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
('870284475', 'S77005446', 'S77005446', 'UT01', 'Granger Medical Clinic', 'Rebecca', 'L', 'Burrage', 'FNP', 'General Practice', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184655532', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005447', 'S77005447', 'UT01', 'Granger Medical Clinic', 'Rebecca', 'L', 'Burrage', 'FNP', 'General Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184655532', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870542399', 'S77005451', 'S77005451', 'UT01', 'Murray Pediatrics', 'Joseph', 'A', 'Roberts', 'MD', 'Pediatrics', '', '', NULL, 'O', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265469621', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870542403', 'S77005452', 'S77005452', 'UT01', 'Intermountain Anesthesia', NULL, NULL, 'Intermountain Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205865029', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'S77005453', 'S77005453', 'UT01', 'Intermountain Anesthesia', NULL, NULL, 'Intermountain Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205865029', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'S77005455', 'S77005455', 'UT01', 'Intermountain Anesthesia', 'Mike', NULL, 'Tyler', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '40.60', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832033', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005463', 'S77005463', 'UT01', 'Utah Cancer Specialists', 'A Jennifer', '', 'Fischbach', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1528017456', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005464', 'S77005464', 'UT01', 'Utah Cancer Specialists', 'Richard', 'N', 'Frame', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '2490 S State St Ste 218', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014660556', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073563516', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005465', 'S77005465', 'UT01', 'Utah Cancer Specialists', 'Xylina', 'T', 'Gregg', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1972554459', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005466', 'S77005466', 'UT01', 'Utah Cancer Specialists', 'Xylina', 'T', 'Gregg', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1972554459', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'S77005467', 'S77005467', 'UT01', 'Utah Cancer Specialists', 'Regina', 'C', 'Klein', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457300980', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005468', 'S77005468', 'UT01', 'Utah Cancer Specialists', 'Regina', 'C', 'Klein', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '520 Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012966665', NULL, '520 Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012966665', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457300980', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('870519691', 'S77005469', 'S77005469', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Litton', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487603916', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005470', 'S77005470', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Litton', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487603916', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005471', 'S77005471', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Litton', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012625679', '8012702242', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487603916', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005472', 'S77005472', 'UT01', 'Utah Cancer Specialists', 'Anne', 'W', 'Marceau', 'NP', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012690304', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1265482012', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005473', 'S77005473', 'UT01', 'Utah Cancer Specialists', 'Anne', 'W', 'Marceau', 'NP', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 135', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012633416', '8012633428', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265482012', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005474', 'S77005474', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Miller', 'MD', 'Hematology and Oncology', 'Oncology', 'Pain Management', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225089790', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005489', 'S77005489', 'UT01', 'Granger Medical Clinic', 'Scott', 'L', 'Carpenter', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1346271715', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77005490', 'S77005490', 'UT01', 'Granger Medical Clinic', 'Scott', 'L', 'Carpenter', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1346271715', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005491', 'S77005491', 'UT01', 'Granger Medical Clinic', 'Peter', 'L', 'Christensen', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992737159', 0, 'Y', 0, '2011-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005493', 'S77005493', 'UT01', 'Granger Medical Clinic', 'James', 'S', 'Coy', 'MD', 'Family Practice', 'Urgent Care', NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley City', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174555320', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005494', 'S77005494', 'UT01', 'Granger Medical Clinic', 'Jennifer', '', 'DenBleyker', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033141270', 0, 'N', 0, '2011-07-06', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77005495', 'S77005495', 'UT01', 'Granger Medical Clinic', 'Alyson', '', 'Eyre', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508897927', 0, 'Y', 0, '2011-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005496', 'S77005496', 'UT01', 'Granger Medical Clinic', 'Randall', 'R', 'Fillmore', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8013525900', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386675627', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5878, -111.959, NULL, NULL),
('870284475', 'S77005497', 'S77005497', 'UT01', 'Granger Medical Clinic', 'Mary', 'L', 'Freeman', 'FNP', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831645', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005498', 'S77005498', 'UT01', 'Granger Medical Clinic', 'Elizabeth', 'M', 'Harmer', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653720', '8019683605', NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992736342', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005499', 'S77005499', 'UT01', 'Granger Medical Clinic', 'David', 'A', 'Harris', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1922023324', 0, 'Y', 0, '2011-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005500', 'S77005500', 'UT01', 'Granger Medical Clinic', 'Christopher', '', 'Hutchison', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1134151384', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005501', 'S77005501', 'UT01', 'Granger Medical Clinic', 'Pinky', '', 'Kotwal', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645444', 0, 'n', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870542605', 'S77005508', 'S77005508', 'UT01', NULL, 'Robert', 'J', 'Alley', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84405', '8013932249', '8013939909', '1652 Wildcat Lane', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255343117', 0, 'N', 0, '2007-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870542605', 'S77005509', 'S77005509', 'UT01', NULL, 'Robert', 'J', 'Alley', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8013932249', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255343117', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543074', 'S77005510', 'S77005510', 'UT01', 'Park City Vision Center', 'Robert', 'S', 'Briggs', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '6584 N Creekside Ln', 'Park City', 'Summit', 'UT', '84098', '4356495200', NULL, 'PO Box 981420', 'Park City', 'Summit', 'UT', '84098', '4356495200', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1063472538', 0, 'N', 0, '2011-12-16', NULL, NULL, 40.7434, -111.533, NULL, NULL),
('870543318', 'S77005511', 'S77005511', 'UT01', 'Mountain West Gastroenterology', 'Mark', 'E', 'Boschert', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', NULL, NULL, '', NULL, NULL, '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346252236', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005512', 'S77005512', 'UT01', 'Mountain West Gastroenterology', 'John', 'H', 'Bowers', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649283318', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005513', 'S77005513', 'UT01', 'Mountain West Gastroenterology', 'Terry', 'D', 'Box', 'MD', 'Gastroenterology', 'Internal Medicine', 'Transplant Heptol', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-02-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235142985', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005514', 'S77005514', 'UT01', 'Mountain West Gastroenterology', 'Deborah', 'D', 'Cobb', 'FNP', 'Gastroenterology', '', '', NULL, 'O', '620 Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912013632', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77005516', 'S77005516', 'UT01', 'Utah Cancer Specialists', 'Nancy', '', 'Weber', 'PA', 'Hematology and Oncology', '', '', NULL, 'O', '520 Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012966665', '', '520 Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012966665', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1194774554', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('870520042', 'S77005517', 'S77005517', 'UT01', 'Nephrology Associates', 'Phyllis', 'T', 'Aseltine', 'NP', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376545251', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77005518', 'S77005518', 'UT01', 'Nephrology Associates', 'Richard', 'C', 'Cline', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245237080', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77005519', 'S77005519', 'UT01', 'Nephrology Associates', 'Richard', 'C', 'Cline', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S', 'Salt Lake City', '', 'UT', '84104', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245237080', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005520', 'S77005520', 'UT01', 'Nephrology Associates', 'Melinda', 'J', 'McAnulty', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902803661', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77005521', 'S77005521', 'UT01', 'Nephrology Associates', 'James', 'B', 'Stinson', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023015260', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77005522', 'S77005522', 'UT01', 'Nephrology Associates', 'James', 'B', 'Stinson', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1023015260', 0, 'N', 0, '2014-03-24', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870520042', 'S77005523', 'S77005523', 'UT01', 'Nephrology Associates', 'Dave', '', 'Tien', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1053319657', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870525567', 'S77005526', 'S77005526', 'UT01', 'South Valley Urology', 'Michael', 'R', 'McFadden', 'MD', 'Urology', '', '', NULL, 'O', '3584 W 9000 S Ste 401', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660204', NULL, '3584 W 9000 S Ste 401', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660204', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811067283', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870525567', 'S77005528', 'S77005528', 'UT01', 'South Valley Urology', 'Michael', 'R', 'McFadden', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 680290', 'Park City', 'Summit', 'UT', '84068', '8015660204', NULL, 'PO Box 680290', 'Park City', 'Summit', 'UT', '84068', '8015660204', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811067283', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870544230', 'S77005530', 'S77005530', 'UT01', 'Rocky Mountain Eye Care', 'Kevin', 'H', 'Charlton', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', '8012644409', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', '8012644409', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699877969', 0, 'N', 0, '2014-01-30', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('870544230', 'S77005531', 'S77005531', 'UT01', 'Rocky Mountain Eye Care', 'David', 'B', 'Petersen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', '8012644409', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', '8012644409', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851482202', 0, 'N', 0, '2012-04-23', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('870544230', 'S77005532', 'S77005532', 'UT01', 'Rocky Mountain Eye Care', 'E', 'Leigh', 'Wilkinson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', NULL, '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012644450', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962512855', 0, 'N', 0, '2014-03-12', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('870545911', 'S77005535', 'S77005535', 'UT01', 'Woodland Hills Radiology', 'Brent', 'T', 'Layton', 'MD', 'Radiologist', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', '8012219154', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', '8012219154', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1346286317', 0, 'Y', 0, '2014-01-17', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('870545911', 'S77005536', 'S77005536', 'UT01', 'Woodland Hills Radiology', 'Ryan', 'B', 'Nielsen', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '8012211339', '8012219154', NULL, NULL, 'Utah', NULL, NULL, '8012211339', '8012219154', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1821032863', 0, 'Y', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77005537', 'S77005537', 'UT01', 'Woodland Hills Radiology', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146524', '8012219154', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146524', '8012219154', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'Y', 0, '2014-01-17', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('870545911', 'S77005538', 'S77005538', 'UT01', 'Woodland Hills Radiology', 'Dalton', 'H', 'Wright', 'MD', 'Radiologist', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146524', '8012219154', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146524', '8012219154', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1174569131', 0, 'Y', 0, '2014-03-20', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('870546501', 'S77005539', 'S77005539', 'UT01', 'Alpine Pediatrics', 'Jefferey', 'H', 'Abram', 'PA', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003855768', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005540', 'S77005540', 'UT01', 'Granger Medical Clinic', 'Bruce', 'Z', 'Montgomerie', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780615153', 0, 'N', 0, '2011-07-05', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77005541', 'S77005541', 'UT01', 'Granger Medical Clinic', 'David', 'C', 'Nelson', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley City', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386676526', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005542', 'S77005542', 'UT01', 'Granger Medical Clinic', 'David', 'C', 'Nelson', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386676526', 0, 'Y', 0, '2011-07-06', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005543', 'S77005543', 'UT01', 'Granger Medical Clinic', 'Mary', 'J', 'Pennington', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1205868452', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005544', 'S77005544', 'UT01', 'Granger Medical Clinic', 'Deborah', '', 'Plasman-Coles', 'PA', 'Gastroenterology', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645469', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005545', 'S77005545', 'UT01', 'Granger Medical Clinic', 'Micah', 'G', 'Rosenfield', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley City', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194757336', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005547', 'S77005547', 'UT01', 'Granger Medical Clinic', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005548', 'S77005548', 'UT01', 'Granger Medical Clinic', 'Jennifer', 'L', 'Scheid', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', '3725 W 4100 S', 'West Valley City', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '929935', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005549', 'S77005549', 'UT01', 'Granger Medical Clinic', 'Saurabh', 'B', 'Shah', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790717957', 0, 'Y', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005550', 'S77005550', 'UT01', 'Granger Medical Clinic', 'Scott', 'D', 'Sheridan', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578594925', 0, 'N', 0, '2011-07-21', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77005551', 'S77005551', 'UT01', 'Granger Medical Clinic', 'Eric', 'M', 'Thompson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', '3725 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043242290', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005552', 'S77005552', 'UT01', 'Granger Medical Clinic', 'Julie', 'I', 'Wilkerson', 'MD', 'Pediatrics', NULL, NULL, 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, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447283932', 0, 'Y', 0, '2012-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77005553', 'S77005553', 'UT01', 'Granger Medical Clinic', 'Kavita', 'G', 'Willesen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831724', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005554', 'S77005554', 'UT01', 'Mountain West Gastroenterology', 'Deborah', 'D', 'Cobb', 'FNP', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912013632', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('870543318', 'S77005557', 'S77005557', 'UT01', 'Mountain West Gastroenterology', 'Clarke', 'A', 'Hilbig', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861404758', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005561', 'S77005561', 'UT01', 'Mountain West Gastroenterology', 'Randall', 'J', 'Ryser', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1528071156', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005566', 'S77005566', 'UT01', 'Retina Associates Of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005571', 'S77005571', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1250 E 3900 S', 'Salt Lake City', 'Davis', 'UT', '84124', '8017758222', '8017758223', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005572', 'S77005572', 'UT01', 'Retina Associates of Utah', 'Robert', '', 'Kwun', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '1250 E 3900 S', 'Salt Lake City', 'Cache', 'UT', '84124', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457338162', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005574', 'S77005574', 'UT01', 'Retina Associates of Utah', 'Mano', '', 'Swartz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801870670', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005575', 'S77005575', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8018738462', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8018738462', '8017758223', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'S77005576', 'S77005576', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005577', 'S77005577', 'UT01', 'Mountain View Anesthesia', 'Kurt', 'L', 'Christensen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832147', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005578', 'S77005578', 'UT01', 'Mountain View Anesthesia', 'Daren', 'J', 'Felix', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832510', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005579', 'S77005579', 'UT01', 'Mountain View Anesthesia', 'Jerry', 'A', 'Matthiesen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834084', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005581', 'S77005581', 'UT01', 'Alpine Pediatrics', 'Heather', 'N', 'Benally', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8019229222', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1659327153', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005582', 'S77005582', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'B', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005584', 'S77005584', 'UT01', 'Alpine Pediatrics', 'David', 'S', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'b', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316985542', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005585', 'S77005585', 'UT01', 'Alpine Pediatrics', 'David', 'S', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316985542', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005587', 'S77005587', 'UT01', 'Alpine Pediatrics', 'Brett', 'K', 'Knorr', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083655120', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005593', 'S77005593', 'UT01', 'Alpine Pediatrics', 'David', 'Todd', 'Whiting', 'MD', 'Pediatrics', NULL, NULL, NULL, 'b', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023056298', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870547025', 'S77005594', 'S77005594', 'UT01', NULL, 'Kimberly', 'E', 'Beck', 'MD', 'Family Practice', '', '', NULL, 'O', '76 E Ctr', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287935', '4355287936', '76 E Ctr', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287935', '4355287936', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1700814803', 0, 'N', 0, '2013-06-27', NULL, NULL, 39.1537, -111.821, NULL, NULL),
