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
('621801973', 'W11018617', 'W11018617', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, '1492 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-05-18', '2014-04-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'N', 0, '2009-06-15', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('841394139', 'W11018618', 'W11018618', 'ID01', 'Southwest Idaho ENT ', 'Jonathan', 'M', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', NULL, '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '          ', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-06-15', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639110109', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('680517981', 'W11018619', 'W11018619', 'UT01', 'Crossroads Canyon Family Medicine', NULL, NULL, 'Crossroads Canyon Family Medicine', 'GROUP', 'Pediatric Internal Medicine', NULL, NULL, NULL, 'B', '811 N 900 W', 'Orem', 'Utah', 'UT', '84057', '8018123200', NULL, '811 N 900 W', 'Orem', 'Utah', 'UT', '84057', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005842', 0, 'y', 0, '2009-06-15', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11018620', 'W11018620', 'UTMH1', 'Comprehensive Psychological Services', 'Colleen', 'M', 'Kuhn', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2009-06-15', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467557314', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11018621', 'W11018621', 'ID02', 'Primary Health Medical Group', 'John', 'E', 'White', 'MD', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', NULL, '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-06-15', '2011-03-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013982081', 0, 'N', 0, '2013-08-05', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('202630141', 'W11018622', 'W11018622', 'ID02', 'Primary Health Medical Group', 'John', 'E', 'White', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-06-15', '2011-03-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013982081', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018623', 'W11018623', 'UT01', 'Jordan Valley Internal Medicine', 'Joseph', 'C', 'Fyans', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-15', '2014-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447431317', 0, 'N', 0, '2009-06-15', NULL, NULL, 40.588, -111.975, NULL, NULL),
('263541782', 'W11018624', 'W11018624', 'UT01', 'Ogden Pulmonary Assoc', 'Charles', 'T', 'Ivester', 'MD', 'Pulmonary', 'Internal Medicine', NULL, NULL, 'O', '4403 Harrison Blvd Ste 3815', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376585372', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'W11018625', 'W11018625', 'UT01', 'Emery Medical Center', 'Gabriel', 'J', 'Sermon', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-15', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|', '1639299282', 0, 'Y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'W11018626', 'W11018626', 'UT01', 'Emery Medical Center', 'Gabriel', 'J', 'Sermon', 'PA', 'Family Practice', '', '', NULL, 'O', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-15', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|', '1639299282', 0, 'N', 0, '2013-10-24', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('134332141', 'W11018627', 'W11018627', 'UT01', 'MountainStar Cardiovascular Surgery', '', '', 'MountainStar Cardiovascular Surgery', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007746', 0, 'N', 0, '2011-04-12', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018628', 'W11018628', 'UT01', 'MountainStar Cardiovascular Surgery', 'David', 'G', 'Affleck', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710979653', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018629', 'W11018629', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018630', 'W11018630', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018631', 'W11018631', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '8014766991', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '8014766991', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018632', 'W11018632', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '5405 S 500 E Ste 110', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 110', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018633', 'W11018633', 'UT01', 'MountainStar Cardiovascular Surgery', 'J', 'K', 'Thorne', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356335970', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11018634', 'W11018634', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018635', 'W11018635', 'UT01', 'Lone Peak General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', NULL, 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018636', 'W11018636', 'UT01', 'Lone Peak General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-29', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W11018637', 'W11018637', 'UT01', 'Maternal Fetal Services of Utah', '', '', 'Maternal Fetal Services of Utah', 'GROUP', 'Perinatology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007469', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11018638', 'W11018638', 'UT01', 'Layton Family Practice', '', '', 'Layton Family Practice', 'GROUP', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Williamson', 'GA', '37027', '8015469441', NULL, 'PO Box 281221', 'Atlanta', 'Williamson', 'GA', '37027', '8015469441', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538220306', 0, 'N', 0, '2014-03-06', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11018639', 'W11018639', 'UT01', 'Monarch Womens Cancer Center', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'n', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11018640', 'W11018640', 'UT01', 'St Marks Gynocology Oncology Care', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', NULL, '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11018641', 'W11018641', 'UT01', 'St Marks Gynocology Oncology Care', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11018642', 'W11018642', 'UT01', 'Layton Family Practice', 'Jody', 'L', 'Fowers', 'APRN', '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, '2009-06-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11018643', 'W11018643', 'UT01', 'Pinnacle Home Health Inc', '', '', 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '2040 E Murray Holladay Rd Ste 205', 'Holladay', 'Salt Lake', 'UT', '84117', '8012740299', NULL, '2040 E Murray Holladay Rd Ste 205', 'Holladay', 'Salt Lake', 'UT', '84117', '8012740299', '', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851303390', 0, 'n', 0, '2012-09-24', NULL, NULL, 40.6658, -111.833, NULL, NULL),
