-- Table structure for table `providers_new`
--

DROP TABLE IF EXISTS `providers_new`;
CREATE TABLE IF NOT EXISTS `providers_new` (
  `Provider_Tax_ID` varchar(9) NOT NULL,
  `Provider_Suffix` varchar(9) NOT NULL,
  `Provider_Network_ID` varchar(20) NOT NULL,
  `Provider_Region` varchar(20) NOT NULL,
  `Provider_Name` varchar(255) DEFAULT NULL,
  `Provider_Doctor_First_Name` varchar(100) DEFAULT NULL,
  `Provider_Doctor_Middle_Name` varchar(100) DEFAULT NULL,
  `Provider_Doctor_Last_Name` varchar(100) DEFAULT NULL,
  `Provider_Doctor_Degree` varchar(50) DEFAULT NULL,
  `Provider_Specialty_1` varchar(50) DEFAULT NULL,
  `Provider_Specialty_2` varchar(50) DEFAULT NULL,
  `Provider_Specialty_3` varchar(50) DEFAULT NULL,
  `Provider_Specialty_4` varchar(50) DEFAULT NULL,
  `Provider_Address_Type` char(2) DEFAULT NULL,
  `Provider_Address` varchar(255) DEFAULT NULL,
  `Provider_City` varchar(50) DEFAULT NULL,
  `Provider_County` varchar(20) DEFAULT NULL,
  `Provider_State` char(4) DEFAULT NULL,
  `Provider_Zip` varchar(10) DEFAULT NULL,
  `Provider_Phone` varchar(20) DEFAULT NULL,
  `Provider_Fax` varchar(20) DEFAULT NULL,
  `Provider_Mailing_Address` varchar(255) DEFAULT NULL,
  `Provider_Mailing_City` varchar(50) DEFAULT NULL,
  `Provider_Mailing_County` varchar(20) DEFAULT NULL,
  `Provider_Mailing_State` char(4) DEFAULT NULL,
  `Provider_Mailing_Zip` varchar(10) DEFAULT NULL,
  `Provider_Mailing_Phone` varchar(20) DEFAULT NULL,
  `Provider_Mailing_Fax` varchar(20) DEFAULT NULL,
  `Provider_Primary_Schedule` varchar(20) DEFAULT NULL,
  `Provider_Secondary_Schedule` varchar(20) DEFAULT NULL,
  `Provider_Rate_Sheet` varchar(20) DEFAULT NULL,
  `Provider_Anes_Rate` decimal(10,2) DEFAULT NULL,
  `Provider_Default_Rate` decimal(10,2) DEFAULT NULL,
  `Provider_Max_DOS` decimal(10,2) DEFAULT NULL,
  `Provider_Min_Match_Value` int(10) unsigned DEFAULT NULL,
  `Provider_Effective_Date` date DEFAULT NULL,
  `Provider_Term_Date` date DEFAULT NULL,
  `Provider_Pend` int(10) unsigned DEFAULT '0',
  `Provider_Anes_Minutes` int(10) unsigned DEFAULT '12',
  `Provider_PPO` int(10) unsigned DEFAULT '0',
  `Provider_Hospital_1` varchar(255) DEFAULT NULL,
  `Provider_Hospital_2` varchar(255) DEFAULT NULL,
  `Provider_Hospital_3` varchar(255) DEFAULT NULL,
  `Provider_Hospital_4` varchar(255) DEFAULT NULL,
  `Provider_Type` varchar(20) DEFAULT 'HCFA|UB|',
  `Provider_NPI` varchar(10) DEFAULT NULL,
  `Provider_Check_Override` int(10) unsigned NOT NULL DEFAULT '0',
  `Exclude_Dir` varchar(1) DEFAULT NULL,
  `Audit_Status` int(10) unsigned NOT NULL DEFAULT '0',
  `Last_Change_Date` date DEFAULT NULL,
  `Medicare_ID` varchar(45) DEFAULT NULL,
  `Provider_Lang` varchar(45) DEFAULT NULL,
  `Provider_Latitude` float DEFAULT '0',
  `Provider_Longitude` float DEFAULT '0',
  `Provider_school` varchar(255) DEFAULT NULL,
  `Provider_cert` varchar(255) DEFAULT NULL,
  PRIMARY KEY (`Provider_Tax_ID`,`Provider_Suffix`) USING BTREE,
  KEY `Search` (`Provider_Name`,`Provider_Doctor_First_Name`,`Provider_Doctor_Last_Name`,`Provider_Specialty_1`,`Provider_Specialty_2`,`Provider_Specialty_3`,`Provider_Specialty_4`,`Provider_City`,`Provider_County`,`Provider_State`,`Provider_Zip`),
  KEY `Imagine` (`Provider_Network_ID`),
  KEY `Claims_search` (`Provider_Suffix`,`Provider_Region`),
  KEY `NewSearch` (`Provider_Address_Type`,`Provider_Address`,`Provider_City`,`Provider_County`,`Provider_State`,`Provider_Zip`,`Provider_Phone`,`Provider_Hospital_1`),
  KEY `suffix` (`Provider_Suffix`),
  KEY `Region` (`Provider_Region`),
  KEY `State` (`Provider_State`),
  KEY `address type` (`Provider_Address_Type`),
  KEY `effdate` (`Provider_Effective_Date`),
  KEY `termdate` (`Provider_Term_Date`),
  KEY `Exclude` (`Exclude_Dir`)
) ENGINE=MyISAM DEFAULT CHARSET=latin1 COMMENT='InnoDB free: 9421824 kB';

--
-- Dumping data for table `providers_new`
--

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
('541707322', 'DONTMAP01', 'DONTMAP01', 'UT01', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', '', '', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8004879644', NULL, 'Phone Number Only', '', '', '', '', '8004879644', '', 'WCSTCROP5', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578562468', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'DONTMAP02', 'DONTMAP02', 'UT01', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8008638010', NULL, 'Phone Number Only', '', '', '', '', '8008638010', '', 'WISEDJO', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('521262870', 'DONTMAP03', 'DONTMAP03', 'UT01', 'Dynasplint Systems Inc  (Custom Braces)', '', '', 'Dynasplint Systems Inc  (Custom Braces)', 'GROUP', 'Durable Medical Equipment', 'Custom Splints', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006386771', NULL, 'Phone Number Only', '', '', '', '', '8006386771', '', 'WCSTDSS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643856', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('411310335', 'DONTMAP04', 'DONTMAP04', 'UT01', 'Empi Inc (Neuromuscular Stimulator)', '', '', 'Empi Inc (Neuromuscular Stimulator)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003282536', NULL, 'Phone Number Only', '', '', '', '', '8003282536', '', 'WCSTEMPI5', 'DME90', NULL, '0.00', '15.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174574032', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'DONTMAP05', 'DONTMAP05', 'UT01', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only 8003075930', '', '', '', '', '8003075930', NULL, 'Phone Number Only 8003075930', '', '', '', '', '8003075930', '          ', 'WCSTEPSI5', 'DME80', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870616123', 'DONTMAP06', 'DONTMAP06', 'UT01', 'Intermountain Orthopedic Care ', NULL, NULL, 'Intermountain Orthopedic Care ', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', ' ', NULL, NULL, NULL, NULL, '8013769004', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUDME5', NULL, NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699798827', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'DONTMAP07', 'DONTMAP07', 'UT01', 'LifeWatch', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8777749846', NULL, 'Phone Number Only', '', '', '', '', '8777749846', '          ', 'WCSTLWI5', '', '', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'DONTMAP08', 'DONTMAP08', 'UT01', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005270404', '          ', 'Phone Number Only', '', '', '', '', '8005270404', '          ', 'WCSTORFIX5', '', '', '0.00', '100.00', '0.00', 3, '2007-01-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235136060', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'DONTMAP09', 'DONTMAP09', 'UT01', 'RS Medical (Muscle Stimulators)', '', '', 'RS Medical (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006830353', NULL, 'Phone Number Only', '', '', '', '', '8006830353', '', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992791230', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('510123924', 'DONTMAP10', 'DONTMAP10', 'UT01', 'Smith Nephew Inc (Muscle Stimulators)', '', '', 'Smith Nephew Inc (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8008215700', NULL, 'Phone Number Only', '', '', '', '', '8008215700', '', '', NULL, '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532901', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'DONTMAP11', 'DONTMAP11', 'UT01', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003670300', NULL, 'PO BOX 727', 'Windsor', '', 'CT', '06095', '8003670300', '', 'WCSTRCS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1194776518', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870392388', 'M77000001', 'M77000001', 'UT01', NULL, 'David', 'B', 'Adams', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326080367', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870526396', 'M77000004', 'M77000004', 'UT01', NULL, 'Joan', 'B', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1199 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8012966166', NULL, '1199 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8012966166', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730278631', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'M77000007', 'M77000007', 'UT01', '', 'Tracy', 'B', 'Anderson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '323 S 600 E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321052', NULL, '323 S 600 E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321052', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568595106', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('528469723', 'M77000008', 'M77000008', 'UT01', NULL, 'Neil', 'G', 'Anderton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '110 E 100 S Ste 2', 'Vernal', 'Uintah', 'UT', '84078', '8886570660', NULL, '110 E 100 S Ste 2', 'Vernal', 'Uintah', 'UT', '84078', '8886570660', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427101518', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528469723', 'M77000009', 'M77000009', 'UT01', NULL, 'Neil', 'G', 'Anderton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '135 S Main St Ste 205', 'Heber City', 'Wasatch', 'UT', '84032', '4356570660', NULL, '135 S Main St Ste 205', 'Heber City', 'Wasatch', 'UT', '84032', '4356570660', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427101518', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('260019198', 'M77000010', 'M77000010', 'UT01', NULL, 'Amanda', 'A', 'Andrus', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '275 E S Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', NULL, '275 E S Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093883027', 0, 'N', 0, '2012-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870613568', 'M77000013', 'M77000013', 'UT01', NULL, 'Joyce', NULL, 'Anis', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '1002 S Temple Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016804211', NULL, '1002 S Temple', 'Salt Lake City', '', 'UT', '84102', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005057', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870613568', 'M77000014', 'M77000014', 'UT01', NULL, 'Joyce', NULL, 'Anis', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 260', 'Layton', 'Davis', 'UT', '84041', '8016804211', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005057', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('287726555', 'M77000015', 'M77000015', 'UT01', NULL, 'Steven', NULL, 'Ater', 'PSYD', 'Mental Health', NULL, NULL, NULL, 'O', '44 S 100 W', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', NULL, '44 S 100 W', 'Vernal', '', 'UT', '84078', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005111', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('555829270', 'M77000016', 'M77000016', 'UT01', NULL, 'Thomas', 'E', 'Atkin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '550 N 1400 E Ste K', 'Logan', 'Cache', 'UT', '84341', '4357920355', NULL, '550 N 1400 E Ste K', 'Logan', 'Cache', 'UT', '84341', '4357920355', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1730232513', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('529783876', 'M77000018', 'M77000018', 'UT01', NULL, 'Pamela', 'R', 'Awana', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '111 E 5600 S Ste 310', 'Murray', 'Salt Lake', 'UT', '84107', '8012613449', NULL, '111 E 5600 S', 'Murray', '', 'UT', '84107', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005131', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'M77000019', 'M77000019', 'UT01', NULL, 'Trudy', '', 'Whitehead', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('753117278', 'M77000021', 'M77000021', 'UT01', NULL, 'Judy', 'A', 'Bailey', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '2032 Ribbon Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012740043', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'M77000022', 'M77000022', 'UT01', NULL, 'Jeffery', 'P', 'Baird', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750434049', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('529862403', 'M77000023', 'M77000023', 'UT01', NULL, 'David', 'T', 'Ballard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3549 N University Ave Ste 300', 'Provo', 'Utah', 'UT', '84604', '8017630662', NULL, '3549 N University Ave', 'Provo', 'Utah', 'UT', '84604', '8017630662', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1023143211', 0, 'N', 0, '2011-06-19', NULL, NULL, 0, 0, NULL, NULL),
('481028511', 'M77000027', 'M77000027', 'UT01', NULL, 'Carol', 'M', 'Bauman', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '162 E 100 S', 'Hyde Park', 'Cache', 'UT', '84318', '4355631121', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'M77000030', 'M77000030', 'UT01', NULL, 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '3600 S Market St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8017558799', NULL, '3600 S Market St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8017558799', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'M77000031', 'M77000031', 'UT01', NULL, 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '425 E 5350 S Ste 270', 'Ogden', 'Weber', 'UT', '84405', '8017558799', NULL, '425 E 5350 S Ste 270', 'Ogden', 'Weber', 'UT', '84405', '8017558799', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('522828100', 'M77000032', 'M77000032', 'UT01', NULL, 'Bryan', 'D', 'Bingham', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1747 S Heritage Ln Ste B 103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', NULL, '1747 S Heritage Ln Ste B 103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164508487', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('431807685', 'M77000033', 'M77000033', 'UT01', NULL, 'David', 'E', 'Bone', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '10 W Broadway Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8013637700', NULL, '10 W Broadway', 'Salt Lake City', '', 'UT', '84101', '', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005347', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870486136', 'M77000034', 'M77000034', 'UT01', NULL, 'Lewis', 'L', 'Boone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '954 E N Union Ave Bldg B, Ste 204', 'Midvale', 'Salt Lake', 'UT', '84047', '8017481442', NULL, '954 E N Union Ave Bldg B, Ste 204', 'Midvale', 'Salt Lake', 'UT', '84047', '8017481442', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208051', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('508589214', 'M77000131', 'M77000131', 'UT01', NULL, 'Michael', NULL, 'JAMES', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '77 S 700 E Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015325675', NULL, '77 S 700 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006909', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('870575977', 'M77000136', 'M77000136', 'UT01', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870575977', 'M77000137', 'M77000137', 'UT01', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', NULL, '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('870667490', 