('870284475', 'S77005595', 'S77005595', 'UT01', 'Granger Medical Clinic', 'Susan', 'M', 'Zimmerman', 'MD', 'Neurology', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063444214', 0, 'Y', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870285509', 'S77005597', 'S77005597', 'UT01', 'Provo Ob/Gyn Clinic', 'Kent', 'R', 'Gamette', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8013750369', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538284120', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005599', 'S77005599', 'UT01', 'Ogden Clinic', 'Jon', 'W', 'Ahlstrom', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-01-04', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437146065', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005600', 'S77005600', 'UT01', 'Ogden Clinic', 'Jon', 'W', 'Ahlstrom', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-02-01', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437146065', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005601', 'S77005601', 'UT01', 'Ogden Clinic', 'Kelly', 'R', 'Amann', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '2595 N Highway 162', 'Eden', 'Weber', 'UT', '84310', '8014794621', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134116783', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005602', 'S77005602', 'UT01', 'Ogden Clinic', 'Kelly', 'R', 'Amann', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2013-11-04', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134116783', 0, 'N', 0, '2013-11-14', 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
('870286381', 'S77005603', 'S77005603', 'UT01', 'Ogden Clinic', 'Elisabeth', 'G', 'Anderson', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518955624', 0, 'N', 0, '2013-09-23', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77005604', 'S77005604', 'UT01', 'Ogden Clinic', 'Brent', 'M', 'Baranko', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-01-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306833967', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005606', 'S77005606', 'UT01', 'Ogden Clinic', 'Carolyn', NULL, 'Belfry', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417944083', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005607', 'S77005607', 'UT01', 'Ogden Clinic', 'Carolyn', NULL, 'Belfry', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417944083', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870545723', 'S77005622', 'S77005622', 'UT01', 'Lihai Medical Clinic', 'Kingi', 'M', 'Langi', 'PA, MT', 'Family Practice', '', '', NULL, 'O', '255 S 100 E', 'Tooele', 'Tooele', 'UT', '84074', '4358820424', NULL, '255 S 100 E', 'Tooele', 'Tooele', 'UT', '84074', '4358820424', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942257795', 0, 'Y', 0, '2012-04-17', NULL, NULL, 40.5257, -112.296, NULL, NULL),
('870545911', 'S77005623', 'S77005623', 'UT01', 'Central Utah Clinic PC', 'Kent', 'M', 'Gledhill', 'MD', 'Radiologist', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657100', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657100', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871539833', 0, 'Y', 0, '2014-07-16', NULL, NULL, 40.0446, -111.716, NULL, NULL),
('870525882', 'S77005624', 'S77005624', 'UT01', 'Mountain View Anesthesia', 'Kenneth', 'A', 'Money', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832109', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'S77005625', 'S77005625', 'UT01', 'Mountain View Anesthesia', 'Paul', 'B', 'Reichert', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8019939555', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316042732', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'S77005657', 'S77005657', 'UT01', 'Ogden Clinic', 'Roxina', NULL, 'Fischer', 'NP', 'Family Practice', NULL, NULL, NULL, 'b', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932197084', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870545911', 'S77005665', 'S77005665', 'UT01', 'Woodland Hills Radiology', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '          ', NULL, 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '          ', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77005667', 'S77005667', 'UT01', 'Woodland Hills Radiology', 'Dalton', 'H', 'Wright', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', NULL, NULL, 'PO Box 1475', 'Orem', 'Utah', 'UT', '84059', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1174569131', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005670', 'S77005670', 'UT01', 'Alpine Pediatrics', 'Jefferey', 'H', 'Abram', 'PA', 'Pediatrics', '', '', NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003855768', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005672', 'S77005672', 'UT01', 'Alpine Pediatrics', 'Bradley', 'C', 'Arnold', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417995671', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005674', 'S77005674', 'UT01', 'Alpine Pediatrics', 'Catherine', 'G', 'Caldwell', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1639118375', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005676', 'S77005676', 'UT01', 'Alpine Pediatrics', 'Beverly', 'L', 'Vargo', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316991565', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77005680', 'S77005680', 'UT01', 'Davis Family Physicians', 'D', 'C', 'Christensen', 'NP', 'Family Practice', 'Emergency Medicine', NULL, NULL, 'O', '2084 Robins Dr Ste 6', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-09', NULL, 0, NULL, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619086501', 0, 'N', 0, '2011-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'S77005681', 'S77005681', 'UT01', 'Davis Family Physicians', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2012-01-05', NULL, NULL, 41.0747, -112.027, NULL, NULL),
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('870550021', 'S77005693', 'S77005693', 'UT01', 'Utah Physicians Care Center', 'Stephen', 'S', 'Aslami', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134151558', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
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('870550021', 'S77005695', 'S77005695', 'UT01', 'Utah Physicians Care Center', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005696', 'S77005696', 'UT01', 'Utah Physicians Care Center', 'Kevin', 'W', 'Stigge', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '10965 S State St', 'Sandy', 'Salt Lake', 'UT', '84070', '8012742000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972528982', 0, 'Y', 0, '2011-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('870550021', 'S77005698', 'S77005698', 'UT01', 'Utah Physicians Care Center', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.5523, -111.891, NULL, NULL),
('870550021', 'S77005699', 'S77005699', 'UT01', 'Utah Physicians Care Center', 'Kathleen', 'Barrett', 'Wilson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160  E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477515690', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870550275', 'S77005700', 'S77005700', 'UT01', 'Cottonwood Pediatrics', 'Mark', 'B', 'Barrett', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1710969100', 0, 'Y', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005701', 'S77005701', 'UT01', 'Cottonwood Pediatrics', 'Barbara', 'E', 'Bean', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-03-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659353472', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
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('870550275', 'S77005703', 'S77005703', 'UT01', 'Cottonwood Pediatrics', 'Brian', 'J', 'Buchanan', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952383796', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'S77005705', 'S77005705', 'UT01', 'Ogden Clinic', 'Phil', 'H', 'Johnson', 'NP', 'Pediatrics', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831336', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005706', 'S77005706', 'UT01', 'Ogden Clinic', 'Damon', 'B', 'Marsh', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343179', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467441089', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.244, -111.95, NULL, NULL),
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('870286381', 'S77005709', 'S77005709', 'UT01', 'Ogden Clinic', 'Bradley', 'R', 'Melville', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013982021', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013982021', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2010-12-31', NULL, 0, NULL, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1407867658', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005710', 'S77005710', 'UT01', 'Ogden Clinic', 'Phil', 'R', 'Merrill', 'PA', 'Gastroenterology', 'Family Practice', NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639144702', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005715', 'S77005715', 'UT01', 'Ogden Clinic', 'Travis', 'Kay', 'Schelling', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225027857', 0, 'y', 0, '2006-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005716', 'S77005716', 'UT01', 'Ogden Clinic', 'Travis', 'Kay', 'Schelling', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225027857', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870286381', 'S77005717', 'S77005717', 'UT01', 'Ogden Clinic', 'J', 'David', 'Schmitz', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891782819', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870286381', 'S77005719', 'S77005719', 'UT01', 'Ogden Clinic', 'Kelly', 'S', 'Stagg', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2011-08-15', NULL, 0, NULL, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1316935117', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('870547016', 'S77005720', 'S77005720', 'UT01', NULL, 'Jeffrey', 'G', 'Ogden', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '421 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8017640200', NULL, '421 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8017640200', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1801953518', 0, 'N', 0, '2013-10-21', NULL, NULL, 40.3048, -111.701, NULL, NULL),
('870547025', 'S77005721', 'S77005721', 'UT01', NULL, 'Kimberly', 'E', 'Beck', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 640', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287935', '4355287936', 'PO Box 640', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287935', '4355287936', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1700814803', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870548726', 'S77005724', 'S77005724', 'UT01', 'Snow Creek Emergency Center', 'John', 'A', 'Silverman', 'MD', 'Emergency Medicine', NULL, NULL, 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', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2012-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114974359', 0, 'Y', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005725', 'S77005725', 'UT01', 'Utah Valley Pediatrics', 'Marsena', 'E', 'Conner', 'MD', 'Pediatrics', '', '', NULL, 'O', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565609', NULL, '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565609', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1609812122', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005726', 'S77005726', 'UT01', 'Utah Valley Pediatrics', 'Marsena', 'E', 'Conner', 'MD', 'Pediatrics', '', '', NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1609812122', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005728', 'S77005728', 'UT01', 'Utah Valley Pediatrics', 'Jennifer', 'Geary', 'Brinton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831657', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005729', 'S77005729', 'UT01', 'Utah Valley Pediatrics', 'Douglas', 'W', 'Hacking', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012254197', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215904164', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005730', 'S77005730', 'UT01', 'Utah Valley Pediatrics', 'Jeffrey', 'L', 'Jensen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275591471', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005731', 'S77005731', 'UT01', 'Utah Valley Pediatrics', 'Melissa', 'A', 'Kendall', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598772089', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005732', 'S77005732', 'UT01', 'Utah Valley Pediatrics', 'Richard', 'W', 'Later', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962476002', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005733', 'S77005733', 'UT01', 'Jordan Valley Family Health', 'Deserae', 'J', 'Goble', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831719', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005734', 'S77005734', 'UT01', 'Jordan Valley Family Health', 'Dennis', 'R', 'Hamp', 'DO', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-11-11', NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568405397', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005735', 'S77005735', 'UT01', 'Jordan Valley Family Health', 'Bari', 'M', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063445948', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870536032', 'S77005736', 'S77005736', 'UT01', 'Jordan Valley Family Health', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870539841', 'S77005738', 'S77005738', 'UT01', 'Mountain View Eye Center', 'Lamont', NULL, 'Ericson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 175', 'Layton', 'Davis', 'UT', '84041', '8017732233', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833983', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870540729', 'S77005741', 'S77005741', 'UT01', '', 'Douglas', 'M', 'Vogeler', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '9600 S 1300 E Ste 303', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720443', NULL, '9600 S 1300 E Ste 303', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720443', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790869550', 0, 'N', 0, '2012-05-18', NULL, NULL, 0, 0, NULL, NULL),
('870541103', 'S77005742', 'S77005742', 'UT01', 'The Avenues Womens Clinic', 'Cynthia', 'S', 'Cannon', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'O', '455 E S Temple Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', NULL, '455 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013559951', '', 'WUSTDOBG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700894383', 0, 'N', 0, '2011-05-24', NULL, NULL, 40.7694, -111.878, NULL, NULL),
('870542236', 'S77005746', 'S77005746', 'UT01', 'Alpine Plastic & Reconstructive Surgery', 'Clinton', 'B', 'Webster', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3680', 'Ogden', 'Weber', 'UT', '84403', '8013873900', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013873900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-10', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000929612', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005747', 'S77005747', 'UT01', 'Cottonwood Pediatrics', 'Karla', 'A', 'Feindt', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255313953', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005748', 'S77005748', 'UT01', 'Grow Up Great', 'Claudia', 'J', 'Fruin', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1619959319', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005749', 'S77005749', 'UT01', 'Cottonwood Pediatrics', 'Claudia', 'J', 'Fruin', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1619959319', 0, 'Y', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005750', 'S77005750', 'UT01', 'Grow Up Great', 'Jacqueline', 'K', 'Giannini', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881676583', 0, 'N', 0, '2014-01-06', 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