('295443048', 'W11018644', 'W11018644', 'UTMH1', '', 'Marlo', '', 'Bennett', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 644', 'Oakley', 'Summit', 'UT', '84055', '4359013218', NULL, 'PO Box 644', 'Oakley', 'Summit', 'UT', '84055', '4359013218', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720059819', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('295443048', 'W11018645', 'W11018645', 'UTMH1', '', 'Marlo', '', 'Bennett', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1887 Gold Dust Ln Ste 303', 'Park City', 'Summit', 'UT', '84060', '4359013218', NULL, '1887 Gold Dust Ln Ste 303', 'Park City', 'Summit', 'UT', '84060', '4359013218', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720059819', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018646', 'W11018646', 'UT01', 'Jordan Family Health', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018647', 'W11018647', 'UT01', 'Jordan Family Health', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018648', 'W11018648', 'UT01', 'Jordan Family Health', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820357655', 'W11018649', 'W11018649', 'ID02', NULL, 'Minton', 'T', 'Cooper', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083771000', '2083771003', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003030', 0, 'N', 0, '2009-06-17', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820477852', 'W11018650', 'W11018650', 'ID01', 'Saint Alphonsus Medical Group Internal Medicine', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.615, -116.256, NULL, NULL),
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('870584427', 'W11018711', 'W11018711', 'UT01', 'University of Utah Vascular Surgeons', 'Dominic', 'J', 'Albo', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407937295', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('710885968', 'W11018699', 'W11018699', 'UT01', 'University of Utah Pain Management Physicians Group', 'Perry', 'G', 'Fine', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861582462', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
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('870490866', 'W11018701', 'W11018701', 'UT01', 'University of Utah Surgical Associates', 'Julie', 'L', 'OBrien', 'APRN', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669551131', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('942764098', 'W11018703', 'W11018703', 'UT01', 'University Neurosurgery Associates', 'Meghan', 'S', 'Zorn', 'PA', 'Neurology', 'Neurosurgery', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-08-22', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972528784', 0, 'y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
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('562627040', 'W11018705', 'W11018705', 'UT01', 'University of Utah Dept of Ob/Gyn', 'Michael', 'W', 'Varner', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', NULL, NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396783486', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11018706', 'W11018706', 'UT01', 'University of Utah Dept of Ob/Gyn', 'Michael', 'W', 'Varner', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396783486', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870442845', 'W11018707', 'W11018707', 'UT01', 'U-U Hematology / Oncology Division', 'Bernadette', 'J', 'Bittner', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578653101', 0, 'N', 0, '2009-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11018708', 'W11018708', 'UT01', 'University Health Care', 'Bernadette', 'J', 'Bittner', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '8015853655', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578653101', 0, 'N', 0, '2009-06-22', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11018709', 'W11018709', 'UT01', 'University of Utah Dept of Ob/Gyn', 'Nancy', 'C', 'Rose', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', 'Clinical Genetics', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826159', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11018710', 'W11018710', 'UT01', 'University of Utah Dept of Ob/Gyn', 'Nancy', 'C', 'Rose', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', 'Clinical Genetics', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826159', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870584427', 'W11018712', 'W11018712', 'UT01', 'University Health Care', 'Dominic', 'J', 'Albo', 'MD', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015818301', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015818301', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407937295', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W11018713', 'W11018713', 'UT01', 'University Health Care', 'Amanda', NULL, 'Al-khudairi', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-23', '2012-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861613242', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W11018714', 'W11018714', 'UT01', 'University Health Care', 'Amanda', NULL, 