'M77000139', 'M77000139', 'UT01', NULL, 'Leann', 'G', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '807 E S Temple Ste 370', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014672072', NULL, '807 E S Temple Ste 370', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014672072', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962569426', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('900136549', 'M77000142', 'M77000142', 'UT01', NULL, 'Catherina', 'H', 'Kang', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609927466', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870499318', 'M77000143', 'M77000143', 'UT01', NULL, 'Kathie', '', 'Keeler', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '70 N Main Ste 103', 'Bountiful', 'Davis', 'UT', '84010', '8012985222', NULL, '70 N Main Ste 103', 'Bountiful', 'Davis', 'UT', '84010', '8012985222', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386758498', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('102403214', 'M77000145', 'M77000145', 'UT01', NULL, 'Joyce', 'A', 'Kelen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', NULL, '925 E 900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1609947712', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'M77000147', 'M77000147', 'UT01', NULL, 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529572392', 'M77000148', 'M77000148', 'UT01', NULL, 'Evan', 'T', 'Kenison', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358502547', NULL, '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358502547', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912977505', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870559169', 'M77000149', 'M77000149', 'UT01', NULL, 'Ruth', 'M', 'Killpack', 'PHD', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932281227', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870519533', 'M77000152', 'M77000152', 'UT01', NULL, 'Frederick', 'T', 'King', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2351 Grant Ave Ste 100', 'Ogden', 'Weber', 'UT', '84401', '8016218670', NULL, '2351 Grant Ave', 'Ogden', 'Weber', 'UT', '84401', '8016218670', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1518131622', 0, 'N', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
('546664058', 'M77000153', 'M77000153', 'UT01', NULL, 'John', 'L', 'Kluthe', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '425 E 5350 S Ste 370', 'Ogden', 'Weber', 'UT', '84405', '8014798286', NULL, '425 E 5350 S Ste 370', 'Ogden', 'Weber', 'UT', '84405', '8014798286', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427192087', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'M77000154', 'M77000154', 'UT01', NULL, 'Kevin', 'V', 'Knutson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '250 S 600 E', 'Nephi', 'Juab', 'UT', '84648', '4359795218', NULL, '250 S 600 E', 'Nephi', 'Juab', 'UT', '84648', '4359795218', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326254731', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'M77000155', 'M77000155', 'UT01', NULL, 'Kevin', 'V', 'Knutson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '60 W 100 S', 'Salina', 'Sevier', 'UT', '84654', '4359795218', NULL, '60 W 100 S', 'Salina', 'Sevier', 'UT', '84654', '4359795218', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326254731', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528844386', 'M77000156', 'M77000156', 'UT01', NULL, 'Jeff', 'C', 'Kocherhans', 'PHD', 'Mental Health', 'Psychology', '', NULL, '', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'PHD', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700836996', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('528869249', 'M77000276', 'M77000276', 'UT01', NULL, 'Valerie', '', 'Talbot', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '404 E 4500 S Ste B23', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012698202', NULL, '404 E 4500 S', 'Salt Lake City', '', 'UT', '84107', '', '', 'ARNP', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('200353976', 'M77000278', 'M77000278', 'UT01', NULL, 'David', 'B', 'Tate', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1071 E 100 S Ste A4', 'St George', 'Washington', 'UT', '84770', '4356560506', NULL, '1071 E 100 S Ste A4', 'St George', 'Washington', 'UT', '84770', '4356560506', '', 'PHD', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093992711', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
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('402822084', 'M77000280', 'M77000280', 'UT01', NULL, 'John', 'R', 'Taylor', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '1760 Prospector Ave', 'Park City', 'Summit', 'UT', '84060', '4356472911', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659431401', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870577591', 'M77000282', 'M77000282', 'UT01', NULL, 'Patricia', 'E', 'Taylor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '814 E BAMBURGER Dr Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017720202', NULL, '814 E BAMBURGER Dr Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '', 'PHD', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922158096', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('010764960', 'M77000283', 'M77000283', 'UT01', NULL, 'Robert', 'J', 'Thomas', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 2100 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014843089', NULL, '675 E 2100 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014843089', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215011408', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'M77000287', 'M77000287', 'UT01', NULL, 'Denise', '', 'Thorhill', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '546 S Chipeta Way Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817246', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870638284', 'M77000288', 'M77000288', 'UT01', NULL, 'Joseph', 'M', 'Timmins', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780652271', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870542255', 'M77000289', 'M77000289', 'UT01', NULL, 'Grant', 'L', 'Tolley', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '4568 S Highland Dr Ste 145', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726030', NULL, '4568 S Highland Dr', 'Salt Lake City', '', 'UT', '84117', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009121', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('551311368', 'M77000290', 'M77000290', 'UT01', NULL, 'Mark', '', 'Treuhaft', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '12300 S 1111 E Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8014816662', NULL, '12300 S 1111 E', 'Draper', 'Salt Lake', 'UT', '84020', '8014816662', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1871719799', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('529841145', 'M77000293', 'M77000293', 'UT01', NULL, 'Kristin', 'K', 'Urry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017066487', NULL, '1399 S 700 E Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017066487', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427126499', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870414241', 'M77000294', 'M77000294', 'UT01', NULL, 'Becky', NULL, 'Valcarce', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '3809 S W Temple Ste 1-B', 'Salt Lake City', 'Salt Lake', 'UT', '84165', '8012684454', NULL, '3809 S W Temple', 'Salt Lake City', '', 'UT', '84165', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009403', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870636109', 'M77000295', 'M77000295', 'UT01', NULL, 'Richard', 'E', 'Vassar Jr', 'LMFT', 'Mental Health', NULL, NULL, NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('529743181', 'M77000297', 'M77000297', 'UT01', NULL, 'Richard', 'L', 'Wailes', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '4667 S Holladay Blvd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8018081072', NULL, '4667 S Holladay Blvd', 'Salt Lake City', '', 'UT', '84114', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009477', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('060488333', 'M77000298', 'M77000298', 'UT01', NULL, 'Kimberly', 'R', 'Walsh', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1452 E Ridgeline Dr Ste 151', 'South Ogden', 'Weber', 'UT', '84415', '8014797009', NULL, '1452 E Ridgeline Dr Ste 151', 'South Ogden', 'Weber', 'UT', '84415', '8014797009', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1699750018', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870672215', 'M77000299', 'M77000299', 'UT01', NULL, 'John', 'O', 'Waterbury', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '52 W Boulton Way', 'Bountiful', 'Davis', 'UT', '84010', '8012982334', NULL, '52 W Boulton Way', 'Bountiful', '', 'UT', '84010', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009528', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('565766184', 'M77000300', 'M77000300', 'UT01', NULL, 'Sandy', 'K', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '466 N Main St Ste 201C', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', NULL, '466 N Main St Ste 201C', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396899712', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529426724', 'M77000301', 'M77000301', 'UT01', NULL, 'Steven', 'L', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3670 Quincy Ave Ste 104', 'Ogden', 'Weber', 'UT', '84403', '8016215666', NULL, '3670 Quincy Ave Ste 104', 'Ogden', 'Weber', 'UT', '84403', '8016215666', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619905098', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'M77000302', 'M77000302', 'UT01', NULL, 'Dex', '', 'Whitehead', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '459 N 300 W Ste 9', 'Kaysville', 'Davis', 'UT', '84037', '8012649522', NULL, '459 N 300 W Ste 9', 'Kaysville', 'Davis', 'UT', '84037', '8012649522', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487721841', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'M77000303', 'M77000303', 'UT01', NULL, 'Dex', '', 'Whitehead', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487721841', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'M77000304', 'M77000304', 'UT01', NULL, 'Sandra', 'L', 'Whitehouse', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('552988980', 'M77000308', 'M77000308', 'UT01', NULL, 'Gayle', 'B', 'Adams', 'LSW', 'Mental Health', NULL, NULL, NULL, 'O', '275 E S Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982610960', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870577774', 'M77000309', 'M77000309', 'UT01', NULL, 'Shane', '', 'Adamson', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '525 W 4500 S ', 'Murray', 'Salt Lake', 'UT', '84107', '8017472300', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'M77000310', 'M77000310', 'UT01', NULL, 'Clarence', 'L', 'Anderson', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S', 'Murray', '', 'UT', '84107', '', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005020', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('743115973', 'M77000311', 'M77000311', 'UT01', NULL, 'Jennifer', 'M', 'Anderson', 'PSYD', 'Mental Health', NULL, NULL, NULL, 'O', '14 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014919340', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811087125', 0, 'N', 0, '2007-04-04', 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
('529082093', 'M77000312', 'M77000312', 'UT01', NULL, 'Larry', 'A', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', NULL, '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700942281', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529082093', 'M77000313', 'M77000313', 'UT01', NULL, 'Larry', 'A', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8015582788', NULL, '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8015582788', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700942281', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870488011', 'M77000314', 'M77000314', 'UT01', NULL, 'Robert', 'H', 'Anderson', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84404', '8013937138', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'M77000315', 'M77000315', 'UT01', NULL, 'Victoria', 'E', 'Anderson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548323017', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('528869999', 'M77000316', 'M77000316', 'UT01', NULL, 'Marlin', 'V', 'Andrus', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1196 W S Jordan Pkwy Ste A3', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533169', NULL, '1196 W S Jordan Pkwy Ste A3', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533169', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215085691', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870633050', 'M77000317', 'M77000317', 'UT01', NULL, 'John', 'W', 'Arrington', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '120 N Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', NULL, '120 N Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730251828', 0, 'N', 0, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('202185222', 'M77000318', 'M77000318', 'UT01', NULL, 'Cynthia', 'H', 'Aune', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0199288618', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('880413974', 'M77000400', 'M77000400', 'UT01', NULL, 'Lucille', '', 'Hesse', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 8', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014851271', NULL, '1399 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014851271', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1821122268', 0, 'N', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870415391', 'M77000401', 'M77000401', 'UT01', NULL, 'Wilfred', 'H', 'Higashi', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '533 - 26th St Ste 102', 'Ogden', 'Weber', 'UT', '84401', '8016213624', NULL, '533 - 26th St', 'Ogden', 'Weber', 'UT', '84401', '8016213624', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1992754907', 0, 'N', 0, '2011-09-30', NULL, NULL, 0, 0, NULL, NULL),