('870550275', 'S77005751', 'S77005751', 'UT01', 'Grow Up Great', 'Allison', 'M', 'Groebs', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235111949', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005752', 'S77005752', 'UT01', 'Willow Creek Pediatrics', 'Kimberly', '', 'Hansen', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427030030', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'S77005753', 'S77005753', 'UT01', 'Summit Pediatrics', 'David', 'C', 'Larson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356324511', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005754', 'S77005754', 'UT01', 'Wasatch Pediatrics', 'David', 'C', 'Larson', 'MD', 'Pediatrics', '', '', NULL, 'O', '380 E 1500 S Ste 210', 'Heber City', 'Wasatch', 'UT', '84032', '4356570101', NULL, '380 E 1500 S Ste 210', 'Heber City', 'Wasatch', 'UT', '84032', '4356570101', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-01-01', 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1356324511', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005755', 'S77005755', 'UT01', 'Wasatch Pediatrics', 'David', 'C', 'Larson', 'MD', 'Pediatrics', '', '', NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-01-01', 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1356324511', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005756', 'S77005756', 'UT01', 'Southpoint Pediatrics', 'Kevin', 'B', 'Lash', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', NULL, '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999630', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'S77005757', 'S77005757', 'UT01', 'Willow Creek at St Marks', 'Jim', 'C', 'Memmott', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144202771', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005758', 'S77005758', 'UT01', 'Cottonwood Pediatrics', 'Kathy', 'M', 'Ostler', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700869153', 0, 'Y', 0, '2013-12-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005759', 'S77005759', 'UT01', 'Wasatch Pediatrics', 'Katherine', 'A', 'Price', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831860', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005760', 'S77005760', 'UT01', 'Ogden Clinic', 'Karen', NULL, 'Vastardis', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2013-08-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487643011', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005762', 'S77005762', 'UT01', 'Ogden Clinic', 'Michelle', NULL, 'Wasden', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700875333', 0, 'y', 0, '2006-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005764', 'S77005764', 'UT01', 'Ogden Clinic', 'Renee', NULL, 'West', 'MD', 'Family Practice', NULL, NULL, NULL, 'b', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609864412', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77005765', 'S77005765', 'UT01', 'Ogden Clinic Physical Therapy', 'Dorian', 'M', 'Wood', 'PT', 'Physical Therapy', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '1838', '', '', '0.00', '0.00', '70.00', 6, '2006-08-01', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376532911', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870288569', 'S77005766', 'S77005766', 'UT01', NULL, 'C James', '', 'Graham', 'MD', 'Family Practice', '', '', NULL, 'O', '10 N 600 E', 'Hyrum', 'Cache', 'UT', '84319', '4352456451', NULL, '10 N 600 E', 'Hyrum', 'Cache', 'UT', '84319', '4352456451', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1346313046', 0, 'N', 0, '2014-03-20', NULL, NULL, 41.634, -111.838, NULL, NULL),
('870290203', 'S77005767', 'S77005767', 'UT01', 'Podiatry Center', 'Michael', 'K', 'Lowe', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '144 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321822', '8015327544', '144 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321822', '8015327544', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1063417335', 0, 'N', 0, '2012-05-02', NULL, NULL, 40.7659, -111.871, NULL, NULL),
('870549057', 'S77005768', 'S77005768', 'UT01', 'Utah Valley Pediatrics', 'Michael', 'H', 'Lauret', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013738930', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821056029', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005769', 'S77005769', 'UT01', 'Utah Valley Pediatrics', 'Ryan', 'B', 'Wilcox', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1159 E 200 N Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017565290', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679501720', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005770', 'S77005770', 'UT01', 'Utah Valley Pediatrics', 'Gregory', 'S', 'Wynn', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376550855', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77005771', 'S77005771', 'UT01', 'Utah Valley Pediatrics', 'John', 'R', 'Wynn', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255308102', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549673', 'S77005772', 'S77005772', 'UT01', 'Mark S Naisbitt MD', NULL, NULL, 'Mark S Naisbitt MD PC', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-12-01', '2006-12-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833039', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549673', 'S77005773', 'S77005773', 'UT01', NULL, 'Mark', 'S', 'Naisbitt', 'MD', 'Anesthesiology', '', '', NULL, 'B', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013921401', NULL, '3460 Baker Dr', 'Ogden', '', 'UT', '84403', '', '', '', NULL, '1000', '45.00', '0.00', '0.00', 3, '2006-12-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '0000833937', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005774', 'S77005774', 'UT01', 'Utah Physicians Care Center', 'Alireza', NULL, 'Falahati-Nini', 'MD', 'Endocrinology', NULL, NULL, NULL, 'B', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619561', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417989971', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005775', 'S77005775', 'UT01', 'Utah Physicians Care Center', 'Thomas', 'Anton', 'Kurrus', 'MD', 'Infectious Disease', 'Internal Medicine', NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831120567', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005776', 'S77005776', 'UT01', 'Utah Physicians Care Center', 'Mark', 'R', 'Oliver', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760400865', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870550021', 'S77005777', 'S77005777', 'UT01', 'Utah Physicians Care Center', 'Mark', 'A', 'Rada', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1770515140', 0, 'N', 0, '2014-03-20', NULL, NULL, 40.5523, -111.891, NULL, NULL),
('870550021', 'S77005778', 'S77005778', 'UT01', 'Utah Physicians Care Center', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'Y', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005779', 'S77005779', 'UT01', 'Utah Physicians Care Center', 'John', 'B', 'Stanchfield', 'MD', 'Endocrinology', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134147226', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005780', 'S77005780', 'UT01', 'Utah Physicians Care Center', 'John', 'B', 'Stanchfield', 'MD', 'Endocrinology', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134147226', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005781', 'S77005781', 'UT01', 'Utah Physicians Care Center', 'Kevin', 'W', 'Stigge', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972528982', 0, 'N', 0, '2011-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870542399', 'S77005782', 'S77005782', 'UT01', 'Murray Pediatrics', 'Robert', 'R', 'Hightower', 'MD', 'Pediatrics', '', '', NULL, 'O', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1548296312', 0, 'N', 0, '2012-07-11', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870542399', 'S77005783', 'S77005783', 'UT01', 'Murray Pediatrics', 'Anna', 'G', 'Orchard', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1730172651', 0, 'N', 0, '2012-05-18', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870542399', 'S77005784', 'S77005784', 'UT01', 'Murray Pediatrics', 'Gary', 'W', 'Schlichter', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', '164 E 5900 S Ste A112', 'Murray', 'Salt Lake', 'UT', '84107', '8012622673', '8012699894', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326031246', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870542403', 'S77005785', 'S77005785', 'UT01', 'Intermountain Anesthesia', 'Max', NULL, 'Shurtliff', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '40.60', NULL, NULL, 3, '2007-01-01', '2007-11-30', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851484489', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005796', 'S77005796', 'UT01', 'Willow Creek Pediatrics', 'Daniel', 'R', 'Stampfl', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871576280', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'S77005797', 'S77005797', 'UT01', 'Cottonwood Pediatrics', 'Lena', 'S', 'Terry', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477536886', 0, 'Y', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005798', 'S77005798', 'UT01', 'Cottonwood Pediatrics', 'John', 'B', 'Wall', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-04-25', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1174506554', 0, 'Y', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005800', 'S77005800', 'UT01', 'Cottonwood Pediatrics', 'Paul', 'E', 'Wirkus', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1134101835', 0, 'Y', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870550276', 'S77005801', 'S77005801', 'UT01', 'City Creek Pediatrics', 'Jennifer', 'A', 'Cox', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 S 700 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015758080', '8015951133', '77 S 700 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015758080', '8015951133', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-02-29', 0, 0, 0, 'Primary Childrens Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1790822542', 0, 'N', 0, '2012-02-23', NULL, NULL, 0, 0, NULL, NULL),
('870550776', 'S77005803', 'S77005803', 'UT01', NULL, 'Edward', 'W', 'Berry', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '4403 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', '', NULL, '1000', '45.00', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639230089', 0, 'Y', 0, '2007-01-10', NULL, NULL, 41.1901, -111.936, NULL, NULL),
('870293594', 'S77005813', 'S77005813', 'UT01', 'Fit Quest Therapy', 'Stephanie', 'Brooke', 'O''Reilly', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '2120 N 400 E', 'North Ogden', 'Weber', 'UT', '84414', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832929', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77005814', 'S77005814', 'UT01', 'Fit Quest Therapy', 'Mike', NULL, 'Smith', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832569', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005815', 'S77005815', 'UT01', 'Tri City Medical Clinic', 'Steven', 'B', 'Cherrington', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871608893', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005816', 'S77005816', 'UT01', 'Tri City Medical Clinic', 'Glen', 'R', 'Fuller', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467557330', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005817', 'S77005817', 'UT01', 'Tri City Medical Clinic', 'Joseph', 'B', 'Liddle', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1427166701', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005818', 'S77005818', 'UT01', 'Tri City Medical Clinic', 'Garrett', 'B', 'Smith', 'DO', 'Family Practice', '', '', NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1669587630', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005819', 'S77005819', 'UT01', 'Tri City Medical Clinic', 'Scott', 'Leroy', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336257617', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77005820', 'S77005820', 'UT01', 'Tri City Medical Clinic', 'Marshall', 'F', 'Willis', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', 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|', '1194833475', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870302621', 'S77005824', 'S77005824', 'UT01', 'Rocky Mountain Retina Consultants', 'Douglas', 'S', 'Mehr', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '620 E Medical Dr Ste 210', 'Bountiful', 'Davis', 'UT', '84010', '8012644444', '8012812383', '4400 S 700 E', 'Salt Lake City', '', 'UT', '84107', '', '', 'WKRETINA', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-06-05', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720070899', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77005825', 'S77005825', 'UT01', 'Utah Physicians Care Center', 'Joel', 'Daniel', 'Trachtenberg', 'MD', 'Internal Medicine', 'Infectious Disease', NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417972571', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005826', 'S77005826', 'UT01', 'Willow Creek Pediatrics', 'R Dennis', '', 'Ashton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760464580', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005827', 'S77005827', 'UT01', 'Cottonwood Pediatrics', 'Mark', 'B', 'Barrett', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1710969100', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'S77005828', 'S77005828', 'UT01', 'Southpoint Pediatrics', 'Darin', 'G', 'Bosworth', 'MD', 'Pediatrics', '', '', NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', NULL, '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225010051', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'S77005829', 'S77005829', 'UT01', 'Cottonwood Pediatrics', 'Kara', 'F', 'Burnett', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669454401', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005830', 'S77005830', 'UT01', 'Cottonwood Pediatrics', 'Jacqueline', 'K', 'Giannini', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881676583', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005831', 'S77005831', 'UT01', 'Southpoint Pediatrics', 'Leslie', '', 'Goodwin', 'MD', 'Pediatrics', '', '', NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', NULL, '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184606782', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'S77005832', 'S77005832', 'UT01', 'Cottonwood Pediatrics', 'David', 'C', 'Hurley', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396727269', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'S77005833', 'S77005833', 'UT01', 'Cottonwood Pediatrics', 'David', 'C', 'Hurley', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396727269', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005834', 'S77005834', 'UT01', 'Wasatch Pediatrics at St Marks', 'Edward', 'G', 'Jenkins', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1265414882', 0, 'N', 0, '2011-02-01', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005835', 'S77005835', 'UT01', 'Cottonwood Pediatrics', 'R Joe', '', 'Jopling', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992788152', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005836', 'S77005836', 'UT01', 'Cottonwood Pediatrics', 'Kevin', 'B', 'Lash', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999630', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005837', 'S77005837', 'UT01', 'Cottonwood Pediatrics', 'Jim', 'C', 'Memmott', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144202771', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005845', 'S77005845', 'UT01', 'Mountain West Gastroenterology', 'Mark', 'E', 'Boschert', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1346252236', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005846', 'S77005846', 'UT01', 'Mountain West Gastroenterology', 'Mark', 'E', 'Boschert', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1346252236', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005847', 'S77005847', 'UT01', 'Mountain West Gastroenterology', 'John', 'H', 'Bowers', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-11-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1649283318', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005848', 'S77005848', 'UT01', 'Mountain West Gastroenterology', 'Terry', 'D', 'Box', 'MD', 'Gastroenterology', 'Internal Medicine', 'Transplant Heptol', NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235142985', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870555165', 'S77005859', 'S77005859', 'UT01', 'Pediatric Care Of Ogden', 'Donald', 'F', 'Watts', 'MD', 'Pediatrics', '', '', NULL, 'O', '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', NULL, '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134217649', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870303840', 'S77005863', 'S77005863', 'UT01', NULL, 'Val', 'R', 'Hansen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '425 Medical Dr Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012959467', NULL, '425 Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235224296', 0, 'N', 0, '2006-11-10', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870305037', 'S77005864', 'S77005864', 'UT01', 'Nelson, John C', 'Russell', 'B', 'Jackson', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '3465 Pioneer Pkwy Ste 4', 'West Valley', 'Salt Lake', 'UT', '84120', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922008663', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306625', 'S77005865', 'S77005865', 'UT01', NULL, 'H Ronald', '', 'Brown', 'DPM', 'Podiatry', '', '', NULL, 'O', '4370 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019673338', '8019670722', '4370 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019673338', '8019670722', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619965225', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.6759, -111.939, NULL, NULL),
('870306625', 'S77005866', 'S77005866', 'UT01', 'H Ronald Brown DPM', 'H Ronald', NULL, 'Brown', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8019673338', '8019670722', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619965225', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005867', 'S77005867', 'UT01', 'Emergency Physicians Group', NULL, NULL, 'Emergency Physicians Group', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '8013529502', '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588611016', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005868', 'S77005868', 'UT01', 'Emergency Physicians Group', 'Lester', NULL, 'Dixon', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833260', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005869', 'S77005869', 'UT01', 'Emergency Physicians Group', 'Steven', 'R', 'Mimnaugh', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1962464453', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005871', 'S77005871', 'UT01', 'Emergency Physicians Group', 'Mark', '', 'Paradise', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833266', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005872', 'S77005872', 'UT01', 'Emergency Physicians Group', 'Celeste', 'E', 'Raffin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174552863', 0, 'Y', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005873', 'S77005873', 'UT01', 'Emergency Physicians Group', 'Brian', 'E', 'Shiozawa', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306887666', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005876', 'S77005876', 'UT01', 'Wasatch Pediatrics at St Marks', 'Thomas', 'J', 'Metcalf', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-08-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1669454294', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005877', 'S77005877', 'UT01', 'Cottonwood Pediatrics', 'Kathleen', 'A', 'O''Mara', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205819653', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005878', 'S77005878', 'UT01', 'Willow Creek Pediatrics', 'Kathleen', 'A', 'O''Mara', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205819653', 0, 'N', 0, '2011-06-23', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'S77005879', 'S77005879', 'UT01', 'Cottonwood Pediatrics', 'Sarah', 'A', 'Ormsby', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912980368', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005880', 'S77005880', 'UT01', 'Cottonwood Pediatrics', 'Charles', 'W', 'Ralston', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1588647978', 0, 'N', 0, '2014-01-16', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'S77005881', 'S77005881', 'UT01', 'Summit Pediatrics', 'Lena', 'S', 'Terry', 'MD', 'Pediatrics', '', '', NULL, 'O', '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-10-17', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477536886', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005882', 'S77005882', 'UT01', 'Summit Pediatrics', 'Leslie', 'W', 'Webster', 'MD', 'Pediatrics', '', '', NULL, 