL, NULL, 'Resurrection Behavioral Health at Procare ', 'Group', 'BH', NULL, NULL, NULL, 'O', '1820 S 25th Ave', 'Broadview', 'Cook', 'IL', '60155', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60157', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00155', 'TEMP00155', 'TEMPSTD', 'Resurrection Behavioral Health at Procare ', NULL, NULL, 'Resurrection Behavioral Health at Procare ', 'Group', 'BH', NULL, NULL, NULL, 'O', '9845 Roosevelt Rd', 'Westchester ', 'Cook', 'IL', '60154', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60156', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00154', 'TEMP00154', 'TEMPSTD', 'Resurrection Behavioral Health at Procare ', NULL, NULL, 'Resurrection Behavioral Health at Procare ', 'Group', 'BH', NULL, NULL, NULL, 'O', '1414 Main St', 'Melrose Park', 'Cook', 'IL', '60160', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60155', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00153', 'TEMP00153', 'TEMPSTD', 'Proviso Family Services', NULL, NULL, 'Proviso Family Services', 'Group', 'BH', NULL, NULL, NULL, 'O', '11824 Southwest Hwy #230            ', 'Palos Heights', 'Cook', 'IL', '60463', '8474933650', NULL, '2001 Butterfield Rd. , Suite 320                                 ', 'Downers Grove', NULL, 'IL', '60515', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851586614', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00152', 'TEMP00152', 'TEMPSTD', 'Proviso Family Services', NULL, NULL, 'Proviso Family Services', 'Group', 'BH', NULL, NULL, NULL, 'O', '71  N Waukegan Rd #900', 'Lake Bluffs', 'Lake', 'IL', '60044', '8474933575', NULL, '2001 Butterfield Rd. , Suite 320                                 ', 'Downers Grove', NULL, 'IL', '60515', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851586614', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00151', 'TEMP00151', 'TEMPSTD', 'Proviso Family Services', NULL, NULL, 'Proviso Family Services', 'Group', 'BH', NULL, NULL, NULL, 'O', '8 S Michigan Ave #2110            ', 'Chicago', 'Cook', 'IL', '60603', '8474933700', NULL, '2001 Butterfield Rd. , Suite 320                                 ', 'Downers Grove', NULL, 'IL', '60515', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851586614', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00150', 'TEMP00150', 'TEMPSTD', 'Proviso Family Services', NULL, NULL, 'Proviso Family Services', 'Group', 'BH', NULL, NULL, NULL, 'O', '2001 Butterfield Rd #320           ', 'Downers Grove', 'Dupage', 'IL', '60515', '8474933600', NULL, '2001 Butterfield Rd. , Suite 320                                 ', 'Downers Grove', NULL, 'IL', '60515', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851586614', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'TEMP00149', 'TEMP00149', 'TEMPSTD', 'Proviso Family Services', NULL, NULL, 'Proviso Family Services', 'Group', 'BH', NULL, NULL, NULL, 'O', '2913 N Commonwealth Ave  Manor Building 6th Fl', 'Chicago', 'Cook', 'IL', '60657', '8474933500', NULL, '2001 Butterfield Rd. , Suite 320                                 ', 'Downers Grove', NULL, 'IL', '60515', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851586614', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801360', 'TEMP00017', 'TEMP00017', 'TEMPSTD', 'Alvin Emergency Center', NULL, NULL, 'Alvin Emergency Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '301 Medic Lane', 'Alvin', 'Brazoria', 'TX', '77511', '2813316141', NULL, 'P.O. Box 406795', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1063466035', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621619857', 'TEMP00018', 'TEMP00018', 'TEMPSTD', 'HealthOne Emergency Center  Fall Creek', NULL, NULL, 'HealthOne Emergency Center  Fall Creek', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '9711 North Sam Houston Pkwy East', 'Humble ', 'Harris', 'TX', '77396', '2814416520', NULL, 'P.O. Box 406320', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1811942238', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801360', 'TEMP00019', 'TEMP00019', 'TEMPSTD', 'HealthOne Emergency Center  Pearland', NULL, NULL, 'HealthOne Emergency Center  Pearland', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '10970 Shadow Creek Ranch Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137707200', NULL, 'P.O. Box 406795', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1063466035', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801363', 'TEMP00020', 'TEMP00020', 'TEMPSTD', 'HealthOne 24 Hour Emergency Care West Campus', NULL, NULL, 'HealthOne 24 Hour Emergency Care West Campus', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '5510 West Grand Pkwy S', 'Richmond', 'Fort Bend', 'TX', '77406', '2812321600', NULL, 'P.O. Box 