('680585689', 'M77000402', 'M77000402', 'UT01', NULL, 'Diane', '', 'Hill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2040 E Murray-Holliday Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', NULL, '2040 E Murray-Holliday Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710045679', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('575669140', 'M77000403', 'M77000403', 'UT01', NULL, 'Susan', 'E', 'Hollenbeck', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194762997', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('575669140', 'M77000404', 'M77000404', 'UT01', NULL, 'Susan', 'E', 'Hollenbeck', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194762997', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870525799', 'M77000405', 'M77000405', 'UT01', NULL, 'Janet', 'E', 'Hooper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', NULL, '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111277', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870525799', 'M77000406', 'M77000406', 'UT01', NULL, 'Janet', 'E', 'Hooper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '750 Ridgeview Dr Ste 103', 'St George', 'Washington', 'UT', '84770', '4856686398', NULL, '750 Ridgeview Dr Ste 103', 'St George', 'Washington', 'UT', '84770', '4856686398', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111277', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870645661', 'M77000407', 'M77000407', 'UT01', NULL, 'John', 'W', 'Howard', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', NULL, '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689738130', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870560190', 'M77000408', 'M77000408', 'UT01', NULL, 'Beth', '', 'Hughes', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1255 E 3900 S Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667435', NULL, '1255 E 3900 S Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667435', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-26', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033289301', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('585325888', 'M77000409', 'M77000409', 'UT01', NULL, 'Cynthia', 'A', 'Hunt', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851432553', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('585325888', 'M77000410', 'M77000410', 'UT01', NULL, 'Cynthia', 'A', 'Hunt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '171 E 3rd Ave Ste 707', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8013555888', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '8013555888', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1851432553', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('585325888', 'M77000411', 'M77000411', 'UT01', NULL, 'Cynthia', 'A', 'Hunt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '275 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013555888', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '8013555888', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1851432553', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870626387', 'M77000412', 'M77000412', 'UT01', NULL, 'Karin', 'N', 'Hunt', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '40 W Cache Valley Blvd Ste 10-A', 'Logan', 'Cache', 'UT', '84341', '4357872272', NULL, '40 W Cache Valley Blvd', 'Logan', '', 'UT', '84341', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-05-26', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006809', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('383926786', 'M77000413', 'M77000413', 'UT01', NULL, 'Jeff', '', 'Hurd', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '5250 S Commerce Dr Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012314782', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('383926786', 'M77000414', 'M77000414', 'UT01', NULL, 'Jeff', '', 'Hurd', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '653 N Main St Ste 100', 'Farmington', 'Davis', 'UT', '84025', '8016269912', NULL, NULL, NULL, '', NULL, NULL, '', '', 'PHD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810501715', 'M77000415', 'M77000415', 'UT01', NULL, 'Howard', 'G', 'Ingle', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1208 E 33RD S', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8014831600', NULL, '1208 E 33RD S', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8014831600', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992854079', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870401368', 'M77000416', 'M77000416', 'UT01', NULL, 'Christopher', 'A', 'Isakson', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '950 S 663 W', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349449', NULL, '950 S 663 W', 'Brigham City', '', 'UT', '84302', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-06-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006877', 0, 'N', 0, '2007-04-04', 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
('201130097', 'M77000417', 'M77000417', 'UT01', NULL, 'Jennifer', NULL, 'Jackson', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '447 N 300 W Ste 7', 'Kaysville', 'Davis', 'UT', '84037', '8015442815', NULL, '447 N 300 W', 'Kaysville', '', 'UT', '84037', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720161177', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('770605641', 'M77000418', 'M77000418', 'UT01', NULL, 'Peggy', 'A', 'Jerome', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '1399 S 700 E Ste 17A', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015682898', NULL, '1399 S 700 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-26', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006945', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('770605641', 'M77000419', 'M77000419', 'UT01', NULL, 'Peggy', 'A', 'Jerome', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015682898', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-26', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870344043', 'M77000420', 'M77000420', 'UT01', NULL, 'Glen', 'E', 'Johnson', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '3940 W 4100 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019663700', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MD', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326157298', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'M77000421', 'M77000421', 'UT01', NULL, 'Kathryn', 'S', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce St Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce St', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613500', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1154486728', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('528783875', 'M77000422', 'M77000422', 'UT01', NULL, 'Jeryl', 'K', 'Kalinowski', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', NULL, '300 W 1400 S', 'Garland', '', 'UT', '84312', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007027', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('528783875', 'M77000423', 'M77000423', 'UT01', NULL, 'Jeryl', 'K', 'Kalinowski', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '415 Medical Dr Ste C100', 'Bountiful', 'Davis', 'UT', '84010', '8012922389', NULL, '415 Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007027', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('900012863', 'M77000424', 'M77000424', 'UT01', NULL, 'Shannette', NULL, 'Keeler', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '399 N Main St 3rd Flr', 'Logan', 'Cache', 'UT', '84321', '4357536882', NULL, '399 N Main St', 'Logan', '', 'UT', '84321', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007051', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('900012863', 'M77000425', 'M77000425', 'UT01', NULL, 'Shannette', NULL, 'Keeler', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '4184 W 1975 N', 'Plain City', 'Weber', 'UT', '84404', '8017321102', NULL, '4184 W 1975 N', 'Plain City', '', 'UT', '84404', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007051', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('900012863', 'M77000426', 'M77000426', 'UT01', NULL, 'Shannette', NULL, 'Keeler', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '9 W Forest 3rd Flr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232363', NULL, '9 W Forest', 'Brigham City', '', 'UT', '84302', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007051', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'M77000427', 'M77000427', 'UT01', NULL, 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529572392', 'M77000428', 'M77000428', 'UT01', NULL, 'Evan', 'T', 'Kenison', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8016348727', NULL, 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8016348727', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912977505', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('546963662', 'M77000429', 'M77000429', 'UT01', NULL, 'Lorraine', 'S', 'Kilpatrick', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '6925 Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528089711', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'M77000430', 'M77000430', 'UT01', NULL, 'Cynthia', NULL, 'Kimberlin-Flanders', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '459 N 300 W Ste 9', 'Kaysville', 'Davis', 'UT', '84037', '8018649522', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164588703', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'M77000431', 'M77000431', 'UT01', '', 'Cynthia', '', 'Kimberlin-Flanders', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 6, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164588703', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('573530177', 'M77000432', 'M77000432', 'UT01', NULL, 'Helen', NULL, 'Kjolby', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '3098 S Highland Dr Ste 347', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8016411841', NULL, '3098 S Highland Dr', 'Salt Lake City', '', 'UT', '84106', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007111', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('173400029', 'M77000433', 'M77000433', 'UT01', NULL, 'Mitchell', 'R', 'Koles', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 370', 'Ogden', 'Weber', 'UT', '84405', '8014798286', NULL, '425 E 5350 S', 'Ogden', '', 'UT', '84405', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007135', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('810501715', 'M77000514', 'M77000514', 'UT01', NULL, 'Doug', 'T', 'Wagstaff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457414930', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870437180', 'M77000515', 'M77000515', 'UT01', NULL, 'Anna', 'J', 'Waters', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84403', '8014768885', NULL, '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84403', '8014768885', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285715425', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870642460', 'M77000516', 'M77000516', 'UT01', NULL, 'Jackie', '', 'Webb', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '7321 S State St ', 'Midvale', 'Salt Lake', 'UT', '84047', '8015189904', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('265215568', 'M77000517', 'M77000517', 'UT01', NULL, 'Mary', 'B', 'Whittaker', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '970 E Murray-Holladay Rd Ste 2F', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012645099', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'M77000518', 'M77000518', 'UT01', NULL, 'Christopher', 'D', 'Wightman', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '323 S 600 E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013594884', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740337864', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870669782', 'M77000519', 'M77000519', 'UT01', NULL, 'Michelle', 'C', 'Wilcox', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '3392 W 3500 S ', 'West Valley', 'Salt Lake', 'UT', '84119', '8017555889', NULL, NULL, NULL, '', NULL, NULL, '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2006-05-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518986231', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('484768121', 'M77000520', 'M77000520', 'UT01', NULL, 'Pamela', 'C', 'Wilkison', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2700 Homestead Rd Ste 40', 'Park City', 'Summit', 'UT', '84098', '4359014307', NULL, '2700 Homestead Rd Ste 40', 'Park City', 'Summit', 'UT', '84098', '4359014307', '', 'PHD', NULL, '', '0.00', '100.00', '0.00', 3, '2006-06-09', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518923226', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('528843080', 'M77000521', 'M77000521', 'UT01', NULL, 'Ross', 'A', 'Williams', 'LMFT', 'Mental Health', NULL, NULL, NULL, 'O', '203 E Cobble Crk', 'Cedar City', 'Iron', 'UT', '84721', '4355592764', NULL, '203 E Cobble Crk', 'Cedar City', '', 'UT', '84721', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009634', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870390017', 'M77000522', 'M77000522', 'UT01', NULL, 'Jessica', 'L', 'Wolfinger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1325 W 2200 S Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019441666', NULL, '1325 W 2200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019441666', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1134189277', 0, 'N', 0, '2012-01-18', 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
('870390017', 'M77000523', 'M77000523', 'UT01', NULL, 'Jessica', 'L', 'Wolfinger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8184 S Highland Dr Ste C8', 'Sandy', 'Salt Lake', 'UT', '84093', '8019441666', NULL, '8184 S Highland Dr', 'Sandy', 'Salt Lake', 'UT', '84093', '8019441666', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1134189277', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('550926231', 'M77000524', 'M77000524', 'UT01', NULL, 'Nancy', 'G', 'Wooldridge', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012773810', NULL, '9263 B Redwood Rd', 'West Jordan', '', 'UT', '84088', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009671', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('520808921', 'M77000525', 'M77000525', 'UT01', NULL, 'Ellie', 'L', 'Young', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '14 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014726294', NULL, '14 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014726294', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-05-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235261983', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'M77000526', 'M77000526', 'UT01', NULL, 'Abbott', 'W', 'Kelly', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676238', NULL, '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 6, '2005-04-08', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007058', 0, 'N', 0, '2007-04-04', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('942854057', 'M77000527', 'M77000527', 'UT02', NULL, 'Chauncey', 'S', 'Adams', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '544 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4356884343', NULL, '544 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4356884343', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 8, '2006-10-13', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437251170', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('611500556', 'M77000529', 'M77000529', 'UT01', NULL, 'Becky', 'L', 'Anderson', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '2573 N 2450 E', 'Layton', 'Davis', 'UT', '84040', '8012729980', NULL, '2573 N 2450 E', 'Layton', '', 'UT', '84040', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-09-29', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005019', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('518547318', 