'O', '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-10-17', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821071242', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77005883', 'S77005883', 'UT01', 'Cottonwood Pediatrics', 'Leslie', 'W', 'Webster', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821071242', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870550276', 'S77005885', 'S77005885', 'UT01', 'City Creek Pediatrics', 'Shireen', 'M', 'Mooers', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '77 S 700 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015758080', '8015951133', '77 S 700 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-02-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760588735', 0, 'N', 0, '2007-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005889', 'S77005889', 'UT01', 'Mountain West Gastroenterology', 'Deborah', 'D', 'Cobb', 'FNP', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912013632', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005891', 'S77005891', 'UT01', 'Mountain West Gastroenterology', 'Gordon', 'E', 'Harmston', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1972516748', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005892', 'S77005892', 'UT01', 'Mountain West Gastroenterology', 'Andrew', 'M', 'Heiner', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8013144253', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497768014', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77005893', 'S77005893', 'UT01', 'Mountain West Gastroenterology', 'Andrew', 'M', 'Heiner', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497768014', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560471', 'S77005902', 'S77005902', 'UT01', 'Aspen Womens Center', 'Gregory', 'R', 'Gordon', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1355 N University Ave Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013745000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831206', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560471', 'S77005903', 'S77005903', 'UT01', 'Aspen Womens Center', 'Thomas', NULL, 'Judd', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1355 N University Ave Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013745000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '830977', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005904', 'S77005904', 'UT01', 'Utah Navajo Health System PT', 'ystem Inc PT', '', 'Utah Navajo Health S', NULL, 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', '57.75', 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005905', 'S77005905', 'UT01', 'Blanding Family Practice', 'Lloyd', 'V', 'Jones', NULL, 'Family Practice', 'Emergency Medicine', NULL, NULL, 'O', '799 S 200 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932102514', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005907', 'S77005907', 'UT01', 'Utah Navajo Health System', 'Martin', 'G', 'Neubert', NULL, NULL, NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649273921', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005908', 'S77005908', 'UT01', 'Utah Navajo Health System', 'Norman', 'S', 'Nielson', NULL, 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558364125', 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
('870560763', 'S77005910', 'S77005910', 'UT01', 'Blanding Family Practice', 'Freddie', NULL, 'Riggs', NULL, NULL, NULL, NULL, NULL, 'O', '799 S 200 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881697365', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77005912', 'S77005912', 'UT01', 'Emergency Physicians Group', 'Richard', 'D', 'Wallin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833269', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870308023', 'S77005915', 'S77005915', 'UT01', 'Middleton Urological Associates', 'George', 'W', 'Middleton', 'MD', 'Urology', NULL, NULL, NULL, 'B', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851394639', 0, 'y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870321597', 'S77005917', 'S77005917', 'UT01', NULL, 'Richard', 'L', 'Stone', 'MD', 'Dermatology', '', '', NULL, 'O', '1375 N University Ave', 'Provo', 'Utah', 'UT', '84604', '8013774745', NULL, '1375 N University Ave', 'Provo', 'Utah', 'UT', '84604', '8013774745', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1548262801', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.2521, -111.659, NULL, NULL),
('870323929', 'S77005921', 'S77005921', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8008606260', NULL, '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-10-21', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870323929', 'S77005922', 'S77005922', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '9730 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8008606260', NULL, '9730 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2012-08-23', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870324719', 'S77005923', 'S77005923', 'UT01', 'Utah Neurological Clinic', 'Matthew', 'J', 'Badger', 'NP', 'Neurology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912029778', 0, 'N', 0, '2010-08-03', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870324719', 'S77005924', 'S77005924', 'UT01', 'Utah Neurological Clinic', 'Paul', 'K', 'Gardner', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821012832', 0, 'N', 0, '2014-02-21', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870324719', 'S77005925', 'S77005925', 'UT01', 'Utah Neurological Clinic', 'David', 'R', 'Glassford', 'NP', 'Neurology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', '1055 N 300 W', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1285854612', 0, 'N', 0, '2010-09-13', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870551290', 'S77005932', 'S77005932', 'UT01', 'Eye Health Professionals', 'Lanny', 'F', 'Duclos', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '88 E 700 N Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358826452', NULL, '88 E 700 N Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358826452', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508827262', 0, 'N', 0, '2012-03-13', NULL, NULL, 40.5439, -112.296, NULL, NULL),
('870551310', 'S77005933', 'S77005933', 'UT01', 'Donaldson, Stephen L', 'Stephen', 'L', 'Donaldson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1275 N University Ave Ste 10', 'Provo', 'Utah', 'UT', '84604', '8013756565', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578552634', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870553496', 'S77005935', 'S77005935', 'UT01', 'Riverton Family Health Center', 'Daniel', 'O', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'O', '1756 Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', NULL, '1756 Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831186717', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870555521', 'S77005937', 'S77005937', 'UT01', 'Box Elder Family Vision Clinic', 'Larry', 'D', 'Terry', 'OD', 'Optometry', '', '', NULL, 'O', '34 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232485', NULL, '34 S Main St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232485', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437137379', 0, 'N', 0, '2014-02-03', NULL, NULL, 41.5097, -112.016, NULL, NULL),
('870543444', 'S77005940', 'S77005940', 'UT01', NULL, 'Tod', 'L', 'Berg', 'MD', 'Family Practice', '', '', NULL, 'O', '1467 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356546321', NULL, '1467 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356546321', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497713648', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.4894, -111.41, NULL, NULL),
('870544230', 'S77005948', 'S77005948', 'UT01', 'Rocky Mountain Eye Care', 'E Leigh', NULL, 'Wilkinson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '4400 S 700 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, '4400 S 700 E', 'Salt Lake City', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962512855', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005949', 'S77005949', 'UT01', 'Montezuma Creek Community Clinic', 'Brooks', 'D', 'Thompson', NULL, 'Family Practice', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487657763', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005950', 'S77005950', 'UT01', 'Utah Navajo Health System', 'Brooks', 'D', 'Thompson', NULL, 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487657763', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005951', 'S77005951', 'UT01', 'Utah Navajo Health System', 'Richard', 'T', 'Ward', NULL, 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '7140', '0.00', NULL, NULL, 3, '2006-12-01', '2006-12-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560776', 'S77005952', 'S77005952', 'UT01', NULL, 'Jeffrey', 'B', 'Jackson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1995 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669888', '8015669899', '1995 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669888', '8015669899', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952363285', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.5877, -111.945, NULL, NULL),
('161767581', 'S77005953', 'S77005953', 'UT01', 'Layton Family Practice', 'Nelson', 'L', 'Astle', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-01-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548366552', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77005955', 'S77005955', 'UT01', 'Layton Family Practice', 'Paul', 'R', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84015', '8015469441', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831021', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'S77005959', 'S77005959', 'UT01', 'Ogden Womens Clinic', 'LeAnne', 'P', 'Gundy', 'NP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932109261', 0, 'N', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870330589', 'S77005960', 'S77005960', 'UT01', 'American Fork Radiology', 'Daniel', 'J', 'Hatch', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'B', 'PO Box 374', 'American Fork', 'Utah', 'UT', '84003', NULL, NULL, 'PO Box 374', 'American Fork', 'Utah', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1588608582', 0, 'Y', 0, '2010-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870332618', 'S77005961', 'S77005961', 'UT01', NULL, 'Keith', 'Joseph', 'Clayton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1675 N Freedom Blvd Ste 9C', 'Provo', 'Utah', 'UT', '84604', '8013774800', NULL, '1675 N Freedom Blvd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730185224', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.257, -111.662, NULL, NULL),
('870333048', 'S77005969', 'S77005969', 'UT01', 'Physical & Sports Therapy', 'Craig', 'A', 'Schultz', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657070', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833814', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'S77005970', 'S77005970', 'UT01', 'Gastroenterology Assoc', 'Ronald', 'D', 'Joseph', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033205760', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'S77005971', 'S77005971', 'UT01', 'Gastroenterology Assoc', 'Peder', 'J', 'Pedersen', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568558211', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870338016', 'S77005972', 'S77005972', 'UT01', '', 'Stephen', 'T', 'Thomson', 'MD', 'Dermatology', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 102', 'Ogden', 'Weber', 'UT', '84405', '8013993324', '8013942807', '6028 S Ridgeline Dr Ste 102', 'Ogden', 'Weber', 'UT', '84405', '8013993324', '8013942807', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-09-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1912960014', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870560763', 'S77005980', 'S77005980', 'UT01', 'Utah Navajo Health System', 'Kevin', 'M', 'Matteson', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2010-01-14', NULL, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407853013', 0, 'y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005981', 'S77005981', 'UT01', 'Montezuma Creek Community Clinic', 'Peggy', 'A', 'Towles', NULL, NULL, NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77005982', 'S77005982', 'UT01', 'Montezuma Creek Community Clinic', 'Richard', 'T', 'Ward', NULL, 'Physical Therapy', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '7140', '0.00', NULL, NULL, 3, '2006-12-01', '2006-12-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870545723', 'S77005983', 'S77005983', 'UT01', 'Lihai Medical Clinic', 'Kingi', 'M', 'Langi', 'PA, MT', 'Family Practice', '', '', NULL, 'B', '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4358820424', NULL, '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4358820424', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942257795', 0, 'Y', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870545911', 'S77005984', 'S77005984', 'UT01', 'Woodland Hills Radiology', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014659201', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014659201', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'Y', 0, '2014-01-17', NULL, NULL, 40.0446, -111.716, NULL, NULL),
('870545911', 'S77005986', 'S77005986', 'UT01', 'Woodland Hills Radiology', 'Dalton', 'H', 'Wright', 'MD', 'Radiologist', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012211339', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012211339', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1174569131', 0, 'Y', 0, '2014-03-20', NULL, NULL, 40.0446, -111.716, NULL, NULL),
('870546501', 'S77005992', 'S77005992', 'UT01', 'Alpine Pediatrics', 'Melanie', NULL, 'Murphy', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '944219', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005993', 'S77005993', 'UT01', 'Alpine Pediatrics', 'Greg', 'M', 'Pavich', 'MD', 'Pediatrics', '', '', NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1053359216', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77005994', 'S77005994', 'UT01', 'Alpine Pediatrics', 'Greg', 'M', 'Pavich', 'MD', 'Pediatrics', '', '', NULL, 'B', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1053359216', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77006010', 'S77006010', 'UT01', 'Wayne Community Health Centers', 'Joanna', '', 'Masi-Lynch', 'PA', 'Family Practice', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', '2011-11-07', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000925126', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77006011', 'S77006011', 'UT01', 'Wayne Community Health Centers', 'Anthony', 'F', 'Millward', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924549', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870343231', 'S77006012', 'S77006012', 'UT01', NULL, 'Scott', 'M', 'Soulier', 'DPM', 'Podiatry', 'Foot and Ankle', 'Diabetis', NULL, 'O', '4578 Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012749060', '8012749064', '4578 Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012749060', '8012749064', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1043213168', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.6723, -111.841, NULL, NULL),
('870343231', 'S77006013', 'S77006013', 'UT01', NULL, 'Scott', 'M', 'Soulier', 'DPM', 'Podiatry', 'Foot and Ankle', 'Diabetis', NULL, 'O', '7321 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8015611011', '8012749064', '7321 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8015611011', '8012749064', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1043213168', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.6185, -111.891, NULL, NULL),
('870345762', 'S77006015', 'S77006015', 'UT01', NULL, 'Terry', 'P', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812438', NULL, '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015812438', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-11-17', NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013972157', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870347187', 'S77006017', 'S77006017', 'UT01', 'Utah Valley Eye Center', 'Duane', 'J', 'Nelson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841296498', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870562898', 'S77006022', 'S77006022', 'UT01', 'Spine & Sports Medicine', 'Charles', 'M', 'Bova', 'MD', 'Pain Management', 'Sports Medicine', '', NULL, 'B', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012611946', NULL, '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012611946', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013071885', 0, 'Y', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870562898', 'S77006023', 'S77006023', 'UT01', 'Spine & Sports Medicine', 'Charles', 'M', 'Bova', 'MD', 'Pain Management', 'Sports Medicine', '', NULL, 'O', '3336 Pioneer Pkwy Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643249', NULL, '3336 Pioneer Pkwy Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643249', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013071885', 0, 'N', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77006024', 'S77006024', 'UT01', 'Layton Family Practice', 'Charles', 'J', 'Berwald', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194812925', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870546770', 'S77006038', 'S77006038', 'UT01', NULL, 'Max', 'M', 'Steele', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '370 9th Ave Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082999', NULL, '370 9th Ave Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082999', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1316055502', 0, 'N', 0, '2012-07-11', NULL, NULL, 40.7796, -111.878, NULL, NULL),