406325', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1275580938', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801359', 'TEMP00021', 'TEMP00021', 'TEMPSTD', 'HealthOne Emergency Care Fairmont', NULL, NULL, 'HealthOne Emergency Care Fairmont', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '6002 Fairmont Pkwy', 'Pasadena', 'Harris', 'TX', '77505', '7133594949', NULL, 'P.O Box 406787', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1174576698', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('741180155', 'TEMP00022', 'TEMP00022', 'TEMPSTD', 'The Methodist Hospital', NULL, NULL, 'The Methodist Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '6565 Fannin St', 'Houston', 'Harris', 'TX', '77030', '7137903311', NULL, 'P.O. Box 4755', 'Houston', NULL, 'TX', '77210', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1548387418', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'TEMP00023', 'TEMP00023', 'TEMPSTD', 'Methodist Sugar Land Hospital', NULL, NULL, 'Methodist Sugar Land Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '16655 SW Freeway', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812747000', NULL, 'P.O. Box 4755', 'Houston', NULL, 'TX', '77210', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1497871628', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'TEMP00141', 'TEMP00141', 'TEMPSTD', 'Saints Mary and Elizabeth Medical Center                                            ', NULL, NULL, 'Saints Mary and Elizabeth Medical Center                                            ', 'Group', 'OP BH', NULL, NULL, NULL, 'O', '1127 N Oakley', 'Chicago', 'Cook', 'IL', '60622', '8473163600', NULL, '1117 Paysphere Circle ', 'Chicago', NULL, 'IL', '60674', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('362893936', 'TEMP00139', 'TEMP00139', 'TEMPSTD', 'Res Home Health Services', NULL, NULL, 'Res Home Health Services', 'Group', 'HH', NULL, NULL, NULL, 'O', '2380 E Dempster ', 'Des Plaines', 'Cook', 'IL', '60016', '8474934800', NULL, '2380 E. Dempster', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1821198946', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'TEMP00140', 'TEMP00140', 'TEMPSTD', 'Res Home Medical Equipment', NULL, NULL, 'Res Home Medical Equipment', 'Group', 'Med. Equip.', NULL, NULL, NULL, 'O', '2380 E Dempster', 'Des Plaines', 'Cook', 'IL', '60016', '8474934800', NULL, '2380 E. Dempster', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1134120322', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00138', 'TEMP00138', 'TEMPSTD', 'Villa Scalabrini Nursing & Rehab Center', NULL, NULL, 'Villa Scalabrini Nursing & Rehab Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '480 N Wolf Rd                             ', 'Northlake', 'Dupage', 'IL', '60184', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1023002318', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00137', 'TEMP00137', 'TEMPSTD', 'Saint Benedict Nursing & Rehab Center', NULL, NULL, 'Saint Benedict Nursing & Rehab Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '6930 W Touhy Ave ', 'Niles', 'Cook', 'IL', '60714', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1558355842', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00136', 'TEMP00136', 'TEMPSTD', 'Resurrection Nursing & Rehab Center', NULL, NULL, 'Resurrection Nursing & Rehab Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '1001 N Greenwood Ave', 'Park Ridge', 'Cook', 'IL', '60068', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1730173048', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00135', 'TEMP00135', 'TEMPSTD', 'Resurrection Life Center', NULL, NULL, 'Resurrection Life Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '7370 W Talcott Ave                   ', 'Chicago', 'Cook', 'IL', '60631', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1730173881', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00134', 'TEMP00134', 'TEMPSTD', 'MaryHaven Nursing & Rehab Center', NULL, NULL, 'MaryHaven Nursing & Rehab Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '1700 E Lake St                              ', 'Glenview', 'Cook', 'IL', '60025', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1225022510', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'TEMP00133', 'TEMP00133', 'TEMPSTD', 'Ballard Nursing Center', NULL, NULL, 'Ballard Nursing Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '9300 Ballard Rd\n', 'Des Plaines', 'Cook', 'IL', '60016', '8478133663', NULL, '100 N. River Rd, Room 471     ', 'Des Plaines', NULL, 'IL', '60016', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1932497625', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00132', 'TEMP00132', 'TEMPSTD', 'Resurrection Open MRI ', NULL, NULL, 'Resurrection Open MRI ', 'Group', 'Imaging', NULL, NULL, NULL, 'O', '3101 