'M77000530', 'M77000530', 'UT01', NULL, 'Irma', 'C', 'Atkinson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5418 N Eagle Rd Ste 180', 'Boise', 'Ada', 'ID', '83713', '2089383837', NULL, '5418 N Eagle Rd Ste 180', 'Boise', 'Ada', 'ID', '83713', '2089383837', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2005-07-08', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396706396', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('528459481', 'M77000531', 'M77000531', 'UT01', NULL, 'Diana', 'S', 'Ayotte', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', NULL, '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2006-09-08', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326110412', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('083405037', 'M77000532', 'M77000532', 'UT01', NULL, 'Bach-Whitehead', NULL, 'Trudy', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S', 'Salt Lake City', '', 'UT', '84107', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2005-09-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009188', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('202839360', 'M77000533', 'M77000533', 'UT01', NULL, 'Bacon', 'L', 'Jaime', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '220 W 300 N Ste 4', 'Kanab', 'Kane', 'UT', '84741', '4356442735', NULL, '220 W 300 N', 'Kanab', '', 'UT', '84741', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0202839360', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'M77000534', 'M77000534', 'UT01', NULL, 'Jeffrey', 'P', 'Baird', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2005-07-29', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750434049', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('519524217', 'M77000535', 'M77000535', 'UT01', NULL, 'Bills', NULL, 'Sandra', 'LCPC', 'Mental Health', NULL, NULL, NULL, 'O', '283 N 1st E', 'Driggs', 'Teton', 'ID', '83422', '2087879804', NULL, '283 N 1st E', 'Driggs', '', 'ID', '83422', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-02-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008580', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('519524217', 'M77000536', 'M77000536', 'UT01', NULL, 'Bills', NULL, 'Sandra', 'LCPC', 'Mental Health', NULL, NULL, NULL, 'O', '956 E Maple', 'Pocatello', 'Bannock', 'ID', '83201', '2087879804', NULL, '956 E Maple', 'Pocatello', '', 'ID', '83201', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-02-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008580', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('321587586', 'M77000537', 'M77000537', 'UT01', NULL, 'Bohmer', 'M', 'Kate', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', NULL, '131 N Allumbaugh', 'Boise', '', 'ID', '83704', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2004-03-26', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007042', 0, 'N', 0, '2007-04-04', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('238197561', 'M77000538', 'M77000538', 'UT01', NULL, 'Borg', 'C', 'Michael', 'PHD', 'Mental Health', NULL, NULL, NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', NULL, '131 N Allumbaugh', 'Boise', '', 'ID', '83704', '', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2004-04-30', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007590', 0, 'N', 0, '2007-04-04', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('529411310', 'M77000539', 'M77000539', 'UT01', NULL, 'Bradford', NULL, 'Lisa', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '1466 N Hwy 89 Ste 220', 'Farmington', 'Davis', 'UT', '84025', '8014510475', NULL, '1466 N Hwy 89', 'Farmington', '', 'UT', '84025', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-09-08', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007298', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('452766405', 'M77000540', 'M77000540', 'UT01', NULL, 'Nancy', '', 'Bradish', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1745 Sidewinder', 'Park City', 'Summit', 'UT', '84068', '4356492430', NULL, '1745 Sidewinder', 'Park City', 'Summit', 'UT', '84068', '4356492430', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-02-23', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942340963', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('529480464', 'M77000541', 'M77000541', 'UT01', NULL, 'Anne', 'R', 'Brockbank', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1199 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012928685', NULL, '1199 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012928685', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-01-13', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795702', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('533463728', 'M77000542', 'M77000542', 'UT01', NULL, 'Brown', NULL, 'Crete', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '303 N 12th Ave', 'Pocatello', 'Bannock', 'ID', '83201', '2082512400', NULL, '303 N 12th Ave', 'Pocatello', '', 'ID', '83201', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2005-08-12', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005834', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('528250674', 'M77000544', 'M77000544', 'UT01', NULL, 'Brandon', 'M', 'Burr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '45 N State St', 'Salina', 'Sevier', 'UT', '84654', '4359795218', NULL, '45 N State St', 'Salina', 'Sevier', 'UT', '84654', '4359795218', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2004-01-30', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225191984', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('529459777', 'M77000545', 'M77000545', 'UT01', NULL, 'Cynthia', 'P', 'Butters', 'APRN', 'Family Practice', 'Mental Health', 'Counseling', NULL, 'O', '3761 S 700 E Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013130555', NULL, '3761 S 700 E Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013130555', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-10-27', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952398737', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('528395645', 'M77000546', 'M77000546', 'UT01', NULL, 'Butters', 'P', 'Rob', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '3761 S 700 E Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013130555', NULL, '3761 S 700 E', 'Salt Lake City', '', 'UT', '84106', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-02-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008417', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('529400458', 'M77000547', 'M77000547', 'UT01', NULL, 'Patsy', 'G', 'Butts', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '1893 Wide River Dr', 'St George', 'Washington', 'UT', '84790', '4356569258', NULL, '1893 Wide River Dr', 'St George', '', 'UT', '84790', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-06-30', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053477919', 0, 'N', 0, '2007-11-20', NULL, NULL, 0, 0, NULL, NULL),
('534604243', 'M77000548', 'M77000548', 'UT01', NULL, 'Paulette', '', 'Caprai-Findlay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3940 W  4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '3940 W  4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 3, '2005-12-16', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174639231', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870616652', 'M77000549', 'M77000549', 'UT01', NULL, 'Chidester', 'C', 'Robert', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '3670 Quincy Ave Ste 104', 'Ogden', 'Weber', 'UT', '84404', '8018146561', NULL, '3670 Quincy Ave', 'Ogden', '', 'UT', '84404', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-09-29', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008419', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('528136237', 'M77000631', 'M77000631', 'UT01', NULL, 'Richard', '', 'Schuurman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '545 W 500 S Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012960223', NULL, '545 W 500 S', 'Bountiful', 'Davis', 'UT', '84010', '8012960223', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-07-14', '2008-06-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1790837771', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('558842204', 'M77000632', 'M77000632', 'UT01', NULL, 'Seager', NULL, 'Stephen', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', NULL, '544 S 400 E', 'St George', '', 'UT', '84770', '', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-26', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008902', 0, 'N', 0, '2007-04-04', 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
('529582704', 'M77000633', 'M77000633', 'UT01', NULL, 'Smith', 'L', 'Brian', 'PHD', 'Mental Health', '', '', NULL, 'O', '1816 No 200 W', 'Layton', 'Davis', 'UT', '84041', '8017217581', NULL, '1816 No 200 W', 'Layton', 'Davis', 'UT', '84041', '8017217581', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-02-23', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005414', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870577721', 'M77000634', 'M77000634', 'UT01', NULL, 'St John', NULL, 'Sharon', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '555 E 5300 S Bldg 2 Ste 6', 'Ogden', 'Weber', 'UT', '84405', '8016215385', NULL, '555 E 5300 S', 'Ogden', '', 'UT', '84405', '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2007-12-01', '2007-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437121357', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870577721', 'M77000635', 'M77000635', 'UT01', NULL, 'St John', NULL, 'Sharon', 'LPC', 'Mental Health', NULL, NULL, NULL, 'O', '431 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '8663343574', NULL, '431 W 600 N', 'Tremonton', '', 'UT', '84337', '', '', 'MA', NULL, NULL, '0.00', '100.00', NULL, 3, '2007-12-01', '2007-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437121357', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('486540913', 'M77000636', 'M77000636', 'UT01', NULL, 'Stanhope', 'L', 'Helen', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '1399 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015682898', NULL, '1399 S 700 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-12', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629003900', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('486540913', 'M77000637', 'M77000637', 'UT01', NULL, 'Stanhope', 'L', 'Helen', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '8537 S Redwood Rd Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8015682898', NULL, '8537 S Redwood Rd', 'Salt Lake City', '', 'UT', '84115', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-12', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629003900', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'M77000638', 'M77000638', 'UT01', NULL, 'Gail', 'T', 'Szykula', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1545 E  3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014782780', NULL, '1545 E  3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014782780', '', 'MA', NULL, '', '0.00', '100.00', '0.00', 6, '2006-01-13', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043284953', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870616151', 'M77000639', 'M77000639', 'UT01', NULL, 'John', 'R', 'Taylor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '136 Heber Ave', 'Park City', 'Summit', 'UT', '84060', '4356472911', NULL, '136 Heber Ave', 'Park City', 'Summit', 'UT', '84060', '4356472911', '', 'PHD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2004-05-14', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659431401', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('519029116', 'M77000640', 'M77000640', 'UT01', NULL, 'Thaxton', 'D', 'Stephen', 'LCPC', 'Mental Health', NULL, NULL, NULL, 'O', '1674 Hill Rd Ste 20', 'Boise', 'Ada', 'ID', '83702', '2083360954', NULL, '1674 Hill Rd', 'Boise', '', 'ID', '83702', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2000-01-14', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008903', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'M77000641', 'M77000641', 'UT01', NULL, 'Thayne', '', 'Melissa', 'LCSW', 'Mental Health', '', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 6, '2007-03-09', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007560', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'M77000642', 'M77000642', 'UT01', NULL, 'Thayne', '', 'Melissa', 'LCSW', 'Mental Health', '', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'MD', NULL, NULL, '0.00', '100.00', '0.00', 6, '2007-03-09', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007560', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('520742989', 'M77000643', 'M77000643', 'UT01', NULL, 'Nicholas', 'K', 'Tsandes', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '2040 E Murray Holladay Rd Ste 117', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019131497', NULL, '2040 E Murray Holladay Rd', 'Salt Lake City', '', 'UT', '84117', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-12-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009195', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('550900061', 'M77000644', 'M77000644', 'UT01', NULL, 'Uberuaga-Rodgers', 'L', 'Damiana', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', NULL, '131 N Allumbaugh', 'Boise', '', 'ID', '83704', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2004-04-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005880', 0, 'N', 0, '2007-04-04', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('544587673', 'M77000645', 'M77000645', 'UT01', NULL, 'Anita', 'C', 'Ure', 'LCSW', 'Mental Health', NULL, NULL, NULL, 'O', '3771 S 5500 W', 'Hooper', 'Weber', 'UT', '84315', '8019412196', NULL, '3771 S 5500 W', 'Hooper', '', 'UT', '84315', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-09-29', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009335', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'M77000646', 'M77000646', 'UT01', '', 'Christopher', 'D', 'Wightman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '323 S 600 E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013594884', NULL, '323 S 600 E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013594884', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 6, '2005-12-02', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740337864', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('528478267', 'M77000647', 'M77000647', 'UT01', NULL, 'Williams', 'John', 'Jason', 'LMFT', 'Mental Health', NULL, NULL, NULL, 'O', '120 N  Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', NULL, '120 N  Main St', 'Brigham City', '', 'UT', '84302', '', '', 'MA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-03-09', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006918', 0, 'N', 0, '2007-04-04', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S32000002', 'S32000002', 'UT01', 'Office of Recovery