('870548726', 'S77006039', 'S77006039', 'UT01', 'Snow Creek Emergency Center (Mtn Family Health)', 'Brian', 'J', 'Rush', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184672511', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006042', 'S77006042', 'UT01', 'Utah Valley Pediatrics', 'Jennifer', 'Geary', 'Brinton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '716 W 800 N Ste 300', 'Orem', 'Utah', 'UT', '84057', '8012240421', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831657', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006043', 'S77006043', 'UT01', 'Utah Valley Pediatrics', 'Gordon', 'B', 'Glade', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699703702', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006044', 'S77006044', 'UT01', 'Utah Valley Pediatrics', 'Richard', 'W', 'Later', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 307', 'Provo', 'Utah', 'UT', '84604', '8013717883', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962476002', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006045', 'S77006045', 'UT01', 'Utah Valley Pediatrics', 'Gregory', 'W', 'Nielsen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', '1355 N University Ave Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013748863', '8013730308', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427025378', 0, 'Y', 0, '2012-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870564308', 'S77006056', 'S77006056', 'UT01', NULL, 'Larry', 'E', 'Urry', 'MD', 'Dermatology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2635', 'Ogden', 'Weber', 'UT', '84403', '8013873515', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013873515', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083716955', 0, 'N', 0, '2011-09-21', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870565773', 'S77006057', 'S77006057', 'UT01', 'Mountain Medical Physician Specialists Radiology', '', '', 'Mountain Medical Physician Specialists Radiology', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'O', '5323 S Woodrow St Ste 100', 'Murray', 'Salt Lake', 'UT', '84123', '8017130600', NULL, '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, 'N', 0, '2006-12-11', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870565773', 'S77006058', 'S77006058', 'UT01', 'Mountain Medical Vascular Specialists', 'David', 'S', 'Feuer', 'MD', 'Vascular Surgery', 'Vascular Surgery', NULL, NULL, 'O', '5323 S Woodrow St Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8017131010', NULL, '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447251894', 0, 'N', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870565773', 'S77006059', 'S77006059', 'UT01', 'Mountain Medical Physician Specialists', 'Margaret', 'G', 'Moses', 'NP', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', NULL, '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386691434', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870565773', 'S77006060', 'S77006060', 'UT01', 'Mountain Medical Vascular Specialists', 'Margaret', 'G', 'Moses', 'NP', 'Radiologist', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017131010', NULL, '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386691434', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870353003', 'S77006063', 'S77006063', 'UT01', 'Bountiful Family Physicians', 'Stephen', 'A', 'Beck', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '415 Medical Dr Ste B-200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083724975', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870353003', 'S77006064', 'S77006064', 'UT01', 'Bountiful Family Physicians', 'Stephen', 'A', 'Beck', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '415 Medical Dr Ste B200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', NULL, '415 Medical Dr Ste B200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1083724975', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870353501', 'S77006065', 'S77006065', 'UT01', 'Emery Medical Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'O', '90 W Main St Ste 3', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4356376799', '250 N Fairgrounds', 'Price', 'Emery', 'UT', '84501', '4353812305', '4356376799', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-04-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77006066', 'S77006066', 'UT01', 'Rocky Mountain Womens Health Center', 'Teresa', 'V', 'Durbin', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609987791', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77006067', 'S77006067', 'UT01', 'Rocky Mountain Womens Health Center', 'Gretchen', 'Thorn', 'Faucett', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477647741', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77006068', 'S77006068', 'UT01', 'Rocky Mountain Womens Health Center', 'William', 'G', 'Hughes', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881787885', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77006070', 'S77006070', 'UT01', 'Rocky Mountain Womens Health Center', 'Vivian', NULL, 'Dearden', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437260510', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77006071', 'S77006071', 'UT01', 'Rocky Mountain Womens Health Center', 'Kristine', 'M', 'Zelenkov', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2013-03-20', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1326159427', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870357016', 'S77006074', 'S77006074', 'UT01', 'Old Farm OBGYN', 'Dennis', 'C', 'Hughes', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', NULL, '3970 S 700 E', 'Salt Lake City', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-05-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427027051', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870565773', 'S77006083', 'S77006083', 'UT01', 'Mountain Medical Physician Specialists', '', '', 'Mountain Medical Physician Specialists Radiology', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'O', '296 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012622647', '8012628118', '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, 40.6871, -111.883, NULL, NULL),
('870565773', 'S77006084', 'S77006084', 'UT01', 'Mountain Medical Physician Specialists', 'Greg', 'R', 'Goodman', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', NULL, 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1023019346', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870565773', 'S77006085', 'S77006085', 'UT01', 'Mountain Medical Vascular Specialists', 'Kristine', 'A', 'Miller', 'PA', 'Vascular Surgery', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017131010', NULL, '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '905453', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870566422', 'S77006086', 'S77006086', 'UT01', 'Christine S Osborne', NULL, NULL, 'Christine S Osborne LLC', 'GROUP', 'Audiology', NULL, NULL, NULL, 'O', '8017 Royal Ln', 'Sandy', 'Salt Lake', 'UT', '84093', '8016529854', '8013734008', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834810', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006089', 'S77006089', 'UT01', 'Utah Valley Pediatrics', 'Gregory', 'S', 'Wynn', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '716 W 800 N Ste 300', 'Orem', 'Utah', 'UT', '84057', '8012240421', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376550855', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549057', 'S77006090', 'S77006090', 'UT01', 'Utah Valley Pediatrics', 'John', 'R', 'Wynn', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '171 N 400 W Ste C12', 'Orem', 'Utah', 'UT', '84057', '8012244550', '8012254197', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255308102', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870549673', 'S77006091', 'S77006091', 'UT01', NULL, NULL, NULL, 'Mark S Naisbitt MD P', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '3460 Baker Dr', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-12-01', '2006-12-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833039', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006092', 'S77006092', 'UT01', 'Utah Physicians Care Center', 'Stephen', 'S', 'Aslami', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134151558', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870550021', 'S77006093', 'S77006093', 'UT01', 'Utah Physicians Care Center', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006094', 'S77006094', 'UT01', 'Utah Physicians Care Center', 'David', 'Brent', 'Gubler', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797595', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006095', 'S77006095', 'UT01', 'Utah Physicians Care Center', 'Mark', 'R', 'Oliver', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760400865', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006096', 'S77006096', 'UT01', 'Utah Physicians Care Center', 'Mark', 'A', 'Rada', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1770515140', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006097', 'S77006097', 'UT01', 'Utah Physicians Care Center', 'Venkatesh', 'Babu', 'Segu', 'MD', 'Internal Medicine', 'Endocrinology', NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834577', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77006098', 'S77006098', 'UT01', 'Utah Physicians Care Center', 'Kathleen', 'Barrett', 'Wilson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '1160  E 3900 S', 'Sandy', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477515690', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006099', 'S77006099', 'UT01', 'Cottonwood Pediatrics', 'Darin', 'G', 'Bosworth', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225010051', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006100', 'S77006100', 'UT01', 'Cottonwood Pediatrics', 'Julia', 'C', 'Brogli', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1336121177', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'S77006101', 'S77006101', 'UT01', 'Cottonwood Pediatrics', 'William', 'E', 'Cosgrove', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477535243', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870565773', 'S77006102', 'S77006102', 'UT01', 'Mountain Medical Physician Specialists', 'Douglas', 'J', 'Wirthlin', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', NULL, 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609816602', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870566422', 'S77006103', 'S77006103', 'UT01', 'Christine S Osborne', NULL, NULL, 'Christine S Osborne LLC', 'GROUP', 'Audiology', NULL, NULL, NULL, 'O', '182 Barnes Dr', 'Kaysville', 'Davis', 'UT', '84037', '8015478719', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834810', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870566422', 'S77006104', 'S77006104', 'UT01', 'Christine S Osborne', 'Christine', 'S', 'Osborne', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '182 Barnes Dr', 'Kaysville', 'Davis', 'UT', '84037', '8015478719', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093880312', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870566781', 'S77006105', 'S77006105', 'UT01', 'Benita Medical', 'Ray', '', 'Morris', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3465 Pioneer Pkwy Ste 2', 'West Valley', 'Salt Lake', 'UT', '84120', '8019637636', '8019638130', '3465 Pioneer Pkwy Ste 2', 'West Valley', 'Salt Lake', 'UT', '84120', '8019637636', '8019638130', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023171014', 0, 'N', 0, '2012-04-25', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870358019', 'S77006117', 'S77006117', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Steven', 'T', 'Jackson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '201 E 5900 S Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-07-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1447215173', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77006118', 'S77006118', 'UT01', 'Olympus Clinic', 'Steven', 'W', 'Heath', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366497166', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77006119', 'S77006119', 'UT01', 'Olympus Clinic', 'Jared', 'B', 'Probst', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346295177', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870360395', 'S77006121', 'S77006121', 'UT01', NULL, 'Walter', 'M', 'Snihurowych', 'MD', 'Urology', '', '', NULL, 'O', '250 N Fairgrounds Rd Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356374048', NULL, '250 N Fairgrounds Rd Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356374048', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', 'Uintah Basin Medical Center', NULL, 'HCFA|UB|', '1669428736', 0, 'N', 0, '2014-01-20', NULL, NULL, 39.6058, -110.835, NULL, NULL),
('870362387', 'S77006122', 'S77006122', 'UT01', NULL, 'Ross', 'J', 'Kelson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '6028 S Ridgeline Dr Ste 201A', 'Ogden', 'Weber', 'UT', '84405', '8014756520', NULL, '6028 S Ridgeline Dr', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447280169', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870363636', 'S77006123', 'S77006123', 'UT01', NULL, 'Douglas', '', 'Schow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 203', 'Provo', 'Utah', 'UT', '84604', '8013749053', NULL, '1055 N 300 W Ste 203', 'Provo', 'Utah', 'UT', '84604', '8013749053', '', 'WiseSTD6', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1811995004', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.2476, -111.664, 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
('870363826', 'S77006124', 'S77006124', 'UT01', '', 'Harrison', 'M', 'Lazarus', 'MD', 'General Surgery', 'Vascular Surgery', NULL, NULL, 'O', '324 10th Ave Ste 254', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012630778', '8015325717', '324 10th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012630778', '8015325717', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-27', NULL, 0, NULL, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407854821', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870363964', 'S77006127', 'S77006127', 'UT01', NULL, 'Gordon', 'R', 'Kimball', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 275', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717061', NULL, '9844 S 1300 E Ste 275', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717061', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1578545919', 0, 'N', 0, '2013-10-14', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('870364077', 'S77006128', 'S77006128', 'UT01', 'Wasatch Neurological Clinic', 'Gregory', 'K', 'Call', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '6040 Fashion Blvd Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012681888', NULL, '6040 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407839608', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870566422', 'S77006129', 'S77006129', 'UT01', NULL, 'Christine', 'S', 'Osborne', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '8017 Royal Ln', 'Sandy', 'Salt Lake', 'UT', '84093', '8016529854', '8013734008', '8017 Royal Ln', 'Sandy', '', 'UT', '84093', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-07-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093880312', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006143', 'S77006143', 'UT01', 'Cottonwood Pediatrics', 'William', 'E', 'Cosgrove', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477535243', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006144', 'S77006144', 'UT01', 'Cottonwood Pediatrics', 'Joseph', 'G', 'Cramer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-06-30', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477535169', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006145', 'S77006145', 'UT01', 'Willow Creek Pediatrics', 'Karla', 'A', 'Feindt', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255313953', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'S77006146', 'S77006146', 'UT01', 'Cottonwood Pediatrics', 'Allison', 'M', 'Groebs', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235111949', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006148', 'S77006148', 'UT01', 'Grow Up Great', 'Kathleen', 'M', 'Liou', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999721', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006149', 'S77006149', 'UT01', 'Cottonwood Pediatrics', 'Kathleen', 'M', 'Liou', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999721', 0, 'Y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006150', 'S77006150', 'UT01', 'Cottonwood Pediatrics', 'Thomas', 'J', 'Metcalf', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-08-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1669454294', 0, 'Y', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006151', 'S77006151', 'UT01', 'Cottonwood Pediatrics', 'Terry', 'H', 'Omura', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1417939117', 0, 'Y', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006152', 'S77006152', 'UT01', 'Wasatch Pediatrics at St Marks', 'Sarah', 'A', 'Ormsby', 'MD', 'Pediatrics', '', '', NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912980368', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'S77006153', 'S77006153', 'UT01', 'Summit Pediatrics', 'Kathy', 'M', 'Ostler', 'MD', 'Pediatrics', '', '', NULL, 'O', '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-10-16', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700869153', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006154', 'S77006154', 'UT01', 'Cottonwood Pediatrics', 'Katherine', 'A', 'Price', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144400', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831860', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006155', 'S77006155', 'UT01', 'Willow Creek Pediatrics', 'Shellie', 'J', 'Ring', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 Highland Dr Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-10-24', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1316920770', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('870364077', 'S77006171', 'S77006171', 'UT01', 'Wasatch Neurological Clinic', 'Thomas', 'D', 'Houts', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '6040 Fashion Blvd Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012681888', NULL, '6040 Fashion Blvd Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012681888', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467434803', 0, 'N', 0, '2013-07-12', NULL, NULL, 40.6397, -111.883, NULL, NULL),
('870364311', 'S77006172', 'S77006172', 'UT01', NULL, 'Barry', 'P', 'Cook', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '92 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4356376290', '4356376291', '92 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4356376290', '4356376291', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215031372', 0, 'N', 0, '2013-12-10', NULL, NULL, 39.6009, -110.804, NULL, NULL),
('870364697', 'S77006174', 'S77006174', 'UT01', 'Mountain View Womens Care', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013561113', NULL, '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013561113', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-09-30', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870365762', 'S77006175', 'S77006175', 'UT01', 'Crestwood Medical Group', 'John', 'B', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '47 Crestwood Rd Ste 2', 'Kaysville', 'Davis', 'UT', '84037', '8015461273', NULL, '47 Crestwood Rd', 'Kaysville', 'Davis', 'UT', '84037', '8015461273', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-09-01', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1730270760', 0, 'N', 0, '2011-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870366939', 'S77006176', 'S77006176', 'UT01', NULL, 'Lee', 'S', 'Broadbent', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '550 E 1400 N Ste D', 'Logan', 'Cache', 'UT', '84341', '4357527122', NULL, '550 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-12-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265467567', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870370541', 'S77006177', 'S77006177', 'UT01', 'Ogden Speech & Hearing Center', 'Tel', 'S', 'Bowman', 'MS Aud', 'Audiology', NULL, NULL, NULL, 'O', '978 Chambers St Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013995601', '8013942230', '978 E Chambers St', 'South Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834723', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870371439', 'S77006178', 'S77006178', 'UT01', NULL, 'James', 'E', 'Pearl', 'MD', 'Internal Medicine', 'Pulmonary', 'Emergency Medicine', NULL, 'O', '324 10th Ave Ste 170', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8013221000', '8014085556', '324 10th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8013221000', '8014085556', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-06-15', NULL, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1417959206', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870371792', 'S77006179', 'S77006179', 'UT01', NULL, 'Ronald', 'G', 'Duerksen', 'MD', 'Physical Medicine and Rehabilitation', 'Electrodiagnosis', NULL, NULL, 'O', '1055 N 300 W Ste 416', 'Provo', 'Utah', 'UT', '84604', '8013577770', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164503900', 0, 'N', 0, '2008-04-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870371964', 'S77006180', 'S77006180', 'UT01', 'Cache Valley Ear Nose And Throat', 'Gordon', 'S', 'Wood', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', 'Plastic Surgery', 'B', '2380 N 400 E Ste D', 'Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255328969', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870371964', 'S77006181', 'S77006181', 'UT01', 'Cache Valley Ear Nose and Throat', 'Gordon', 'S', 'Wood', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255328969', 0, 'N', 0, '2013-08-26', NULL, NULL, 41.775, -111.823, NULL, NULL),