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7738369360', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851628630', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00131', 'TEMP00131', 'TEMPSTD', 'Resurrection Health Services WorkPlus Elmwood Park', NULL, NULL, 'Resurrection Health Services WorkPlus Elmwood Park', 'Group', 'OccH', NULL, NULL, NULL, 'O', '7230 W North Ave Ste 107', 'Elmwood Park', 'Cook', 'IL', '60707', '7733552822', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1447587225', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00130', 'TEMP00130', 'TEMPSTD', 'Resurrection Health Services WorkPlus  Des Plaines', NULL, NULL, 'Resurrection Health Services WorkPlus  Des Plaines', 'Group', 'OccH', NULL, NULL, NULL, 'O', '4900 North Cumberland Avenue', 'Norridge', 'Cook', 'IL', '60706', '7733552822', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1780913368', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'TEMP00129', 'TEMP00129', 'TEMPSTD', 'Resurrection  Health Services WorkPlus Norridge', NULL, NULL, 'Resurrection  Health Services WorkPlus Norridge', 'Group', 'OccH', NULL, NULL, NULL, 'O', '150 N River Rd Ste 110', 'Des Plaines', 'Cook', 'IL', '60016', '7733552822', NULL, 'P.O. Box 6670', 'River Forest', NULL, 'IL', '60305', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1932436094', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00128', 'TEMP00128', 'TEMPSTD', 'Provena Hospice', NULL, NULL, 'Provena Hospice', 'Group', 'Hospitalpice', NULL, NULL, NULL, 'O', '799 S McLean Blvd\n', 'Elgin', 'Kane', 'IL', '60123', '8476223467', NULL, '2749 Momentum Place', 'Chicago', NULL, 'IL', '60691', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1033168430', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00127', 'TEMP00127', 'TEMPSTD', 'Provena Home Health', NULL, NULL, 'Provena Home Health', 'Group', 'HH', NULL, NULL, NULL, 'O', '222 South Greenleaf Ave Ste 103', 'Gurnee', 'Lake', 'IL', '60031', '8473607600', NULL, '2749 Momentum Place', 'Chicago', NULL, 'IL', '60690', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477502672', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00126', 'TEMP00126', 'TEMPSTD', 'Provena Home Health', NULL, NULL, 'Provena Home Health', 'Group', 'HH', NULL, NULL, NULL, 'O', '1060 Essington Road\n', 'Joliet', 'Will', 'IL', '60435', '8157417371', NULL, '2749 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1881645125', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00125', 'TEMP00125', 'TEMPSTD', 'Provena Home Health', NULL, NULL, 'Provena Home Health', 'Group', 'HH', NULL, NULL, NULL, 'O', '799 S McLean Blvd\n', 'Elgin', 'Kane', 'IL', '60123', '8478315553', NULL, '2749 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1942259346', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00124', 'TEMP00124', 'TEMPSTD', 'Provena Villa Franciscan', NULL, NULL, 'Provena Villa Franciscan', 'Group', 'SNF', NULL, NULL, NULL, 'O', '210 North Springfield Avenue', 'Joliet', 'Will', 'IL', '60435', '8157253400', NULL, '2860 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '192294051', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00123', 'TEMP00123', 'TEMPSTD', 'Provena Pine View Care Center', NULL, NULL, 'Provena Pine View Care Center', 'Group', 'SNF', NULL, NULL, NULL, 'O', '611 Allen Lane', 'St. Charles', 'Kane', 'IL', '60174', '6303774352', NULL, '2857 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1396731428', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'TEMP00122', 'TEMP00122', 'TEMPSTD', 'Provena McAuley Manor', NULL, NULL, 'Provena McAuley Manor', 'Group', 'SNF', NULL, NULL, NULL, 'O', '400 West Sullivan Road', 'Aurora', 'Kane', 'IL', '60506', '6308593700', NULL, '2859 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1205822335', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00121', 'TEMP00121', 'TEMPSTD', 'Provena Immediate Care and Plainfield Imaging', NULL, NULL, 'Provena Immediate Care and Plainfield Imaging', 'Group', 'Immediate Care/ Imaging', NULL, NULL, NULL, 'O', '7000 Caton Farm Rd', 'Plainfield', 'Will', 'IL', '60586', '8156095501', NULL, '2668 Momentum Place', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00120', 'TEMP00120', 'TEMPSTD', 'Provena Glenwood Medical Imaging', NULL, NULL, 'Provena Glenwood Medical Imaging', 'Group', 'Imaging', NULL, NULL, NULL, 'O', '2000 Glenwood Ave Ste 102', 'Joliet', 'Will', 'IL', '60435', '8157417555', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00119', 'TEMP00119', 'TEMPSTD', 'Provena Physical Therapy & Industrial Rehab Center', NULL, NULL, 'Provena Physical Therapy & Industrial Rehab Center', 'Group', 'PT', NULL, NULL, NULL, 'O', '852 Sharp Drive ', 'Shorewood', 'Will', 'IL', '60431', '8157417416', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00118', 'TEMP00118', 