Services', NULL, NULL, 'Office of Recovery Services', 'GROUP', 'Recovery Services', NULL, NULL, NULL, 'B', 'PO Box 45025', 'Salt Lake City', 'Salt Lake', 'UT', '84145', NULL, NULL, '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007935', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('510123924', 'S33000001', 'S33000001', 'UT01', 'Smith Nephew Inc (Bone Stimulators)', '', '', 'Smith Nephew Inc (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 22987', 'Chicago', 'Cook', 'IL', '60673', '8006374391', NULL, '1450 Brooks Rd', 'Memphis', 'Cook', 'Tenn', '38116', '8006374391', '          ', '', '', '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000002531', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000008', 'S33000008', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1218 W Hwy 40', 'Vernal', 'Uintah', 'UT', '84078', '4357899500', NULL, '1218 W Hwy 40', 'Vernal', 'Uintah', 'UT', '84078', '4357899500', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000009', 'S33000009', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '165 E 1400 N Ste D', 'Logan', 'Cache', 'UT', '84341', '4357522100', NULL, '165 E 1400 N Ste D', 'Logan', 'Cache', 'UT', '84341', '4357522100', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000010', 'S33000010', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '206 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013944000', NULL, '206 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013944000', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000011', 'S33000011', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '235 E 6100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012615100', NULL, '235 E 6100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012615100', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000012', 'S33000012', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 N Geneva Rd', 'Lindon', 'Utah', 'UT', '84042', '8017851000', NULL, '400 N Geneva Rd', 'Lindon', 'Utah', 'UT', '84042', '8017851000', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000013', 'S33000013', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '60 S 700 E Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356379500', NULL, '60 S 700 E Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356379500', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000014', 'S33000014', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'Dept CH 14104', 'Palatine', 'Cook', 'IL', '60055', '4357522100', NULL, 'Dept CH 14104', 'Palatine', 'Cook', 'IL', '60055', '4357522100', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000015', 'S33000015', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1509 S 270 E Ste 9', 'St George', 'Washington', 'UT', '84790', '4356733250', NULL, '1509 S 270 E Ste 9', 'St George', 'Washington', 'UT', '84790', '4356733250', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000016', 'S33000016', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1333 N Main St Ste 102', 'Cedar City', 'Iron', 'UT', '84720', '4355860379', NULL, '1333 N Main St Ste 102', 'Cedar City', 'Iron', 'UT', '84720', '4355860379', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2006-05-01', '2014-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('450467418', 'S33000017', 'S33000017', 'UT01', 'Praxair Healthcare Services', NULL, NULL, 'Praxair Healthcare Services Inc', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', 'CH Dept 14104', 'Palatine', 'Cook', 'IL', '60055', '4357522100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'Wpraxair', NULL, NULL, '0.00', '20.00', NULL, 3, '2006-05-01', '2006-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '676746', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'S33000018', 'S33000018', 'UT01', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', NULL, '1000E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', '', '', NULL, NULL, '0.00', '36.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'N', 0, '2011-07-13', NULL, NULL, 40.0446, -111.716, NULL, NULL),
('870333048', 'S33000019', 'S33000019', 'UT01', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '8014659201', NULL, '1000 E 100 N', 'Payson', 'Fulton', 'UT', '84651', '8014659201', '', '', NULL, NULL, '0.00', '36.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('270006645', 'S33000020', 'S33000020', 'UT01', 'Alpine Surgical Center ', NULL, NULL, 'Alpine Surgical Center LLC', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3680', 'Ogden', 'Weber', 'UT', '84403', '8013873900', '8013873905', '4403 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000830846', 0, 'N', 0, '2007-01-05', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870566789', 'S33000021', 'S33000021', 'UT01', 'Central Utah Surgical Center', NULL, NULL, 'Central Utah Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1067 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013740354', NULL, '1067 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013740354', '          ', '', '', '2', '0.00', '0.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962463950', 0, 'N', 0, '2013-11-25', NULL, NULL, 40.2484, -111.667, NULL, NULL),
('870566789', 'S33000022', 'S33000022', 'UT01', 'Central Utah Surgical Center', NULL, NULL, 'Central Utah Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 271472', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013566002', NULL, 'PO Box 271472', 'Salt Lake City', '', 'UT', '84127', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962463950', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('481272182', 'S33000023', 'S33000023', 'UT01', 'Eastern Utah Surgical Center', NULL, NULL, 'Eastern Utah Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '200 N Fairgrounds Rd Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356371744', NULL, '200 N Fairgrounds Rd', 'Price', '', 'UT', '84501', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 6, '2006-11-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619048170', 0, 'N', 0, '2006-10-19', NULL, NULL, 39.6051, -110.835, NULL, NULL),
('721342565', 'S33000030', 'S33000030', 'UT01', 'Mountain West Endoscopy', NULL, NULL, 'Mountain West Endoscopy', 'GROUP', 'Endoscopy Center', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443141', NULL, '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 3, '2006-06-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000830859', 0, 'N', 0, '2006-08-31', NULL, NULL, 40.6339, -111.806, NULL, NULL),
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('870419324', 'S33000085', 'S33000085', 'UT01', 'Central Valley Medical Center', NULL, NULL, 'Central Valley Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 412', 'Nephi', 'Juab', 'UT', '84648', NULL, NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, '1', '0.00', '11.00', NULL, 3, '2006-11-01', '2006-11-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881658110', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680562507', 'S33000088', 'S33000088', 'UT01', 'Davis Hospital', '', '', 'Davis Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '', '', NULL, NULL, '0.00', '47.00', '0.00', 6, '2007-07-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1548205818', 0, 'N', 0, '2011-07-18', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('680562507', 'S33000089', 'S33000089', 'UT01', 'Davis Hospital', '', '', 'Davis Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 26894', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '8017287200', NULL, '1600 W Antelope Dr', 'Layton', 'Salt Lake', 'UT', '84041', '8017287200', '', '', NULL, NULL, '0.00', '47.00', '0.00', 6, '2007-07-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1548205818', 0, 'Y', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870674233', 'S33000090', 'S33000090', 'UT01', 'Utah Surgical Center', NULL, NULL, 'Utah Surgical Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '3715 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570200', NULL, '3715 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 3, '2006-11-01', '2009-09-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629032305', 0, 'N', 0, '2009-09-24', NULL, NULL, 0, 0, NULL, NULL),
('870674233', 'S33000091', 'S33000091', 'UT01', 'Utah Surgical Center', NULL, NULL, 'Utah Surgical Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', 'PO Box 26211', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '8019570200', NULL, '3715 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', '', NULL, '2', '0.00', '0.00', '0.00', 3, '2006-11-01', '2009-09-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629032305', 0, 'Y', 0, '2009-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742715684', 'S33000103', 'S33000103', 'UT01', 'Rocky Mountain Care-Clearfield', NULL, NULL, 'Rocky Mountain Care-Clearfield', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '1450 S 1500 E', 'Clearfield', 'Davis', 'UT', '84015', '8013974300', '8013974390', NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '7', '0.00', '100.00', NULL, 3, '2006-11-01', '2007-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629075361', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200290337', 'S33000104', 'S33000104', 'UT01', 'Heritage Woodland Park Care Center', '', '', 'Heritage Woodland Park Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '3855 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012684766', '8012684893', '3855 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012684766', '8012684893', '', NULL, '7', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831931', 0, 'N', 0, '2012-10-02', NULL, NULL, 40.6879, -111.871, NULL, NULL),
('200290337', 'S33000105', 'S33000105', 'UT01', 'Woodland Park Care Center', '', '', 'Woodland Park Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'B', 'PO Box 27648', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012684766', NULL, 'PO Box 27648', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012684766', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336140094', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870257692', 'S33000106', 'S33000106', 'UT01', 'South Davis Community Hospital Home Health and Hospice', NULL, NULL, 'South Davis Community Hospital Home Health and Hospice', 'GROUP', 'Skilled Nursing Facility', 'Home Health Agency', 'Hospice', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', NULL, '401 S 400 E', 'Bountiful', '', 'UT', '84010', '', '', '', NULL, '4', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831932', 0, 'N', 0, '2006-11-01', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('522085558', 'S33000109', 'S33000109', 'UT01', 'Wasatch Care Center', '', '', 'Wasatch Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '3430 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013995609', NULL, '3430 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013995609', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-11-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1467472241', 0, 'N', 0, '2012-04-25', NULL, NULL, 41.2009, -111.949, NULL, NULL),
('522085558', 'S33000110', 'S33000110', 'UT01', 'Wasatch Valley Rehab', '', '', 'Wasatch Valley Rehab', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '2200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014862096', NULL, '2200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014862096', '', '', NULL, '7', '0.00', '100.00', '0.00', 3, '2006-11-01', '2009-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831936', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'S33000111', 'S33000111', 'UT01', 'Crosslands Rehab & Healthcare', '', '', 'Crosslands Rehab & Healthcare', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-11-01', '2013-06-07', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831937', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870208619', 'S33000112', 'S33000112', 'UT01', 'Sunshine Terrace Foundation', '', '', 'Sunshine Terrace Foundation', 'GROUP', 'Skilled Nursing Facility', 'Hospice', 'Home Health Agency', NULL, 'O', '225 N 200 W', 'Logan', 'Cache', 'UT', '84321', '4357520411', '4357521318', '225 N 200 W', 'Logan', 'Cache', 'UT', '84321', '4357520411', '4357521318', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-11-01', '2011-06-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879493', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870208619', 'S33000113', 'S33000113', 'UT01', 'Sunshine Terrace Foundation', NULL, NULL, 'Sunshine Terrace Foundation', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'B', '225 N 200 W Attn: Merrill C Daines - Med Director', 'Logan', 'Cache', 'UT', '84321', '4357520411', '4357521318', '225 N 200 W', 'Logan', '', 'UT', '84321', '', '', NULL, NULL, '7', '0.00', '100.00', NULL, 3, '2000-01-01', '2000-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831938', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S33000114', 'S33000114', 'UT01', 'San Juan Hospital - Pro Fees', '', '', 'San Juan Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '380 W 100 N ', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', NULL, NULL, NULL, '0.00', '8.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1942251459', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S33000115', 'S33000115', 'UT01', 'San Juan Hospital - Pro Fees', '', '', 'San Juan Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', NULL, 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355872116', '', '', NULL, NULL, '0.00', '8.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942251459', 0, 'y', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'S33000118', 'S33000118', 'UT01', 'Salt Lake Regional Medical Center', NULL, NULL, 'Salt Lake Regional Medical Center', 'GROUP', 'Outpatient Facility', NULL, NULL, NULL, 'O', '1050 E S Temple ', 'Salt Lake City', 'Salt Lake', 'UT', '84102', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '0.00', '42.00', 3, '2006-02-01', '2006-02-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417988833', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'S33000119', 'S33000119', 'UT01', 'Salt Lake Regional Medical Center', NULL, NULL, 'Salt Lake Regional Medical Center', 'GROUP', 'Outpatient Facility', NULL, NULL, NULL, 'B', 'PO Box 26935 ', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '8013508141', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '0.00', '42.00', 3, '2006-02-01', '2006-02-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417988833', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'S33000121', 'S33000121', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '1105 S Hwy 191 Ste 3', 'Moab', 'Grand', 'UT', '84532', '4352594879', '4352599877', '350 E 300 S', 'Bountiful', 'Grand', 'UT', '84010', '4352594879', '4352599877', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'S33000122', 'S33000122', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '1190 Spring Creek Pl Ste B', 'Springville', 'Utah', 'UT', '84663', '8014919139', '8014919138', '350 E 300 S', 'Bountiful', 'Utah', 'UT', '84010', '8014919139', '8014919138', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 40.1844, -111.631, NULL, NULL),