('870571315', 'S77006193', 'S77006193', 'UT01', 'Cannon, Max K', 'Max', 'K', 'Cannon', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '39 Professional Way Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014651701', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833167', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77006194', 'S77006194', 'UT01', 'Layton Ambulatory Anesthesia', 'Bryan', 'G', 'Holbrook', 'MD', 'Pain Management', 'Anesthesiology', NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034081', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870572238', 'S77006195', 'S77006195', 'UT01', 'Hidden Valley Family Medicine', 'Gary', 'S', 'Call', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '          ', 'WISESTD', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-11-10', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1255323697', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006196', 'S77006196', 'UT01', 'Cottonwood Pediatrics', 'Daniel', 'R', 'Stampfl', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871576280', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006197', 'S77006197', 'UT01', 'Cottonwood Pediatrics', 'John', 'B', 'Wall', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-04-25', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1174506554', 0, 'Y', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006198', 'S77006198', 'UT01', 'Wasatch Pediatrics', 'Leslie', 'W', 'Webster', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1789 West Sun Peak Dr Ste A 101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821071242', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77006200', 'S77006200', 'UT01', 'Cottonwood Pediatrics', 'Paul', 'E', 'Wirkus', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', NULL, '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1134101835', 0, 'N', 0, '2014-07-10', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550968', 'S77006201', 'S77006201', 'UT01', NULL, 'Timothy', 'S', 'Houden', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 1875', 'Ogden', 'Weber', 'UT', '84403', '8013872090', NULL, '4335 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255339552', 0, 'N', 0, '2006-11-07', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870568890', 'S77006212', 'S77006212', 'UT01', NULL, 'Daniel', 'W', 'Pace', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '70 N Main St Ste 102', 'Bountiful', 'Davis', 'UT', '84010', '8012921408', '8012921966', '70 N Main St Ste 102', 'Bountiful', 'Davis', 'UT', '84010', '8012921408', '8012921966', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447271721', 0, 'N', 0, '2013-04-29', NULL, NULL, 40.8901, -111.881, NULL, NULL),
('870569381', 'S77006213', 'S77006213', 'UT01', 'Cache Valley Cardiology', 'Rudolf', NULL, 'Otrusinik', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003922394', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870569543', 'S77006214', 'S77006214', 'UT01', 'Basin Clinic', 'Laura', '', 'Arnold', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', '379 N 500 W', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-19', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1275629792', 0, 'N', 0, '2011-10-21', NULL, NULL, 0, 0, NULL, NULL),
('870569543', 'S77006215', 'S77006215', 'UT01', 'Basin Clinic', 'Kirk', 'J', 'Woodward', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811083348', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.4616, -109.538, NULL, NULL),
('870569701', 'S77006216', 'S77006216', 'UT01', NULL, 'Gary', 'K', 'Goucher', 'MD', 'Internal Medicine', 'Pulmonary', 'Emergency Medicine', 'Sleep Studies', 'O', '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1043257140', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870569774', 'S77006217', 'S77006217', 'UT01', NULL, 'Blake', 'G', 'Welling', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876520', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876520', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1770627234', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870570172', 'S77006218', 'S77006218', 'UT01', 'Bear River Medical Arts', 'Jan-Erik', '', 'Schow', 'MD', 'Family Practice', '', '', NULL, 'O', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', '4352572434', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', '4352572434', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1215292219', 0, 'N', 0, '2014-07-07', NULL, NULL, 41.7264, -112.158, NULL, NULL),
('870571510', 'S77006219', 'S77006219', 'UT01', 'Layton Ambulatory Anesthesia', 'Earl', 'K', 'Leeman', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831174333', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77006220', 'S77006220', 'UT01', 'Layton Ambulatory Anesthesia', 'Clark', 'E', 'Petersen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519894', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'S77006221', 'S77006221', 'UT01', 'Layton Ambulatory Anesthesia', 'Robert', 'M', 'Sorensen', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', '', 'UT', '84016', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2006-06-01', '2006-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609852243', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77006223', 'S77006223', 'UT01', NULL, 'Peter', NULL, 'Anders', 'CRNA', 'Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013941640', 0, 'Y', 0, '2007-03-27', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870372827', 'S77006224', 'S77006224', 'UT01', NULL, 'Peter', NULL, 'Anders', 'CRNA', 'Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013941640', 0, 'Y', 0, '2007-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77006226', 'S77006226', 'UT01', NULL, 'Paul', 'J', 'Diehl', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821195579', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870372827', 'S77006227', 'S77006227', 'UT01', NULL, 'Paul', 'J', 'Diehl', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821195579', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77006228', 'S77006228', 'UT01', NULL, 'Sherry', '', 'Edon', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy ', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-03-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77006231', 'S77006231', 'UT01', NULL, 'Stephen', 'S', 'Stewart', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134225204', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870372827', 'S77006232', 'S77006232', 'UT01', NULL, 'Stephen', 'S', 'Stewart', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134225204', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870572251', 'S77006237', 'S77006237', 'UT01', 'Hidden Valley Family Practice', 'Harold', 'N', 'Gooch', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '          ', 'WISESTD', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-11-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114910072', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870572251', 'S77006238', 'S77006238', 'UT01', 'Hidden Valley Family Practice', 'Harold', 'N', 'Gooch', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015723750', NULL, '12176 S 1000 E', 'Draper', 'Davis', 'UT', '84020', '8015723750', '          ', 'WISESTD', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-11-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114910072', 0, 'Y', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870573319', 'S77006241', 'S77006241', 'UT01', 'Bountiful Vision Plaza', 'Douglas', 'R', 'Smith', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '311 E 500 S', 'Bountiful', 'Davis', 'UT', '84010', '8012954441', '8012955416', '311 E 500 S', 'Bountiful', 'Davis', 'UT', '84010', '8012954441', '8012955416', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487846655', 0, 'N', 0, '2012-12-07', NULL, NULL, 40.8843, -111.874, NULL, NULL),
('870573947', 'S77006242', 'S77006242', 'UT01', 'Holladay Family Practice', 'Gene', 'R', 'Fuller', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396710281', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870551310', 'S77006252', 'S77006252', 'UT01', 'Donaldson, Stephen L', 'Stephen', 'L', 'Donaldson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1275 N University Ave Ste 10', 'Provo', 'Utah', 'UT', '84604', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578552634', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870553496', 'S77006253', 'S77006253', 'UT01', 'Riverton Family Health Center', 'Don', 'P', 'Allred', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '1756 Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', NULL, '1756 W Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', NULL, 0, NULL, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174510044', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870553496', 'S77006254', 'S77006254', 'UT01', 'Riverton Family Health Center', 'Ryan', 'Paul', 'Peterson', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '1756 Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', NULL, '1756 W Park Ave', 'Riverton', '', 'UT', '84065', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '911507', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870555165', 'S77006257', 'S77006257', 'UT01', 'Pediatric Care of Ogden', 'Julie', 'L', 'Berry', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', NULL, '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144313438', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870555165', 'S77006258', 'S77006258', 'UT01', 'Pediatric Care Of Ogden', 'Charlene', 'G', 'Clawson', 'MD', 'Pediatrics', '', '', NULL, 'O', '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', NULL, '3955 Harrison Blvd Ste L1', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407949795', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870555591', 'S77006259', 'S77006259', 'UT01', 'Womens Health Services', 'Jacqueline', 'M', 'Smithers', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6440 Wasatch Blvd Ste 270', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019425814', '8019425897', '6440 Wasatch Blvd Ste 270', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019425814', '8019425897', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356302624', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.6333, -111.799, NULL, NULL),
('870556715', 'S77006260', 'S77006260', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', NULL, '24 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-02-28', NULL, 0, NULL, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2011-03-08', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'S77006264', 'S77006264', 'UT01', 'Holladay Family Practice', 'Carol', 'A', 'Cheney', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710952791', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'S77006265', 'S77006265', 'UT01', 'Holladay Family Practice', 'Taylor', 'A', 'Jeppson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932174919', 0, 'N', 0, '2011-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'S77006266', 'S77006266', 'UT01', 'Holladay Family Practice', 'David', 'C', 'Larsen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679548564', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77006277', 'S77006277', 'UT01', 'Heart And Lung Institute', 'Mark', 'H', 'Keep', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609859297', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77006278', 'S77006278', 'UT01', 'Heart and Lung Institute', 'Patricia', 'L', 'Nelson', 'MD', 'Pulmonary', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-04-01', NULL, 0, NULL, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1629051206', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77006283', 'S77006283', 'UT01', 'Heart and Lung Institute', 'George', 'K', 'Wong', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316928903', 0, 'N', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870373084', 'S77006285', 'S77006285', 'UT01', NULL, 'David', 'J', 'Henderson', 'MD', 'Urology', '', '', NULL, 'O', '415 Medical Dr Ste 202A', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', NULL, '415 Medical Dr Ste 202A', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-04-01', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417933284', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870373377', 'S77006286', 'S77006286', 'UT01', 'Clark MD PC, Jay D', 'Jay', 'D', 'Clark', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '175 N 400 W Ste C10', 'Orem', 'Utah', 'UT', '84057', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833658', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870375015', 'S77006287', 'S77006287', 'UT01', 'Wasatch Medical Clinic', 'Neal', 'J', 'Burton', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 247', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', '4356542030', 'PO Box 247', 'Heber', 'Wasatch', 'UT', '84032', '4356541501', '4356542030', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-26', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1033141924', 0, 'Y', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870375459', 'S77006288', 'S77006288', 'UT01', NULL, 'A', 'Hamer', 'Reiser', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '324 10th Ave Ste 172', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085155', '8014085156', '324 10th Ave', 'Salt Lake City', '', 'UT', '84140', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833947', 0, 'N', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870559522', 'S77006303', 'S77006303', 'UT01', 'Lihai Medical Clinic', 'Kingi', 'M', 'Langi', 'PA, MT', 'Family Practice', '', '', NULL, 'B', '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '6778 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942257795', 0, 'Y', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006304', 'S77006304', 'UT01', 'Blanding Family Practice', 'Terry', 'R', 'Cook', NULL, 'Podiatry', NULL, NULL, NULL, 'O', '799 S 200 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006306', 'S77006306', 'UT01', 'Montezuma Creek Community Clinic', 'Lloyd', 'V', 'Jones', NULL, 'Family Practice', 'Emergency Medicine', NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932102514', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006308', 'S77006308', 'UT01', 'Blanding Family Practice', 'Michele', 'M', 'Lyman', NULL, NULL, NULL, NULL, NULL, 'O', '799 S 200 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447253091', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006309', 'S77006309', 'UT01', 'Montezuma Creek Community Clinic', 'Michele', 'M', 'Lyman', NULL, NULL, NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447253091', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006310', 'S77006310', 'UT01', 'Montezuma Creek Community Clinic', 'Earl', 'K', 'Plunkett', NULL, 'Family Practice', NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225031792', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006311', 'S77006311', 'UT01', 'Navajo Mountain Community Health Center', 'Earl', 'K', 'Plunkett', 'MD', 'Family Practice', '', '', NULL, 'O', '#2 Rainbow Rd', 'Tonalea', 'Coconino', 'AZ', '86044', '9286722498', NULL, NULL, NULL, 'Coconino', NULL, NULL, '9286722498', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1225031792', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006312', 'S77006312', 'UT01', 'Utah Navajo Health System', 'Tanya', 'D', 'Richey', NULL, '', NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006313', 'S77006313', 'UT01', 'Montezuma Creek Community Clinic', 'Freddie', NULL, 'Riggs', NULL, NULL, NULL, NULL, NULL, 'O', 'East Highway 262 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881697365', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006314', 'S77006314', 'UT01', 'Utah Navajo Health System', 'Freddie', NULL, 'Riggs', NULL, NULL, NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881697365', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870376634', 'S77006331', 'S77006331', 'UT01', NULL, 'Albert', 'R', 'Hartman', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4625', 'Ogden', 'Weber', 'UT', '84403', '8013874800', '8013874805', '4403 Harrison Blvd Ste 4625', 'Ogden', 'Weber', 'UT', '84403', '8013874800', '8013874805', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659474757', 0, 'N', 0, '2013-09-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870379554', 'S77006332', 'S77006332', 'UT01', NULL, 'S', 'T', 'Schiffgen', 'DPM', 'Podiatry', '', '', NULL, 'O', '9690 S 1300 E Ste 120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014335', '8015014338', '9690 S 1300 E Ste 120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014335', '8015014338', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1477556298', 0, 'N', 0, '2014-04-07', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('870380540', 'S77006333', 'S77006333', 'UT01', 'Western Urological Clinic', 'Lane', 'C', 'Childs', 'MD', 'Urology', '', '', NULL, 'O', '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', NULL, '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831239995', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6791, -111.843, NULL, NULL),
('870382132', 'S77006334', 'S77006334', 'UT01', '', 'Howard', 'A', 'Katzman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1485 E 3900 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014243937', NULL, '1485 E 3900 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014243937', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760492912', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.6871, -111.849, NULL, NULL),
('870382132', 'S77006335', 'S77006335', 'UT01', 'Katzman, Howard A', 'Howard', 'A', 'Katzman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1485 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019719066', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760492912', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870382397', 'S77006336', 'S77006336', 'UT01', '', 'Max', 'G', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'O', '230 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356372300', '4356371581', '230 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356372300', '4356371581', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-07-16', 0, 0, 0, 'Castleview Hospital', '', '', '', 'HCFA|UB|', '1285699264', 0, 'N', 0, '2014-07-22', NULL, NULL, 39.6039, -110.831, NULL, NULL),
('870383139', 'S77006337', 'S77006337', 'UT01', NULL, 'Sterling', 'G', 'Potter', 'MD', 'Family Practice', '', '', NULL, 'O', '945 W Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356376190', '4356376317', '945 W Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356376190', '4356376317', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Castleview Hospital', '', '', '', 'HCFA|UB|', '1942314547', 0, 'N', 0, '2014-07-16', NULL, NULL, 39.6064, -110.834, NULL, NULL),