'TEMPSTD', 'Provena Medical Specialty & Physical Therapy Center - Frankfort', NULL, NULL, 'Provena Medical Specialty & Physical Therapy Center - Frankfort', 'Group', 'PT', NULL, NULL, NULL, 'O', '222 Colorado Ave', 'Frankfort', 'Will', 'IL', '60423', '8154648945', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00117', 'TEMP00117', 'TEMPSTD', 'Provena Physical Therapy Services - Romeoville', NULL, NULL, 'Provena Physical Therapy Services - Romeoville', 'Group', 'PT', NULL, NULL, NULL, 'O', '1280 Windham Parkway', 'Romeoville', 'Will', 'IL', '60441', '8153781357', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00116', 'TEMP00116', 'TEMPSTD', 'Provena Physical Therapy Services - New Lenox', NULL, NULL, 'Provena Physical Therapy Services - New Lenox', 'Group', 'PT', NULL, NULL, NULL, 'O', '1812 New Lincoln Highway', 'New Lenox', 'Will', 'IL', '60451', '8154858495', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621810381', 'TEMP00011', 'TEMP00011', 'TEMPSTD', 'Womans Hospital of Texas', NULL, NULL, 'Womans Hospital of Texas', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '7600 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137901234', NULL, 'P.O. Box 406299', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1023065794', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12024382', 'W12024382', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Heather', '', 'Johnson', 'NP', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-25', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518214154', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.6896, -116.35, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820200895', 'W12024383', 'W12024383', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Heather', '', 'Johnson', 'NP', 'Pediatrics', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-25', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518214154', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('364195126', 'TEMP00114', 'TEMP00114', 'TEMPSTD', 'Provena Physical Therapy - Provena Inwood Athletic Club', NULL, NULL, 'Provena Physical Therapy - Provena Inwood Athletic Club', 'Group', 'PT', NULL, NULL, NULL, 'O', '3000 West Jefferson Street', 'Joliet', 'Will', 'IL', '60435', '8157417263', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('742129954', 'TEMP00031', 'TEMP00031', 'TEMPSTD', 'Cypress Fairbanks Urgent Care Center', NULL, NULL, 'Cypress Fairbanks Urgent Care Center', 'Group', 'Urgent Care', NULL, NULL, NULL, 'O', '9110 Barker Cypress Rd', 'Houston', 'Harris', 'TX', '77433', '2815179900', NULL, 'P.O. Box 849762', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', '2012-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477583334', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00112', 'TEMP00112', 'TEMPSTD', 'Provena Physical Rehab & Sports Injury Center - Joliet', NULL, NULL, 'Provena Physical Rehab & Sports Injury Center - Joliet', 'Group', 'Rehab', NULL, NULL, NULL, 'O', '2400 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157417114', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00113', 'TEMP00113', 'TEMPSTD', 'Provena Physical Therapy - Campus Fitness Center', NULL, NULL, 'Provena Physical Therapy - Campus Fitness Center', 'Group', 'PT', NULL, NULL, NULL, 'O', '2701 Black Road', 'Joliet', 'Will', 'IL', '60435', '8157306771', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('760452319', 'TEMP00027', 'TEMP00027', 'TEMPSTD', 'Northwest Surgery Center Red Oak', NULL, NULL, 'Northwest Surgery Center Red Oak', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '17322 Red Oak Drive', 'Houston', 'Harris', 'TX', '77090', '2818959100', NULL, 'P.O. Box 90987', 'Houston', NULL, 'TX', '77290', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', '2012-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1053391870', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('741287015', 'TEMP00026', 'TEMP00026', 'TEMPSTD', 'San Jacinto Methodist Hospital', NULL, NULL, 'San Jacinto Methodist Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '4401 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814208600', NULL, 'P.O. Box 4755', 'Houston', NULL, 'TX', '77210', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1891789772', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'TEMP00115', 'TEMP00115', 'TEMPSTD', 'Provena Physical Therapy - Plainfield', NULL, NULL, 'Provena Physical Therapy - Plainfield', 'Group', 'PT', NULL, NULL, NULL, 'O', '7000 Caton Farm Rd', 'Plainfield', 'Will', 'IL', '60586', '8154368683', NULL, '2668 Momentum Place ', 'Chicago', NULL, 'IL', '60689', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', NULL, 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'TEMP00024', 'TEMP00024', 'TEMPSTD', 'Methodist West Houston