('870468543', 'S33000123', 'S33000123', 'UT01', 'Rocky Mountain Home Care', NULL, NULL, 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', NULL, NULL, 'B', '350 E 300 S Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8013974196', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '4', '0.00', '100.00', NULL, 3, '2006-12-01', '2006-12-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386642965', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'S33000124', 'S33000124', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '5250 Commerce Dr Ste 270', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013974950', '8013974959', '350 E 300 S', 'Bountiful', 'Salt Lake', 'UT', '84010', '8013974950', '8013974959', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 40.6564, -111.899, NULL, NULL),
('870468543', 'S33000125', 'S33000125', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '5734 S 1475 E Ste 200B', 'Ogden', 'Weber', 'UT', '84403', '8014794650', '8014793238', '350 E 300 S', 'Bountiful', 'Weber', 'UT', '84010', '8014794650', '8014793238', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 41.1593, -111.943, NULL, NULL),
('870468543', 'S33000126', 'S33000126', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '60 E 100 N', 'Price', 'Carbon', 'UT', '84501', '4356370665', '4356379284', '350 E 300 S', 'Bountiful', 'Carbon', 'UT', '84010', '4356370665', '4356379284', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 39.601, -110.81, NULL, NULL),
('870468543', 'S33000127', 'S33000127', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '92 E 100 S', 'Blanding', 'San Juan', 'UT', '84511', '4356783266', '4356784054', '350 E 300 S', 'Bountiful', 'San Juan', 'UT', '84010', '4356783266', '4356784054', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'S33000128', 'S33000128', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '95 Golf Course Rd Ste 106', 'Logan', 'Cache', 'UT', '84321', '4357538220', '4357539069', '350 E 300 S', 'Bountiful', 'Cache', 'UT', '84010', '4357538220', '4357539069', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 41.7155, -111.839, NULL, NULL),
('870468543', 'S33000129', 'S33000129', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '350 E 300 S Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8013974800', '8013974890', '350 E 300 S', 'Bountiful', 'Davis', 'UT', '84010', '8013974800', '8013974890', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 40.8863, -111.873, NULL, NULL),
('870468543', 'S33000130', 'S33000130', 'UT01', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '204 N 1000 E', 'St George', 'Washington', 'UT', '84770', '4356736699', '4356561190', '350 E 300 S', 'Bountiful', 'Washington', 'UT', '84010', '4356736699', '4356561190', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'S33000131', 'S33000131', 'UT01', 'Rocky Mountain Home Care', NULL, NULL, 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', NULL, NULL, 'B', '350 E 300 S Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8013974196', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '4', '0.00', '100.00', NULL, 3, '2006-12-01', '2006-12-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386642965', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870425864', 'S33000132', 'S33000132', 'UT01', 'Holladay Health Care Center', NULL, NULL, 'Holladay Health Care Center', NULL, 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '4782 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012777002', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1959', '0.00', '30.00', NULL, 3, '2006-12-01', '2006-12-31', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831950', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'S33000133', 'S33000133', 'UT01', 'Federal Heights Rehab & Nursing', '', '', 'Federal Heights Rehab & Nursing', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8014469154', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-11-01', '2013-06-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831952', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('953723933', 'S33000134', 'S33000134', 'UT01', 'Rocky Mountain Hospice', NULL, NULL, 'Rocky Mountain Hospice', 'GROUP', 'Hospice', NULL, NULL, NULL, 'O', '5250 Commerce Dr Ste 270', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013974900', '8013974196', '5250 Commerce Dr', 'Salt Lake City', '', 'UT', '841077626', '', '', '', NULL, '3', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871535138', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6564, -111.899, NULL, NULL),
('752752908', 'S33000141', 'S33000141', 'UT01', 'Odyssey HealthCare', NULL, NULL, 'Odyssey HealthCare', 'GROUP', 'Hospice', NULL, NULL, NULL, 'O', '25 S Main St Ste 210', 'Centerville', 'Davis', 'UT', '84014', '8012948600', '8012945838', NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '3', '0.00', NULL, NULL, 3, '2007-01-01', '2007-04-07', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831960', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('752752908', 'S33000142', 'S33000142', 'UT01', 'Odyssey Healthcare', NULL, NULL, 'Odyssey Healthcare', 'GROUP', 'Hospice', NULL, NULL, NULL, 'B', 'PO Box 847949', 'Dallas', 'Dallas', 'TX', '75284', '8012948600', '8012945838', NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '3', '0.00', NULL, NULL, 3, '2007-01-01', '2007-04-07', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831960', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'S33000145', 'S33000145', 'UT01', 'Metwest dba Quest Diagnostic', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', NULL, NULL, NULL, 'B', '2032 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', NULL, NULL, '695 S Broadway', 'Denver', '', 'CO', '80209', '', '', 'WUQUEST5', NULL, NULL, '0.00', '20.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831976', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'S33000146', 'S33000146', 'UT01', 'Quest Diagnostics-Layton', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1660 W Antelope Dr Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017792313', '8017792331', '1660 W Antelope Dr Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017792313', '8017792331', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.0892, -111.996, NULL, NULL),
('330363116', 'S33000147', 'S33000147', 'UT01', 'Quest Diagnostics-Ogden', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1464 E Ridgeline Dr Ste 103', 'Ogden', 'Weber', 'UT', '84405', '8014750002', '8014780003', '1464 E Ridgeline Dr Ste 103', 'Ogden', 'Weber', 'UT', '84405', '8014750002', '8014780003', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'S33000148', 'S33000148', 'UT01', 'Quest Diagnostics-Provo', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1875 N 1120 W', 'Provo', 'Utah', 'UT', '84604', '8013735660', '8013735664', '1875 N 1120 W', 'Provo', 'Utah', 'UT', '84604', '8013735660', '8013735664', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2006-12-01', '2008-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'S33000149', 'S33000149', 'UT01', 'Quest Diagnostics-SLC', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1140 E 3900 S Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012691243', '8012632619', '1140 E 3900 S Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012691243', '8012632619', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2006-12-01', '2010-02-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('870683247', 'S33000156', 'S33000156', 'UT01', 'FirstMed Urgent Care M-F 8am-9pm  Sat 9am-9pm  Sun Noon-9pm', '', '', 'FirstMed Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '8822 Redwood Rd Ste E122', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667080', NULL, '8822 Redwood Rd Ste E122', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667080', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831987', 0, 'N', 0, '2013-06-12', NULL, NULL, 40.5916, -111.939, NULL, NULL),
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('876000525', 'S33000161', 'S33000161', 'UT01', 'U of U Hospital - Home Infusion', '', '', 'U of U Hospital - Home Infusion', 'GROUP', 'Infusion Agency', '', '', NULL, 'B', 'PO Box 816', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017547154', NULL, 'PO Box 816', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017547154', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009232', 0, 'Y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'S33000162', 'S33000162', 'UT01', 'University Health Care Hospital Home Infusion', '', '', 'U of U Hospital Home Infusion', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', 'Phone Number Only', '', 'Salt Lake', 'UT', '', '8775180411', NULL, '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8775180411', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1306883954', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('043115329', 'S33000180', 'S33000180', 'UT01', 'Critical Care Systems', '', '', 'Critical Care Systems ', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'B', 'PO Box 52777', 'Phoenix', 'Maricopa', 'AZ', '85072', '8669789600', '6038884701', 'PO Box 52777', 'Phoenix', 'Maricopa', 'AZ', '85072', '8669789600', '6038884701', '', NULL, '1001', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588692164', 0, 'Y', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
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('431850570', 'S33000182', 'S33000182', 'UT01', 'Caremark', '', '', 'Choice Source Therapeutics', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'B', '20333 State Hwy 249 Ste 450', 'Houston', 'Harris', 'TX', '77070', '8002372767', NULL, '2211 Sanders Rd', 'Northbrook', 'Harris', 'IL', '60673', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1164403069', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
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('245712050', 'S33000184', 'S33000184', 'UT01', 'Precision Diagnostic Services', '', '', 'Precision Diagnostic Services ', 'GROUP', 'Sleep Disorders', '', '', NULL, 'O', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', NULL, '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '          ', 'WCSTPDS', '', '', '0.00', '100.00', '0.00', 3, '2006-11-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871691246', 0, 'N', 0, '2013-05-29', NULL, NULL, 0, 0, NULL, NULL),
('841375719', 'S33000187', 'S33000187', 'UT01', 'RGL Medical Services', '', '', 'RGL Medical Services', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'O', '1561 W 7000 S Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689895', NULL, '1561 W 7000 S Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689895', '          ', 'WUSTDRAD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376568907', 0, 'Y', 0, '2012-12-04', NULL, NULL, 40.6241, -111.935, NULL, NULL),
('841375719', 'S33000188', 'S33000188', 'UT01', 'RGL Medical Services', '', '', 'RGL Medical Services', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '          ', 'WUSTDRAD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376568907', 0, 'Y', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'S33000189', 'S33000189', 'UT01', 'St Marks Hospital', NULL, NULL, 'St Marks Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687700', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', NULL, NULL, '0.00', '36.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832716', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'S33000190', 'S33000190', 'UT01', 'St Marks Professional Services', NULL, NULL, 'St Marks Professional Services', 'GROUP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912925629', 0, 'y', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S33000191', 'S33000191', 'UT01', 'Granger Medical Clinic', '', '', 'Granger Medical Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184657041', 0, 'Y', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S33000192', 'S33000192', 'UT01', 'Granger Medical Clinic M-F 9am-9pm  Sat 9am-9pm', '', '', 'Granger Medical Clinic Urgent ', 'GROUP', 'Urgent Care', '', '', NULL, 'B', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653484', '8019653740', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653484', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832840', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('900151382', 'S33000193', 'S33000193', 'UT01', 'Mountain Medical Urgent Care', NULL, NULL, 'Mountain Medical Urgent Care', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'B', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017681555', NULL, '127 E Main St', 'Lehi', '', 'UT', '84043', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832880', 0, 'Y', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'S33000194', 'S33000194', 'UT01', 'Salt Lake Regional Physicians ', NULL, '', 'Salt Lake Regional Physicians', 'GROUP', 'Outpatient Facility', NULL, NULL, NULL, 'O', '1050 E S Temple ', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '0.00', NULL, 3, '2006-02-01', '2006-02-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'S33000195', 'S33000195', 'UT01', 'Salt Lake Regional Physicians ', NULL, '', 'Salt Lake Regional Physicians', 'GROUP', 'Outpatient Facility', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '0.00', NULL, 3, '2006-02-01', '2006-02-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870376400', 'S33000197', 'S33000197', 'UT01', 'Pathology Services', NULL, NULL, 'Pathology Services', 'GROUP', 'Pathology', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512205', NULL, '1380 E Medical Ctr Dr', 'St George', '', 'UT', '847902123', '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832932', 0, 'Y', 0, '2006-12-21', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('870376400', 'S33000198', 'S33000198', 'UT01', 'Pathology Services', NULL, NULL, 'Pathology Services', 'GROUP', 'Pathology', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8435711197', '8435713824', 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832932', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S33000199', 'S33000199', 'UT01', 'After Hours Medical Company', NULL, NULL, 'After Hours Medical Company', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', '', 'UT', '84020', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437251279', 0, 'Y', 0, '2007-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S33000200', 'S33000200', 'UT01', 'After Hours Urgent Care Draper M-Sun 8am-8pm', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S33000201', 'S33000201', 'UT01', 'After Hours Urgent Care S Jordan M-Sun 9am-9pm ', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'S33000202', 'S33000202', 'UT01', 'After Hours Urgent Care WVC M-Sun 9am-10pm', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'S33000204', 'S33000204', 'UT01', 'After Hours Urgent Care American Fork M-Sun  