'Al-khudairi', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-23', '2012-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861613242', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870551044', 'W11018715', 'W11018715', 'UT01', 'University Radiation Oncologists', 'Lynn', NULL, 'Million', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367747', NULL, 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367747', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801840798', 0, 'N', 0, '2009-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870551044', 'W11018716', 'W11018716', 'UT01', 'University Health Care', 'Lynn', NULL, 'Million', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812396', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812396', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801840798', 0, 'N', 0, '2009-06-22', NULL, NULL, 0, 0, NULL, NULL),
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('870442845', 'W11018743', 'W11018743', 'UT01', 'University Health Care', 'Robin', 'A', 'Mountford', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', 'Hematolgy and Oncology', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-01-22', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720264237', 0, 'N', 0, '2009-10-19', NULL, NULL, 0, 0, NULL, NULL),
('743134273', 'W11018744', 'W11018744', 'UT01', 'Pediatric Bone Marrow Transplant-Department of University of', 'Robin', 'A', 'Mountford', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', 'Hematolgy and Oncology', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-01-22', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720264237', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134273', 'W11018745', 'W11018745', 'UT01', 'University Health Care', 'Robin', 'A', 'Mountford', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', 'Hematolgy and Oncology', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-01-22', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720264237', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11018746', 'W11018746', 'UT01', 'University of Utah Dept of Ob/Gyn', 'David', 'W', 'Branch', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922012830', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11018747', 'W11018747', 'UT01', 'University Health Care', 'David', 'W', 'Branch', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922012830', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11018748', 'W11018748', 'UT01', 'University Pathology Associates', 'Monica', 'P', 'Revelo', 'MD', 'Pathology', 'Clinical Pathology', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821018292', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
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('562627040', 'W11018751', 'W11018751', 'UT01', 'University Health Care', 'Robert', 'M', 'Silver', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306926217', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('870619420', 'W11018754', 'W11018754', 'UT01', 'College of Nursing, University of Utah', 'Jodi', '', 'Groot', 'APRN', 'Obstetrics and Gynecology', 'Mental Health', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-08-18', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942488002', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
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('870366372', 'W11018776', 'W11018776', 'UTDT01', '', 'Robert', '', 'Taylor', 'DMD', 'Endodontist', 'Orthodontist', '', NULL, 'O', '5300 Adams Ave Ste 17', 'Ogden', 'Weber', 'UT', '84405', '8014794580', NULL, '5300 Adams Ave Ste 17', 'Ogden', 'Weber', 'UT', '84405', '8014794580', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-06-30', '2009-06-30', 0, 0, 0, '', '', '', '', 'DEN|', '0000009016', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
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('061787631', 'W11018778', 'W11018778', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-29', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11018779', 'W11018779', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-06-29', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('205618494', 'W11018780', 'W11018780', 'UTMH1', 'Blair Counseling Services', 'Michael', 'E', 'Blair', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '90 N Main', 'Sterling', 'Sanpete', 'UT', '84665', '4357030756', NULL, '90 N Main', 'Sterling', 'Sanpete', 'UT', '84665', '4357030756', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-06-26', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063625481', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('205618494', 'W11018781', 'W11018781', 'UTMH1', 'Blair Counseling Services', 'Michael', 'E', 'Blair', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 650158', 'Sterling', 'Sanpete', 'UT', '84665', '4357030756', NULL, 'PO Box 650158', 'Sterling', 'Sanpete', 'UT', '84665', '4357030756', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-06-26', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063625481', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11018782', 'W11018782', 'WY01', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-13', NULL, NULL, 41.3025, -105.537, NULL, NULL),
('830219655', 'W11018783', 'W11018783', 'WY01', 'Gem City Bone and Joint', 'Robert', 'J', 'Curnow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2011-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790765634', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('382084239', 'W11018863', 'W11018863', 'TX01', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1139 E Sonterra Blvd Ste 525', 'San Antonio', 'Bexar', 'TX', '78258', '2104902188', NULL, '1139 E Sonterra Blvd Ste 525', 'San Antonio', 'Bexar', 'TX', '78258', '2104902188', '', 'WUQUEST5', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008294', 0, 'N', 0, '2013-10-15', NULL, NULL, 29.6148, -98.4777, NULL, NULL),