Hospital', NULL, NULL, 'Methodist West Houston Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '18500 Katy Frwy', 'Houston', 'Harris', 'TX', '77094', '8325221000', NULL, 'P.O. Box 4755', 'Houston', NULL, 'TX', '77210', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1083937593', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('460500210', 'W12024396', 'W12024396', 'IDBOISTD', 'Saint Alphonsus Pathology Physician Services', 'Gregory', 'G', 'Ausmus', 'MD', 'Pathology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553798', '2084553878', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553798', '2084553878', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-10-01', '2013-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1437202496', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('362709982', 'TEMP00157', 'TEMP00157', 'TEMPSTD', 'Resurrection Behavioral Health at Saint Francis Hospital ', NULL, NULL, 'Resurrection Behavioral Health at Saint Francis Hospital ', 'Group', 'BH', NULL, NULL, NULL, 'O', '355  Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '7084100615', NULL, '1820 S 25th Ave                           ', 'Broadview', NULL, 'IL', '60158', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1477622298', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621619857', 'TEMP00009', 'TEMP00009', 'TEMPSTD', 'Kingwood Medical Center ', NULL, NULL, 'Kingwood Medical Center ', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '22999 US Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813488000', NULL, 'P.O. Box 406320', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1811942238', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621801361', 'TEMP00008', 'TEMP00008', 'TEMPSTD', 'Conroe Regional Medical Center', NULL, NULL, 'Conroe Regional Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '504 Medical Ctr Blvd', 'Conroe', 'Montgomery', 'TX', '77304', '9365391111', NULL, 'P. O. Box 406796', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1962455816', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('900768532', 'TEMP00007', 'TEMP00007', 'TEMPSTD', 'Memorial Endoscopy Center ', NULL, NULL, 'Memorial Endoscopy Center ', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1233 Campbell Rd', 'Houston', 'Harris', 'TX', '77055', '7134689200', NULL, 'P.O. Box 403646', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1396011615', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('621771718', 'TEMP00003', 'TEMP00003', 'TEMPSTD', 'Humble Kingwood Endoscopy Center', NULL, NULL, 'Humble Kingwood Endoscopy Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '19505 McKay Dr Ste 101', 'Humble ', 'Harris', 'TX', '77338', '2813126900', NULL, 'P.O. Box 741693', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1619265295', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('432016059', 'TEMP00004', 'TEMP00004', 'TEMPSTD', 'Fannin Surgicare', NULL, NULL, 'Fannin Surgicare', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7700 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137963800', NULL, 'P.O. Box 403646', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1225091739', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870354540', 'W12024420', 'W12024420', 'UT01', 'ENT Specialists', 'Denise', '', 'Arcenfaux', 'AUD', 'Audiology', '', '', NULL, 'B', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012603687', '8012603688', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012603687', '8012603688', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730400037', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('760418502', 'TEMP00010', 'TEMP00010', 'TEMPSTD', 'Texas Orthopedic Hospital ', NULL, NULL, 'Texas Orthopedic Hospital ', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '7401 S Main St', 'Houston', 'Harris', 'TX', '77030', '7137998600', NULL, 'P.O. Box 406313', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1134166192', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('621600411', 'TEMP00001', 'TEMP00001', 'TEMPSTD', 'Bay Area Surgicare Center', NULL, NULL, 'Bay Area Surgicare Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '502 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813322433', NULL, 'P.O. Box 409852', 'Atlanta', NULL, 'GA', '30384', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1982667499', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('870649259', 'W12024423', 'W12024423', 'UT01', 'Alpine Orthopaedic Specialists', 'Brian', '', 'Hess', 'PA-C', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357239700', '4357239710', 'PO Box 6250   ', 'Logan', 'Cache', 'UT', '84341', '4357239700', '4357239710', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548540271', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('830237313', 'W12024424', 'W12024424', 'WY01', 'Sheridan Pathology Associates', 'Dennis', '', 'Schreffler', '', 'Clinical Pathology', '', '', NULL, 'O', '1401 W Fifth St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', NULL, '1401 W Fifth St   ', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487672309', 0, 'N', 0, '2013-01-09', NULL, NULL, 44.8074, -106.976, NULL, NULL),