9am-8pm', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014921480', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014921480', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('470901059', 'S33000209', 'S33000209', 'UT01', 'Anatomic Pathology Associates ', NULL, NULL, 'Anatomic Pathology Associates ', 'GROUP', 'Pathology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8007348870', NULL, 'PO Box 727', 'Brigham City', '', 'UT', '84302', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558441485', 0, 'Y', 0, '2006-10-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('470901059', 'S33000210', 'S33000210', 'UT01', 'Anatomic Pathology Associates ', NULL, NULL, 'Anatomic Pathology Associates ', 'GROUP', 'Pathology', NULL, NULL, NULL, 'B', 'PO Box 727', 'Brigham City', 'Box Elder', 'UT', '84302', '8007348870', NULL, 'PO Box 727', 'Brigham City', '', 'UT', '84302', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558441485', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870629575', 'S33000211', 'S33000211', 'UT01', 'Central Utah Pathology', '', '', 'Central Utah Pathology', 'GROUP', 'Pathology', '', '', NULL, 'B', 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84047', '8012630810', '8012708170', 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84057', '8012630810', '8012708170', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000833020', 0, 'Y', 0, '2011-03-07', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S33000233', 'S33000233', 'UT01', 'North Davis Anesthesiology', NULL, NULL, 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', 'PO Box 98', 'Farmington', '', 'UT', '84025', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679525901', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S33000234', 'S33000234', 'UT01', 'North Davis Anesthesiology', NULL, NULL, 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 98', 'Farmington', '', 'UT', '84025', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679525901', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S33000237', 'S33000237', 'UT01', 'North Davis Anesthesiology', NULL, NULL, 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, 'PO Box 98', 'Farmington', '', 'UT', '84025', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679525901', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'S33000238', 'S33000238', 'UT01', 'North Davis Anesthesiology', NULL, NULL, 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013932249', '8013939909', NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-06-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679525901', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870306646', 'S33000257', 'S33000257', 'UT01', 'Emergency Physicians Group', '', '', 'Emergency Physicians Group', 'GROUP', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1598088098', 0, 'Y', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870327686', 'S33000260', 'S33000260', 'UT01', 'Professional Diagnostics', NULL, NULL, 'Professional Diagnostics', 'GROUP', 'Pathology', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012630810', NULL, 'PO Box 276', 'Midvale', '', 'UT', '84047', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184670606', 0, 'Y', 0, '2007-03-27', NULL, NULL, 40.7694, -111.861, NULL, NULL),
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('870565773', 'S33000307', 'S33000307', 'UT01', 'Mountain Medical Physician Specialists', '', '', 'Mountain Medical Physician Specialists Radiology', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'B', '5444 Green St', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012841702', '8012627110', '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720035520', 0, 'Y', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
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('061725406', 'S33000309', 'S33000309', 'UT01', 'Gentiva Rehab Without Walls ', '', '', 'Gentiva Rehab Without Walls LLC', 'GROUP', 'Home Health Agency', '', '', NULL, 'B', '70236 File', 'Los Angeles', 'Los Angeles', 'CA', '90074', '6022654844', '6022654984', '70236 File', 'Los Angeles', 'Los Angeles', 'CA', '90074', '6022654844', '6022654984', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833759', 0, 'Y', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('061725406', 'S33000310', 'S33000310', 'UT01', 'Gentiva Rehab Without Walls ', '', '', 'Gentiva Rehab Without Walls LLC', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002443221', NULL, 'Phone Number Only 8002443221', '', '', '', '', '8002443221', '          ', '', '', '4', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833759', 0, 'Y', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('061725406', 'S33000314', 'S33000314', 'UT01', 'Gentiva Rehab Without Walls ', '', '', 'Gentiva Rehab Without Walls LLC', 'GROUP', 'Home Health Agency', '', '', NULL, 'B', '50 E 100 S Ste 200', 'St George', 'Washington', 'UT', '84770', '8006600337', '4356730432', '50 E 100 S Ste 200', 'St George', 'Washington', 'UT', '84770', '8006600337', '4356730432', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833759', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('870524023', 'S33000317', 'S33000317', 'UT01', 'Specialized Prosthetic and Orthotics', NULL, NULL, 'Specialized Prosthetic and Orthotics', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '5292 College Dr Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012667768', '8012669570', '5292 S College Dr', 'Murray', '', 'UT', '84123', '', '', 'WUDME5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-10-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833763', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870559136', 'S33000318', 'S33000318', 'UT01', 'Eye Prosthetics of Utah', '', '', 'Eye Prosthetics of Utah       ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '7050 Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421600', '8019421717', '7070 Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421600', '8019421717', 'WCSTEPU5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-07-01', '2008-12-31', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1366475154', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000327', 'S33000327', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '221 Springcreek Pkwy Ste G', 'Providence', 'Cache', 'UT', '84332', '8005010014', NULL, '221 Springcreek Pkwy Ste G', 'Providence', 'Cache', 'UT', '84332', '8005010014', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000328', 'S33000328', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '480 S Carbon Ave', 'Price', 'Carbon', 'UT', '84501', '8776138887', '4356138890', '480 S Carbon Ave', 'Price', 'Carbon', 'UT', '84501', '8776138887', '4356138890', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000329', 'S33000329', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '2179 N Robins Ste 1', 'Layton', 'Davis', 'UT', '84041', '8888824678', NULL, '2179 N Robins Ste 1', 'Layton', 'Davis', 'UT', '84041', '8888824678', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 41.089, -111.997, NULL, NULL),
('742534122', 'S33000330', 'S33000330', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '1030 S Bowling Alley Ln', 'Moab', 'Grand', 'UT', '84532', '8662201712', NULL, '1030 S Bowling Alley Ln', 'Moab', 'Grand', 'UT', '84532', '8662201712', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000331', 'S33000331', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '6949 High Tech Dr', 'Midvale', 'Salt Lake', 'UT', '84047', '8004862186', '8012336119', '6949 High Tech Dr', 'Midvale', 'Salt Lake', 'UT', '84047', '8004862186', '8012336119', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 40.6253, -111.897, NULL, NULL),
('742534122', 'S33000332', 'S33000332', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '601 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8668823913', '8012336110', '601 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8668823913', '8012336110', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000333', 'S33000333', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '667 N 1890 W', 'Provo', 'Utah', 'UT', '84601', '8004048138', NULL, '667 N 1890 W', 'Provo', 'Utah', 'UT', '84601', '8004048138', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'S33000334', 'S33000334', 'UT01', 'CNS Community Nursing Services', NULL, NULL, 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', NULL, NULL, 'B', '6949 High Tech Dr', 'Midvale', 'Salt Lake', 'UT', '84047', '8012336100', '8012336110', '6949 S High Tech Dr', 'Midvale', '', 'UT', '84047', '', '', NULL, NULL, '4', '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833771', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870212459', 'S33000337', 'S33000337', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', '', 'Hospice', NULL, 'O', '6949 High Tech Dr', 'Midvale', 'Salt Lake', 'UT', '84047', '8012336100', '          ', '6949 High Tech Dr', 'Midvale', 'Salt Lake', 'UT', '84047', '8012336100', '          ', '', '', '3', '0.00', '35.00', '0.00', 3, '2006-11-01', '2014-06-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833772', 0, 'N', 0, '2014-06-11', NULL, NULL, 40.6253, -111.897, NULL, NULL),
('870450584', 'S33000338', 'S33000338', 'UT01', 'CNS Pharmacy Infusion Service', '', '', 'CNS Pharmacy Infusion Service', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', '383 W Vine St Ste 300', 'Midvale', 'Salt Lake', 'UT', '84047', '8012336120', NULL, '383 W Vine St Ste 300', 'Midvale', 'Salt Lake', 'UT', '84047', '8012336120', '', '', NULL, '1001', '0.00', '100.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833773', 0, 'N', 0, '2012-09-24', 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
('330892907', 'S33000342', 'S33000342', 'UT01', 'Nufactor', '', '', 'Nufactor', 'GROUP', 'Infusion Agency', '', '', NULL, 'B', '41093 County Ctr Dr', 'Temecula', 'Riverside', 'CA', '92591', '8003236832', '8002117418', '41093 County Ctr Dr', 'Temecula', 'Riverside', 'CA', '92591', '8003236832', '8002117418', '', '', '1001', '0.00', '0.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861599540', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870212456', 'S33000357', 'S33000357', 'UT01', 'Gunnison Valley Hospital Pro Fees', NULL, NULL, 'Gunnison Valley Hospital Pro Fees', 'GROUP', NULL, NULL, NULL, NULL, 'O', '65 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287246', NULL, 'PO Box 600', 'Gunnison', '', 'UT', '84634', '', '', '', NULL, NULL, '0.00', '7.00', '0.00', 6, '2006-12-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006509', 0, 'Y', 0, '2006-11-09', NULL, NULL, 39.1567, -111.816, NULL, NULL),
('870212456', 'S33000358', 'S33000358', 'UT01', 'Gunnison Valley Hospital Pro Fees', NULL, NULL, 'Gunnison Valley Hospital Pro Fees', 'GROUP', NULL, NULL, NULL, NULL, 'B', 'PO Box 600', 'Gunnison', 'Sanpete', 'UT', '84634', '4355282165', NULL, 'PO Box 600', 'Gunnison', '', 'UT', '84634', '', '', '', NULL, NULL, '0.00', '7.00', '0.00', 6, '2006-12-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006510', 0, 'Y', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('841428630', 'S33000368', 'S33000368', 'UT01', 'Kings Medical Imaging', NULL, NULL, 'Kings Medical Imaging', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'O', '6243 S Redwood Rd Ste 130', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012889671', NULL, 'Dept 1384', 'Denver', '', 'CO', '80256', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833920', 0, 'N', 0, '2009-10-05', NULL, NULL, 40.6377, -111.939, NULL, NULL),
('841428630', 'S33000369', 'S33000369', 'UT01', 'Kings Medical Imaging', NULL, NULL, 'Kings Medical Imaging', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'B', 'Dept 1384', 'Denver', 'Denver', 'CO', '80256', '8012889671', NULL, 'Dept 1384', 'Denver', '', 'CO', '80256', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833920', 0, 'Y', 0, '2009-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870467917', 'S33000373', 'S33000373', 'UT01', 'Advanced Research Systems Inc', NULL, NULL, 'Advanced Research Systems Inc', 'GROUP', 'Sleep Disorders', NULL, NULL, NULL, 'O', '7090 Union Park Ctr Ste 590', 'Midvale', 'Salt Lake', 'UT', '84047', '8012946907', NULL, '7090 Union Park Ctr', 'Midvale', '', 'UT', '84047', '', '', 'WCSTARS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833929', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870467917', 'S33000374', 'S33000374', 'UT01', 'Advanced Research Systems Inc', NULL, NULL, 'Advanced Research Systems Inc', 'GROUP', 'Sleep Disorders', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', NULL, '7090 Union Park Ctr', 'Midvale', '', 'UT', '84047', '', '', 'WCSTARS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833929', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000378', 'S33000378', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1060 E 100 S Ste L-7', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013558559', NULL, '1060 E 100 S Ste L-7', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013558559', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('133757370', 'S33000379', 'S33000379', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8014959514', NULL, '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8014959514', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.5305, -111.863, NULL, NULL),
('133757370', 'S33000380', 'S33000380', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1250 E 3900 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012649675', NULL, '1250 E 3900 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012649675', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('133757370', 'S33000381', 'S33000381', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1600 Antelope Dr 1st Floor', 'Layton', 'Davis', 'UT', '84041', '8018077130', NULL, '1600 Antelope Dr 1st Floor', 'Layton', 'Davis', 'UT', '84041', '8018077130', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('133757370', 'S33000382', 'S33000382', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1890 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014920507', NULL, '1890 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014920507', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000383', 'S33000383', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', NULL, NULL, NULL, 'O', '1959 Aaron Dr Ste B', 'Tooele', 'Tooele', 'UT', '84074', '4358827106', NULL, '5626 Oberlin Dr', 'San Diego', '', 'CA', '92121', '', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1902809940', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000384', 'S33000384', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '3650 N University Ave Ste 175', 'Provo', 'Utah', 'UT', '84604', '8013562590', NULL, '3650 N University Ave Ste 175', 'Provo', 'Utah', 'UT', '84604', '8013562590', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000385', 'S33000385', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '3920 S 1100 E Ste 170', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648351', NULL, '3920 S 1100 E Ste 170', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648351', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-26', NULL, NULL, 40.6865, -111.86, NULL, NULL),