('870387679', 'S77006338', 'S77006338', 'UT01', 'Lind Lamoreaux Melendez and Aagard', 'Brent', 'K', 'Lind', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E', 'American Fork', '', 'UT', '840032089', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831504', 0, 'N', 0, '2007-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77006340', 'S77006340', 'UT01', 'The Er Group', 'Larry', NULL, 'Wilcken', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma City', 'Oklahoma', 'OK', '73143', NULL, NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790817013', 0, 'Y', 0, '2007-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870576891', 'S77006342', 'S77006342', 'UT01', 'Hidden Valley Family Medicine', 'Ronald', 'F', 'Lopez', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '', 'WISESTD', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1699767012', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.5305, -111.863, NULL, NULL),
('870577952', 'S77006343', 'S77006343', 'UT01', 'Western Newborn Specialists', 'Timothy', 'R', 'LaPine', 'MD', 'Neonatology', 'Pediatrics', NULL, NULL, 'O', '1140 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8017436520', '8017436534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2002-10-02', NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760481162', 0, 'N', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870578259', 'S77006344', 'S77006344', 'UT01', 'Parkway Family Practice', 'Robert', 'D', 'Williams', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1288 W 12700 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012530291', NULL, 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012530291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063596401', 0, 'N', 0, '2010-04-21', NULL, NULL, 40.5206, -111.929, NULL, NULL),
('870578259', 'S77006345', 'S77006345', 'UT01', 'Parkway Family Practice', 'Robert', 'D', 'Williams', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012530291', NULL, 'PO Box 1010', 'Riverton', '', 'UT', '84065', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063596401', 0, 'Y', 0, '2010-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870579572', 'S77006350', 'S77006350', 'UT01', 'Jordan Vision Clinic', 'Robert', 'H', 'Meek', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '9237 Redwood Rd Ste 5-A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015612020', '8012553617', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356310940', 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
('870579572', 'S77006351', 'S77006351', 'UT01', 'Canyon Eye Specialists', 'Lynn', 'D', 'Stromness', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1434 E 9400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84093', '8015761145', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073694212', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'S77006353', 'S77006353', 'UT01', 'Utah Navajo Health System', 'Peggy', 'A', 'Towles', NULL, NULL, NULL, NULL, NULL, 'B', 'PO Box 130 ', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870562898', 'S77006354', 'S77006354', 'UT01', 'Spine & Sports Medicine', 'John', 'Howard', 'Loomis', 'DO', 'Pain Management', 'Sports Medicine', 'Physical Medicine and Rehabilitation', NULL, 'B', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012611946', NULL, '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012611946', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-02-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598820318', 0, 'Y', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'S77006355', 'S77006355', 'UT01', 'Layton Family Practice', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('870574267', 'S77006367', 'S77006367', 'UT01', 'The Er Group', 'Bruce', 'A', 'Daniel', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '8002250953', NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568563591', 0, 'Y', 0, '2007-01-05', NULL, NULL, 40.4585, -109.531, NULL, NULL),
('870574267', 'S77006368', 'S77006368', 'UT01', 'The Er Group', 'Steve', 'E', 'Pehrson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '8002250953', NULL, 'PO Box 96398', 'Oklahoma City', '', 'OK', '83143', '', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164531968', 0, 'Y', 0, '2007-01-05', NULL, NULL, 40.4585, -109.531, NULL, NULL),
('870574277', 'S77006369', 'S77006369', 'UT01', NULL, 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870575989', 'S77006371', 'S77006371', 'UT01', 'Country Hills Eye Center', 'David', 'E', 'Brodstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1912989518', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.1889, -111.958, NULL, NULL),
('870575989', 'S77006372', 'S77006372', 'UT01', 'Country Hills Eye Center', 'Scott', 'C', 'Richards', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1447232806', 0, 'N', 0, '2011-03-10', NULL, NULL, 41.1889, -111.958, NULL, NULL),
('870576522', 'S77006374', 'S77006374', 'UT01', 'Brigham Anesthesia', '', '', 'Brigham Anesthesia', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8005946399', '8017335618', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8005946399', '8017335618', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832248', 0, 'Y', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('870576522', 'S77006375', 'S77006375', 'UT01', 'Brigham Anesthesia', 'David', 'G', 'Hess', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '950 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357344144', '8017335618', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '841216800', '', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891715934', 0, 'Y', 0, '2007-01-10', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('870577952', 'S77006376', 'S77006376', 'UT01', 'Western Newborn Specialists', 'Timothy', 'R', 'LaPine', 'MD', 'Neonatology', 'Pediatrics', NULL, NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', NULL, NULL, 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760481162', 0, 'Y', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
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('870391052', 'S77006388', 'S77006388', 'UT01', 'Sevier Valley Hospital', 'C Brent', NULL, 'Fox', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8002449001', NULL, '1377 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811938939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395257', 'S77006389', 'S77006389', 'UT01', NULL, 'Patricia', NULL, 'Legant', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '164 E 5900 S Ste A106', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012633003', NULL, '164 E 5900 S', 'Salt Lake City', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851365050', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6428, -111.887, NULL, NULL),
('870395551', 'S77006390', 'S77006390', 'UT01', 'Jordan Oaks Chiropractic', 'Alan', 'John', 'Adams', 'DC', 'Chiropractic', '', '', NULL, 'O', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598894685', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870580379', 'S77006391', 'S77006391', 'UT01', 'Summit View Medical', 'David', 'B', 'Douglas', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '9829 S 1300 E Ste 302', 'Sandy', 'Salt Lake', 'UT', '84094', '8015768988', '8015769396', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908303', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870581700', 'S77006393', 'S77006393', 'UT01', 'Southwest Family Medicine', 'Chuck', 'H', 'Gee', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '1561 Fort Union Blvd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013522700', '8013520400', '1561 Fort Union Blvd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013522700', '8013520400', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972620417', 0, 'Y', 0, '2010-08-17', NULL, NULL, 0, 0, NULL, NULL),
('870581700', 'S77006394', 'S77006394', 'UT01', 'Southwest Family Medicine', 'Barbara', 'P', 'Reineke', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '1561 Fort Union Blvd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013522700', '8013520400', '1561 Fort Union Blvd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013522700', '8013520400', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073652145', 0, 'Y', 0, '2010-08-17', NULL, NULL, 0, 0, NULL, NULL),
('870581700', 'S77006395', 'S77006395', 'UT01', 'Southwest Family Medicine', 'Randall', 'L', 'Watson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015699133', '8015699103', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015699133', '8015699103', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952341000', 0, 'N', 0, '2013-09-18', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('870583479', 'S77006396', 'S77006396', 'UT01', 'Phase II Center for Womens Health', 'Elizabeth', 'S', 'Graul', 'MD', 'Gynecology', '', '', NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1417074865', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870603341', 'S77006397', 'S77006397', 'UT01', NULL, 'Christopher', 'A', 'Neville', 'PA', 'Dermatology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 450', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623600', '8012622555', '1260 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689617714', 0, 'N', 0, '2006-11-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870607715', 'S77006398', 'S77006398', 'UT01', NULL, 'Cynthia', 'L', 'Campbell', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '728 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544192', NULL, '728 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544192', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134112998', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5068, -111.424, NULL, NULL),
('870609595', 'S77006399', 'S77006399', 'UT01', 'Utah County Medical Associates', 'Robert', 'B', 'Clark', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014653267', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689692071', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'S77006400', 'S77006400', 'UT01', 'Utah County Medical Associates', 'Elizabeth', 'A', 'Dayton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014653267', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598799421', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870579572', 'S77006421', 'S77006421', 'UT01', 'Jordan Vision Clinic', 'Lynn', 'D', 'Stromness', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '9237 Redwood Rd Ste 5-A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015612020', '8012553617', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073694212', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870583479', 'S77006423', 'S77006423', 'UT01', 'Phase II Center for Womens Health', 'Barbara', '', 'Hurst', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205973070', 0, 'N', 0, '2011-04-26', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870395551', 'S77006428', 'S77006428', 'UT01', NULL, 'Travis', 'R', 'Allan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225082118', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006429', 'S77006429', 'UT01', NULL, 'Von', 'W', 'Alleman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '147 W 400 N', 'Orem', 'Utah', 'UT', '84057', '8012219060', '8012219071', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467472985', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77006433', 'S77006433', 'UT01', NULL, 'John', 'G', 'Aznar', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '555 S State St Ste 203', 'Orem', 'Utah', 'UT', '84057', '8012217012', '8012255826', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832061', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006434', 'S77006434', 'UT01', NULL, 'John', NULL, 'Bach', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841241338', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006435', 'S77006435', 'UT01', NULL, 'Mark', 'L', 'Baker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '610 N Main St', 'Clearfield', 'Davis', 'UT', '84015', '8017737448', '8014871015', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417011016', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006436', 'S77006436', 'UT01', NULL, 'Mark', 'L', 'Baker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417011016', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006437', 'S77006437', 'UT01', NULL, 'Morris', 'L', 'Barton', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '111 S 1200 E Ste B', 'Lehi', 'Utah', 'UT', '84043', '8017680500', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-10', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832940', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006438', 'S77006438', 'UT01', 'Frogley Health & Wellness', 'Sterling', 'P', 'Black', 'DC', 'Chiropractic', '', '', NULL, 'O', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8013973765', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8013973765', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699725747', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006439', 'S77006439', 'UT01', NULL, 'Eric', 'J', 'Brady', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306934393', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006440', 'S77006440', 'UT01', NULL, 'Eric', 'J', 'Brady', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '777 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84601', '8013752420', '8013748588', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306934393', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006441', 'S77006441', 'UT01', 'Chiropractic Health Plan', 'Christopher', 'J', 'Bunn', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '939394', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'S77006442', 'S77006442', 'UT01', 'Utah County Medical Associates', 'Ian', 'B', 'McMaster', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654899', '8014653267', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598799462', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616000', 'S77006446', 'S77006446', 'UT01', 'Salt Lake Podiatry', 'Donald', 'R', 'Call', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012699939', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861594624', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870565773', 'S77006457', 'S77006457', 'UT01', 'Mountain Medical Physician Specialists', 'David', 'S', 'Feuer', 'MD', 'Vascular Surgery', 'Vascular Surgery', NULL, NULL, 'B', 'PO Box 29684', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017134402', NULL, '5444 Green St', 'Murray', '', 'UT', '84107', '', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447251894', 0, 'Y', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
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('870569543', 'S77006516', 'S77006516', 'UT01', 'Basin Clinic', 'Michael', 'T', 'Olsen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356437891', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.4616, -109.538, NULL, NULL),
('870569543', 'S77006517', 'S77006517', 'UT01', 'Basin Clinic', 'Kirk', 'J', 'Woodward', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '4357891169', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811083348', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870616000', 'S77006525', 'S77006525', 'UT01', 'Salt Lake Podiatry', 'Donald', 'R', 'Call', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861594624', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77006541', 'S77006541', 'UT01', '', 'Tiffani', '', 'Fries', 'DC', 'Chiropractic', '', '', NULL, 'O', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852580', '8014852587', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852580', '8014852587', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977105', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006542', 'S77006542', 'UT01', 'Frogley Health & Wellness Center', 'Scott', 'H', 'Frogley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10684 S River Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790825388', 0, 'N', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006543', 'S77006543', 'UT01', NULL, 'Gregory', 'D', 'Futrell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '7086 Highland Dr Ste 50', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019448700', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '912213', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006544', 'S77006544', 'UT01', NULL, 'Paul', NULL, 'Gurney', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649328170', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006545', 'S77006545', 'UT01', NULL, 'Charles', NULL, 'Hagan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2200 E 4500 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728500', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-10', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833506', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006546', 'S77006546', 'UT01', NULL, 'Daryl', NULL, 'Hales', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972504892', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870572238', 'S77006561', 'S77006561', 'UT01', 'Hidden Valley Family Medicine', 'Gary', 'S', 'Call', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', NULL, '12176 S 1000E', 'Draper', 'Davis', 'UT', '84020', '8012946907', '          ', 'WISESTD', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', '2011-11-10', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1255323697', 0, 'Y', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870572573', 'S77006562', 'S77006562', 'UT01', NULL, 'Alan', 'R', 'Abdulla', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3620', 'Ogden', 'Weber', 'UT', '84403', '8013873525', NULL, '4403 Harrison Blvd Ste 3620', 'Ogden', 'Weber', 'UT', '84403', '8013873525', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720025281', 0, 'N', 0, '2013-11-04', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870573947', 'S77006564', 'S77006564', 'UT01', 'Holladay Family Practice', 'Eric', 'C', 'McDougall', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-09-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285609313', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006587', 'S77006587', 'UT01', NULL, 'Gregory', 'K', 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '8915 S 700 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016191439', '8015539019', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275602724', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006588', 'S77006588', 'UT01', NULL, 'Trent', NULL, 'Harrison', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518047026', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006590', 'S77006590', 'UT01', NULL, 'Jeffrey', 'J', 'Hebert', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457449290', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006591', 'S77006591', 'UT01', NULL, 'Donald', 'C', 'Helvey', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832858', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006592', 'S77006592', 'UT01', NULL, 'Bradley', 'J', 'Hendricks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833856', 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