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('820529971', 'W11018866', 'W11018866', 'ID02', 'Childrens Therapy Place Inc', 'Nicole', 'M', 'Hulme', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-06-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1467687848', 0, 'N', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
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('270266601', 'W11018870', 'W11018870', 'WY01', 'Platte Valley Medical Clinic PC', 'Dean', 'W', 'Bartholomew', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 20188', 'Cheyenne', 'Laramie', 'WY', '82003', '3073268381', NULL, 'PO Box 20188', 'Cheyenne', 'Laramie', 'WY', '82003', '3073268381', '', 'WISEWYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1053306662', 0, 'Y', 0, '2012-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('870710584', 'W11018872', 'W11018872', 'UTMH1', 'Jordan West Family Counseling', 'Fay', '', 'Schreyer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-06-27', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831339845', 0, 'n', 0, '2012-05-24', NULL, NULL, 0, 0, NULL, NULL),
('800350980', 'W11018873', 'W11018873', 'UTMH1', 'Life Mosaics Family Counseling', 'Jennifer', 'E', 'JAMES', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1472', 'American Fork', 'Utah', 'UT', '84003', '8017703030', '8017702839', 'PO Box 1472', 'American Fork', 'Utah', 'UT', '84003', '8017703030', '8017702839', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-06-25', '2010-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720131899', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
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('264660061', 'W11018875', 'W11018875', 'TX01', 'Mimari Surgical Associates', 'George', 'E', 'Mimari', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', NULL, '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-07-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982602546', 0, 'Y', 0, '2013-07-19', NULL, NULL, 29.5151, -98.5765, NULL, NULL),
('204203827', 'W11018876', 'W11018876', 'UTMH1', 'Resilient Solutions Inc', 'Becky', 'P', 'Andrews', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730239534', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11018879', 'W11018879', 'UT01', 'Salt Lake Regional Womens Clinic', 'Amanda', 'S', 'Montiel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012147650', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012147650', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-29', '2011-10-04', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1689716888', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11018880', 'W11018880', 'UT01', 'Salt Lake Regional Womens Clinic', 'Amanda', 'S', 'Montiel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 E 1100 S Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', NULL, '24 E 1100 S Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-29', '2011-10-04', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1689716888', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('263770372', 'W11018881', 'W11018881', 'ID02', '', 'Amy', 'E', 'Latta', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1020 W Main St Ste 100B', 'Boise', 'Ada', 'ID', '83702', '2082508939', '2082293099', '1020 W Main St Ste 100B', 'Boise', 'Ada', 'ID', '83702', '2082508939', '2082293099', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2009-06-29', '2012-02-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750536264', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11018882', 'W11018882', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Ryan', NULL, 'Schwanke', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528231537', 0, 'N', 0, '2009-07-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11018883', 'W11018883', 'WYBILLINGS', 'Billings Clinic - ENT', 'Paul', 'S', 'Byorth', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891868485', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('364645864', 'W11018884', 'W11018884', 'UT01', 'Developmental Pediatrics', 'Lisa', 'J', 'Samson-Fang', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', '2009-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821188442', 0, 'y', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('364645864', 'W11018885', 'W11018885', 'UT01', 'University Health Care', 'Lisa', 'J', 'Samson-Fang', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '44 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012133469', NULL, '44 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012133469', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', '2009-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821188442', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('364645864', 'W11018886', 'W11018886', 'UT01', 'Developmental Pediatrics', 'Sarah', 'L', 'Winter', 'MD', 'Pediatrics', 'Pediatric Orthopedic Surgery', NULL, NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133850', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', '2009-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265429906', 0, 'y', 0, '2009-07-06', NULL, NULL, 0, 0, NULL, NULL),