('133757370', 'S33000386', 'S33000386', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '5199 Green St', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012889000', NULL, '5199 Green St', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012889000', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000387', 'S33000387', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014757195', NULL, '6028 S Ridgeline Dr Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014757195', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('133757370', 'S33000388', 'S33000388', 'UT01', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '8002227566', NULL, 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '8002227566', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'Y', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'S33000390', 'S33000390', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 130', 'St George', 'Washington', 'UT', '84790', '4356738266', NULL, '1490 E Foremaster Dr Ste 130', 'St George', 'Washington', 'UT', '84790', '4356738266', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('133757370', 'S33000391', 'S33000391', 'UT01', 'LabCorp of America Holdings', NULL, NULL, 'LabCorp of America Holdings', 'GROUP', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '8002227566', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833974', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('161676334', 'S33000392', 'S33000392', 'UT01', 'Heritage Care Center', '', '', 'Heritage Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '350 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8017565293', '8017568705', '350 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8017565293', '8017568705', '', '', '7', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834013', 0, 'N', 0, '2012-10-11', NULL, NULL, 40.383, -111.789, NULL, NULL),
('161676334', 'S33000393', 'S33000393', 'UT01', 'Heritage Care Center', '', '', 'Heritage Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'B', 'PO Box 511282', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8017565293', NULL, 'PO Box 511282', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8017565293', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834013', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('911632781', 'S33000394', 'S33000394', 'UT01', 'Dynacare Northwest Inc', '', '', 'Dynacare Northwest Inc', 'GROUP', 'Laboratory', '', '', NULL, 'O', '857 E 200 S Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012649675', NULL, '857 E 200 S', 'Salt Lake City', 'Salt Lake', 'UT', '841022334', '8012649675', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1225034739', 0, 'N', 0, '2011-09-01', NULL, NULL, 0, 0, NULL, NULL),
('911632781', 'S33000395', 'S33000395', 'UT01', 'Dynacare Northwest Inc', '', '', 'Dynacare Northwest Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 14954', 'Seattle', 'King', 'WA', '98114', '8015325963', NULL, 'PO Box 14954', 'Seattle', 'King', 'WA', '98114', '8015325963', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1225034739', 0, 'Y', 0, '2011-09-01', NULL, NULL, 0, 0, NULL, NULL),
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('870630100', 'S33000428', 'S33000428', 'UT01', 'Debra Lynns Mastectomy Specialties', '', '', 'Debra Lynns Mastectomy Specialties', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '160 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013932885', NULL, '160 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013932885', '          ', 'WCSTDLMS5', '', '', '0.00', '40.00', '0.00', 3, '2006-09-01', '2011-11-17', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000834354', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'S33000435', 'S33000435', 'UT01', 'University Neuropsychiatric Institute', '', '', 'University Health Care Neuropsychiatric Institute', 'GROUP', 'Mental Health Facility', NULL, NULL, NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', NULL, NULL, 3, '2000-01-01', '2000-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834441', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'S33000436', 'S33000436', 'UT01', 'University Health Care Neuropsychiatric Institute', '', '', 'University Health Care Neuropsychiatric Institute', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', '', '', '1', '0.00', '0.00', '0.00', 3, '2006-01-01', '2011-12-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1760562052', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870656518', 'S33000437', 'S33000437', 'UT01', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', '3793 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014831100', NULL, '3793 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014831100', '', 'WCSTDSC', NULL, NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
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('870419324', 'S33000439', 'S33000439', 'UT01', 'Central Valley Medical Center ', NULL, NULL, 'Central Valley Medical Center', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 412', 'Nephi', 'Juab', 'UT', '84648', '4356230775', '4356233180', NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881658110', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S33000440', 'S33000440', 'UT01', 'Garfield Memorial Hospital', NULL, NULL, 'Garfield Memorial Hospital', 'FNP', 'Hospital', NULL, NULL, NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356768842', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508836867', 0, 'N', 0, '2007-03-20', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('876000309', 'S33000441', 'S33000441', 'UT01', 'Garfield Memorial Hospital - Pro Fees', '', '', 'Garfield Memorial Clinic', 'GROUP', 'Clinic', NULL, NULL, NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834487', 0, 'Y', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'S33000442', 'S33000442', 'UT01', 'St George Care & Rehab Center', NULL, NULL, 'St George Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'B', '1032 E 100 S', 'St George', 'Washington', 'UT', '84770', '8016280488', NULL, '10653 S River Front Pkwy', 'South Jordan', '', 'UT', '84095', '', '', NULL, NULL, '7', '0.00', '100.00', NULL, 3, '2000-01-01', '2000-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834500', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'S33000443', 'S33000443', 'UT01', 'Kindred Nursing & Rehabilitation- St. George', '', '', 'St George Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '1032 E 100 S', 'St George', 'Washington', 'UT', '84770', '4356280488', NULL, '1032 E 100 S', 'St George', 'Washington', 'UT', '84770', '4356280488', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-11-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834500', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('870661741', 'S33000448', 'S33000448', 'UT01', 'Kings Medical Imaging Layton', '', '', 'King''s Medical Imaging Layton', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'O', '2071 N Layton Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018254040', '8018254039', '1894 Georgetown Rd', 'Hudson', '', 'OH', '44236', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174526107', 0, 'N', 0, '2007-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870661741', 'S33000449', 'S33000449', 'UT01', 'Open Imaging - Layton', '', '', 'King''s Medical Imaging Layton', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'B', 'PO BOX 641825', 'Cincinnati', 'Hamilton', 'OH', '45264', '3305281777', NULL, '1894 Georgetown Rd', 'Hudson', '', 'OH', '84236', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174526107', 0, 'Y', 0, '2007-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S33000452', 'S33000452', 'UT01', 'Central Valley Home Medical', NULL, NULL, 'Central Valley Home Medical', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233050', '4356233059', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834584', 0, 'N', 0, '2006-10-27', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'S33000453', 'S33000453', 'UT01', 'Central Valley Home Medical', NULL, NULL, 'Central Valley Home Medical', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'B', 'PO Box 412', 'Nephi', 'Juab', 'UT', '84648', '4356233060', '4356233059', '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834584', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('876000317', 'S33000456', 'S33000456', 'UT01', 'Tooele County Health Dept', NULL, NULL, 'Tooele County Health Dept', 'GROUP', 'Health Department', NULL, NULL, NULL, 'O', '151 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358432300', NULL, '151 N Main St', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023121290', 0, 'N', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'S33000457', 'S33000457', 'UT01', 'Wee Care Pediatrics', NULL, NULL, 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', NULL, NULL, NULL, 'B', '1070 Solutions Ctr', 'Chicago', 'Cook', 'IL', '60677', '8019271562', '8019271591', '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '9555', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'S33000458', 'S33000458', 'UT01', 'Wee Care Pediatrics (Appts Preferred)', '', '', 'Wee Care Pediatrics (Appts Required)', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', NULL, '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '          ', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834768', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('200041310', 'S33000459', 'S33000459', 'UT01', 'Rocky Mountain Care Clinic- Urgent Care M-F 8am-6pm', '', '', 'Rocky Mountain Care Clinic', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'O', '1775 S 4130 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019757799', NULL, '1775 S 4130 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019757799', '          ', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834769', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('200041310', 'S33000460', 'S33000460', 'UT01', 'Rocky Mountain Care Clinic', '', '', 'Rocky Mountain Care Clinic', 'GROUP', 'Urgent Care', NULL, NULL, NULL, 'B', '1775 S 4130 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019757799', '8019757460', '1775 S 4130 W', 'Salt Lake City', '', 'UT', '84104', '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834769', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S33000463', 'S33000463', 'UT01', 'Central Utah Clinic', NULL, NULL, 'Central Utah Clinic PC', 'GROUP', 'Radiologist', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013758858', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834774', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870413860', 'S33000470', 'S33000470', 'UT01', 'Now Care Clinic', '', '', 'Now Care Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', NULL, '698 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834785', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
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('870548726', 'S33000474', 'S33000474', 'UT01', 'Snow Creek Emergency Center', '', '', 'Snow Creek Emergency Center', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356550055', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356550055', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834790', 0, 'Y', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S33000475', 'S33000475', 'UT01', 'Utah Valley Pediatrics', '', '', 'Utah Valley Pediatrics', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, '1355 N University', 'Provo', 'Utah', 'UT', '84604', '8013738930', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000834791', 0, 'N', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
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('870653551', 'S33000478', 'S33000478', 'UT01', 'Park City Family Health Center', '', '', 'Park City Family Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', NULL, 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834796', 0, 'N', 0, '2011-05-20', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('870673680', 'S33000479', 'S33000479', 'UT01', 'Premier Pediatrics', NULL, NULL, 'Premier Pediatrics', 'GROUP', 'Primary Care with Extended Hours', NULL, NULL, NULL, 'O', '1251 Northfield Rd Ste 301', 'Cedar City', 'Iron', 'UT', '84720', '4358657227', NULL, '1251 N Northfield Rd', 'Cedar City', '', 'UT', '84720', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834799', 0, 'N', 0, '2007-01-06', NULL, NULL, 37.6996, -113.068, NULL, NULL),
('870679270', 'S33000480', 'S33000480', 'UT01', 'Kaysville Clinic', '', '', 'Kaysville Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', NULL, '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013047521', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S33000481', 'S33000481', 'UT01', 'Health Clinics of Utah', '', '', 'Health Clinics of Utah', 'GROUP', 'Family Practice', '', '', NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834802', 0, 'N', 0, '2013-06-24', NULL, NULL, 41.2198, -111.971, NULL, NULL),
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('870622942', 'S33000499', 'S33000499', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '2084 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('870622942', 'S33000500', 'S33000500', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017747006', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017747006', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('870622942', 'S33000501', 'S33000501', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('870622942', 'S33000502', 'S33000502', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792450', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792450', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870622942', 'S33000503', 'S33000503', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '3970 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012620300', NULL, '3970 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012620300', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6861, -111.871, NULL, NULL),
('870622942', 'S33000504', 'S33000504', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '3738 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013131955', NULL, '3738 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013131955', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6901, -111.866, NULL, NULL),
('870622942', 'S33000505', 'S33000505', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '2071 N Main St', 'Layton', 'Davis', 'UT', '84041', '8018254040', NULL, '2071 N Main St', 'Layton', 'Davis', 'UT', '84041', '8018254040', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.0906, -112.003, NULL, NULL),
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('870622942', 'S33000507', 'S33000507', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870622942', 'S33000508', 'S33000508', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.0893, -111.997, NULL, NULL);