('870395551', 'S77006593', 'S77006593', 'UT01', '', 'Sidney', '', 'Hendricks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 304', 'Farmington', 'Davis', 'UT', '84025', '8014517900', '8014517211', '867 E 9400 S', 'Sandy', 'Davis', 'UT', '84094', '8014517900', '8014517211', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1831196633', 0, 'Y', 0, '2010-11-09', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006594', 'S77006594', 'UT01', NULL, 'Sidney', NULL, 'Hendricks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831196633', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006595', 'S77006595', 'UT01', '', 'Charles', 'A', 'Howard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '435 S Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834069', '4352830372', '435 S Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834069', '4352830372', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174523906', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006596', 'S77006596', 'UT01', NULL, 'Charles', 'A', 'Howard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174523906', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006597', 'S77006597', 'UT01', NULL, 'Wayne', NULL, 'Hunsaker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205986148', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006598', 'S77006598', 'UT01', 'In House Chiropractic', 'Nancy', 'O', 'Jeffery', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1037 Kimberly Dr', 'Layton', 'Davis', 'UT', '84040', '8015930999', '8015935458', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538211214', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006639', 'S77006639', 'UT01', NULL, 'Nancy', 'O', 'Jeffery', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538211214', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006640', 'S77006640', 'UT01', NULL, 'Curt', 'C', 'Jensen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295863694', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006642', 'S77006642', 'UT01', NULL, 'Wayne', 'T', 'Johnson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558342105', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006643', 'S77006643', 'UT01', '', 'Mark', 'A', 'Jolley', 'DC', 'Chiropractic', '', '', NULL, 'O', '790 E 700 S', 'Clearfield', 'Davis', 'UT', '84015', '8018257338', NULL, '790 E 700 S', 'Clearfield', 'Davis', 'UT', '84015', '8018257338', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801986310', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006644', 'S77006644', 'UT01', NULL, 'Chris', NULL, 'Kesler', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1760 E Fort Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019427272', '8019427287', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720103435', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006645', 'S77006645', 'UT01', '', 'Kyle', 'D', 'Klein', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '790 E 700 S', 'Clearfield', 'Davis', 'UT', '84015', '8018257338', NULL, '867 E 9400 S', 'Sandy', 'Davis', 'UT', '84094', '8018257338', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1104911130', 0, 'N', 0, '2010-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006646', 'S77006646', 'UT01', 'Chiropractic Health Plan', 'Michael', 'P', 'Kunzler', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '471 Heritage Park Blvd Ste 3', 'Layton', 'Davis', 'UT', '84041', '8015251471', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833853', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006647', 'S77006647', 'UT01', 'Chiropractic Health Plan', 'Michael', 'P', 'Kunzler', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833853', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006648', 'S77006648', 'UT01', 'Lane Chiropractic', 'David', NULL, 'Lane', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '75 E 600 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342095', '4357340731', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225138100', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006649', 'S77006649', 'UT01', 'Lane Chiropractic', 'Michael', '', 'Lane', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223067', '8013224054', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8013223067', '8013224054', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1376637116', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006650', 'S77006650', 'UT01', NULL, 'Michael', NULL, 'Lane', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376637116', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006651', 'S77006651', 'UT01', NULL, 'Darwin', 'K', 'Le', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '891 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698181', '8015698191', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497876163', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
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('870618776', 'S77006861', 'S77006861', 'UT01', 'Gamma West Brachytherapy', 'Roger', 'S', 'Hansen', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811036478', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006862', 'S77006862', 'UT01', 'Gamma West Brachytherapy', 'Roger', 'S', 'Hansen', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811036478', 0, 'y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('870618776', 'S77006865', 'S77006865', 'UT01', 'Gamma West Brachytherapy', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006866', 'S77006866', 'UT01', 'Gamma West Brachytherapy', 'Jeremy', 'D', 'Spearman', 'PA', 'Radiation Oncology', NULL, NULL, NULL, 'O', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '8018520215', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832599', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870617391', 'S77006888', 'S77006888', 'UT01', 'Primary Care Pediatrics', 'Glen', 'F', 'Huff', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2380 N 400 E Ste C', 'North Logan', 'Cache', 'UT', '84341', '4357537337', '4357506779', '2380 N 400 E Ste C', 'North Logan', 'Cache', 'UT', '84341', '4357537337', '4357506779', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578520904', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77006889', 'S77006889', 'UT01', 'Utah Eye Centers', 'John', 'D', 'Armstrong', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932188133', 0, 'Y', 0, '2013-04-12', 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
('870617733', 'S77006891', 'S77006891', 'UT01', 'Utah Eye Centers', 'Dane', 'F', 'Dansie', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770562985', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77006892', 'S77006892', 'UT01', 'Bountiful Hills Eye Center', 'Justin', 'C', 'Holt', 'OD', 'Optometry', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', NULL, '4360 Washington Bvld', 'Ogden', 'Davis', 'UT', '84403', '8016771122', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2011-02-25', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1588634521', 0, 'N', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77006895', 'S77006895', 'UT01', 'Mt Ogden Eye Center', 'Justin', 'C', 'Holt', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', '4360 Washington Bvld', 'Ogden', 'Davis', 'UT', '84403', '8015933223', '8015939626', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2011-02-25', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1588634521', 0, 'Y', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77006896', 'S77006896', 'UT01', 'Utah Eye Centers', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77006897', 'S77006897', 'UT01', 'Utah Eye Centers', 'Scott', 'O', 'Sykes', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', NULL, '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083693204', 1, 'N', 0, '2013-04-12', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870617733', 'S77006898', 'S77006898', 'UT01', 'Utah Eye Centers', 'Scott', 'O', 'Sykes', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083693204', 0, 'Y', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006902', 'S77006902', 'UT01', NULL, 'Larry', 'G', 'Wilde', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770515934', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006903', 'S77006903', 'UT01', 'The Chiropractic Place', 'Jeremy', 'P', 'Wimmer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', NULL, '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659318632', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006906', 'S77006906', 'UT01', 'Chiropractic Health Plan', 'Dirk', 'S', 'Woodmansee', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2618 W 7800 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019671400', '8019671515', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834297', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006907', 'S77006907', 'UT01', '', 'Matthew', 'M', 'Woolley', 'PHD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2061 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84093', '8019438308', NULL, '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8019438308', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-09-01', NULL, 0, NULL, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871691956', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77006908', 'S77006908', 'UT01', NULL, 'J', 'Brad', 'Young', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '542 W 2400 N', 'Layton', 'Davis', 'UT', '84041', '8018252923', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832080', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870400650', 'S77006909', 'S77006909', 'UT01', 'Smoot Center', 'David', 'J', 'Smoot', 'DDS DMS', 'Oral Surgeon', 'Oral/Maxillofacial Surgery', '', NULL, 'O', '6095 Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8012648504', '8012640226', '6095 S 300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012648504', '8012640226', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2006-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|DEN|', '1508874090', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870618398', 'S77006944', 'S77006944', 'UT01', NULL, 'Ronald', 'L', 'Baird', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '3200 N Canyon Rd Ste C', 'Provo', 'Utah', 'UT', '84604', '8013737373', '8013731808', '3200 N Canyon Rd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992711659', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870618398', 'S77006945', 'S77006945', 'UT01', 'Canyonview Family Practice', 'Todd', 'D', 'Seamons', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3200 N Canyon Rd Ste C', 'Provo', 'Utah', 'UT', '84604', '8013737373', '8013731808', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908489', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618431', 'S77006946', 'S77006946', 'UT01', '', 'Lars', '', 'Bergeson', 'MD', 'Family Practice', '', '', NULL, 'O', '169 Springcreek Pkwy Ste 100', 'Providence', 'Cache', 'UT', '84332', '4357520330', NULL, '169 Springcreek Pkwy Ste 100', 'Providence', 'Cache', 'UT', '84332', '4357520330', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-06-30', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497721195', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006947', 'S77006947', 'UT01', 'Gamma West Brachytherapy', 'Robert', 'A', 'Harris', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '8014756119', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144369752', 0, 'N', 0, '2013-09-13', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'S77006948', 'S77006948', 'UT01', 'Gamma West Brachytherapy', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1275672933', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006949', 'S77006949', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870618776', 'S77006950', 'S77006950', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006951', 'S77006951', 'UT01', 'Gamma West Brachytherapy', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 71309', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8013598956', '8013504021', 'PO Box 71309', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8013598956', '8013504021', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2006-10-01', 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'Y', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77006952', 'S77006952', 'UT01', 'Gamma West Brachytherapy', 'Jeremy', 'D', 'Spearman', 'PA', 'Radiation Oncology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832599', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870619378', 'S77006953', 'S77006953', 'UT01', NULL, 'Gregory', 'P', 'Tayler', 'MD', 'Family Practice', '', '', NULL, 'O', '1469 S Hwy 40 Ste C', 'Heber City', 'Wasatch', 'UT', '84032', '4356543535', '4356542853', '1469 S Hwy 40 Ste C', 'Heber City', 'Wasatch', 'UT', '84032', '4356543535', '4356542853', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043297815', 0, 'N', 0, '2013-08-26', NULL, NULL, 40.4894, -111.41, NULL, NULL),
('870622803', 'S77006977', 'S77006977', 'UT01', 'Bountiful Surgical Associates', 'Jan', 'S', 'Freeman', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '425 Medical Dr Ste 101', 'Bountiful', 'Davis', 'UT', '84010', '8012982542', '8012921271', '425 Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699764027', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870617733', 'S77007155', 'S77007155', 'UT01', 'Utah Eye Centers', 'Michael', 'B', 'Wilcox', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053391771', 0, 'Y', 0, '2013-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77007157', 'S77007157', 'UT01', 'Gamma West Brachytherapy Orem', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1275672933', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870624273', 'S77007170', 'S77007170', 'UT01', 'Mount Ogden Surgical Center', 'Richard', 'A', 'Boyce', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939223', NULL, 'PO Box 1512', 'Layton', '', 'UT', '84041', '', '', '', NULL, '1000', '34.65', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275535932', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('870626402', 'S77007178', 'S77007178', 'UT01', NULL, 'Robert', 'Leon', 'Flint', 'DMD MD', 'Oral Surgeon', 'Oral/Maxillofacial Surgery', NULL, NULL, 'B', '4970 S 900 E Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012633309', '8012881226', '4970 S 900 E', 'Salt Lake City', '', 'UT', '84117', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093738106', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77007181', 'S77007181', 'UT01', 'Now Care Clinic', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'Y', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77007182', 'S77007182', 'UT01', 'Now Care Clinic', 'Joelle', '', 'Creager', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558394692', 0, 'Y', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77007184', 'S77007184', 'UT01', 'Now Care Clinic', 'Arthur', 'M', 'Davenport', 'MD', 'Family Practice', 'General Practice', NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023079936', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77007185', 'S77007185', 'UT01', 'Now Care Clinic', 'Arthur', 'M', 'Davenport', 'MD', 'Family Practice', 'General Practice', NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', '698 E 12th St', 'Ogden', '', 'UT', '84404', '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023079936', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77007190', 'S77007190', 'UT01', 'Now Care Clinic', 'Shiloh', 'C', 'Manning', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972536001', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870413860', 'S77007193', 'S77007193', 'UT01', 'Now Care Clinic', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007195', 'S77007195', 'UT01', 'Epic', 'Mark', 'S', 'May', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624242', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834177', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007196', 'S77007196', 'UT01', 'Epic', 'Mark', 'S', 'May', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834177', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77007197', 'S77007197', 'UT01', 'Epic', 'Lance', NULL, 'Owens', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1990 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015665691', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834188', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870631360', 'S77007209', 'S77007209', 'UT01', 'Brigham Pediatrics', 'Carey', 'D', 'Lloyd', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 12173', 'Ogden', 'Weber', 'UT', '84412', '8889882433', NULL, 'PO Box 12173', 'Harrisville', 'Weber', 'UT', '84412', '8889882433', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164523494', 0, 'Y', 0, '2010-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870626402', 'S77007223', 'S77007223', 'UT01', 'Flint Oral & Facial Surgery', 'Robert', 'L', 'Flint', 'DMD MD', 'Oral Surgeon', 'Oral/Maxillofacial Surgery', '', NULL, 'O', '114 E 12450 S Ste 104', 'Draper', 'Salt Lake', 'UT', '84020', '8015765910', '8015765911', '114 E 12450 S Ste 104', 'Draper', 'Salt Lake', 'UT', '84020', '8015765910', '8015765911', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1093738106', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5249, -111.887, NULL, NULL),
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('870414075', 'S77007235', 'S77007235', 'UT01', 'Cherry Tree Family Practice', 'William', 'D', 'Preston', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '155 N 400 W Ste B-6', 'Orem', 'Utah', 'UT', '84057', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396709903', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870417150', 'S77007241', 'S77007241', 'UT01', '', 'Stanton', 'M', 'Smith', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '279 E 5900 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012610159', NULL, '279 E 5900 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012610159', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043283856', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'S77007244', 'S77007244', 'UT01', 'Nephi Medical Clinic', 'James', 'M', 'Besendorfer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', NULL, '48 W 1500 N', 'Nephi', '', 'UT', '84648', '', '', NULL, NULL, NULL, '0.00', '11.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194741629', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870634650', 'S77007251', 'S77007251', 'UT01', 'OBGYN Associates', 'Diana', 'L', 'Peterson', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', '1151 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-12-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932115813', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77007253', 'S77007253', 'UT01', 'OBGYN Associates', 'Daren', 'A', 'Watts', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679589600', 0, 'N', 0, '2014-07-10', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870635422', 'S77007257', 'S77007257', 'UT01', 'Rocky Mountain Foot And Ankle', 'Kelly', 'A', 'Gomez', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '777 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84601', '8013756677', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821021957', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870620702', 'S77007258', 'S77007258', 'UT01', 'Orem Foot Clinic', 'Gary', 'R', 'Ridge', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '157 N 400 W Ste B7', 'Orem', 'Utah', 'UT', '84057', '8012262421', '8012263869', '157 N 400 W', 'Orem', '', 'UT', '84057', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144267089', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621466', 'S77007259', 'S77007259', 'UT01', NULL, 'Daniel', 'S', 'Sellers', 'MD', 'Plastic Surgery', 'Hand Surgery', '', NULL, 'O', '620 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012956554', NULL, '620 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012956554', '', 'WUSTDPLAS5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194750711', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.8869, -111.869, NULL, NULL);