('830237313', 'W12024426', 'W12024426', 'WY01', 'Sheridan Pathology Associates', 'Dennis', '', 'Schreffler', '', 'Clinical Pathology', '', '', NULL, 'B', 'PO Box 767', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', NULL, 'PO Box 767    ', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487672309', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
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('272481635', 'W12024436', 'W12024436', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Muhammad', 'K', 'Adnan', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', NULL, 'PO Box 742128   ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1295991784', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
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('272481635', 'W12024448', 'W12024448', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Christoffer', '', 'Spoja', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'PO Box 742128   ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1003062076', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
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('272481635', 'W12024453', 'W12024453', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Stephen', 'J', 'Focht', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'PO Box 742128    ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1043288004', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('751765385', 'TEMP00168', 'TEMP00168', 'TEMPSTD', 'Baylor Specialty Hospital', NULL, NULL, 'Baylor Specialty Hospital', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '3504 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209700', NULL, 'P.O. Box 847137', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1851399406', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('751765385', 'TEMP00170', 'TEMP00170', 'TEMPSTD', 'Our Childrens House at Baylor', NULL, NULL, 'Our Childrens House at Baylor', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '3301 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209850', NULL, 'P.O. Box 847137', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1053319798', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
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('455227009', 'W12024457', 'W12024457', 'UT01', 'UPRI Murray ', 'Gary', 'L', 'Child', 'DO', 'Pain Management', '', '', NULL, 'O', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063492304', 0, 'N', 0, '2012-11-05', NULL, NULL, 40.6332, -111.893, NULL, NULL),
('751837454', 'TEMP00169', 'TEMP00169', 'TEMPSTD', 'Baylor University Medical Center', NULL, NULL, 'Baylor University Medical Center', 'Group', 'Hospital', NULL, NULL, NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148200111', NULL, 'P.O. Box 842022', 'Dallas', NULL, 'TX', '75284', NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1447250253', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820200896', 'W12024454', 'W12024454', 'IDBOISTD', 'Caldwell Cancer Care Center Medical Oncology', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '3123 Medical Dr  ', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '          ', '3123 Medical Dr  ', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '          ', '', '', '', '0.00', '22.00', '0.00', 6, '2012-09-10', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6594, -116.659, NULL, NULL),
('820200896', 'W12024455', 'W12024455', 'IDBOISTD', 'Caldwell Cancer Care Center Medical Oncology', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'B', 'PO Box 190930   ', 'Boise', 'Ada', 'ID', '83719', '2083672396', '          ', 'PO Box 190930   ', 'Boise', 'Ada', 'ID', '83719', '2083672396', '          ', '', '', '', '0.00', '22.00', '0.00', 6, '2012-09-10', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024572', 'W12024572', 'ID01', 'Boise Anesthesia PA', 'Matthew', 'B', 'Fowler', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268    ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2012-07-01', NULL, 1, 15, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801848130', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024573', 'W12024573', 'ID01', 'Boise Anesthesia PA', 'Donald', 'J', 'Fox', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497707830', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
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