('364645864', 'W11018887', 'W11018887', 'UT01', 'University Health Care', 'Sarah', 'L', 'Winter', 'MD', 'Pediatrics', 'Pediatric Orthopedic Surgery', NULL, NULL, 'O', '44 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012133469', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', '2009-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265429906', 0, 'N', 0, '2009-07-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018888', 'W11018888', 'RCM01', 'Rosenberg Cooley Metcalf', 'Steven', 'B', 'Pearmain', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1720096324', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018892', 'W11018892', 'RCM01', 'Rosenberg Cooley Metcalf', 'Troy', 'S', 'Johnson', 'PA-C', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730197252', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018890', 'W11018890', 'RCM01', 'Rosenberg Cooley Metcalf Clinic', '', '', 'Rosenberg Cooley Metcalf Clinic', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649374216', 0, 'Y', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018891', 'W11018891', 'RCM01', 'Rosenberg Cooley Metcalf Clinic', '', '', 'Rosenberg Cooley Metcalf Clinic', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649374216', 0, 'Y', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018893', 'W11018893', 'RCM01', 'Rosenberg Cooley Metcalf', 'Thomas', 'D', 'Rosenberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1144273905', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018889', 'W11018889', 'RCM01', 'Rosenberg Cooley Metcalf', 'Steven', 'B', 'Pearmain', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '4356556600', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1720096324', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018894', 'W11018894', 'RCM01', 'Rosenberg Cooley Metcalf', 'Thomas', 'D', 'Rosenberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1144273905', 0, 'N', 0, '2011-10-05', 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
('841433992', 'W11018895', 'W11018895', 'RCM01', 'Rosenberg Cooley Metcalf', 'Kyle', 'D', 'Wilkins', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689845364', 0, 'N', 0, '2012-04-13', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018896', 'W11018896', 'RCM01', 'Rosenberg Cooley Metcalf', 'Vernon', 'J', 'Cooley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1891747291', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018897', 'W11018897', 'RCM01', 'Rosenberg Cooley Metcalf', 'Vernon', 'J', 'Cooley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1891747291', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018898', 'W11018898', 'RCM01', 'Rosenberg Cooley Metcalf', 'Michael', 'H', 'Metcalf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1750333092', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018899', 'W11018899', 'RCM01', 'Rosenberg Cooley Metcalf', 'Michael', 'H', 'Metcalf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1750333092', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018900', 'W11018900', 'RCM01', 'Rosenberg Cooley Metcalf', 'Charles', 'C', 'Lind', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1275514499', 0, 'N', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018901', 'W11018901', 'RCM01', 'Rosenberg Cooley Metcalf', 'Richard', 'S', 'Klatt', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710995386', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11018902', 'W11018902', 'RCM01', 'Rosenberg Cooley Metcalf', 'Richard', 'S', 'Klatt', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710995386', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('201044157', 'W11018903', 'W11018903', 'UTDT01', NULL, 'Brian D', NULL, 'Call', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '1433 N 1075 W Ste 1', 'Farmington', 'Davis', 'UT', '84025', '8014516222', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005533', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('529686536', 'W11018905', 'W11018905', 'UTDT01', NULL, 'Val', NULL, 'Ludlow', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '4568 S Highland Dr Ste 370', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771748', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007354', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870672043', 'W11018904', 'W11018904', 'UTDT01', NULL, 'James', NULL, 'Call', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '675 E 800 S', 'Orem', 'Utah', 'UT', '84097', '8012252210', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'UT000B', NULL, NULL, '0.00', '100.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005534', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W11018906', 'W11018906', 'UTDT01', 'Monarch Dental', NULL, NULL, 'Monarch Dental', 'GROUP', 'Dentist', NULL, NULL, NULL, 'B', '420 E Sout Temple Ste 312', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8014756121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2007-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007668', 0, 'y', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018907', 'W11018907', 'UTPEHP', 'IHC Home Care Cassia', '', '', 'IHC Home Care Cassia', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1501 Hiland', 'Burley', 'Cassia', 'ID', '83318', '2086788844', NULL, NULL, NULL, 'Cassia', NULL, NULL, '2086788844', '', '', NULL, NULL, '0.00', '5.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006833', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018908', 'W11018908', 'UTPEHP', 'IHC Home Care of Central Utah', '', '', 'IHC Home Care of Central Utah', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '70 E 100 N Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930371', NULL, NULL, NULL, 'Millard', NULL, NULL, '4358930371', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006834', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018909', 'W11018909', 'UTPEHP', 'IHC Home Care of Central Utah', '', '', 'IHC Home Care of Central Utah', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643530', NULL, NULL, NULL, 'Millard', NULL, NULL, '4358643530', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006834', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018910', 'W11018910', 'UTPEHP', 'IHC Home Care at Cedar', '', '', 'IHC Home Care at Cedar', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '1277 N Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358685852', NULL, NULL, NULL, 'Iron', NULL, NULL, '4358685852', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006832', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018911', 'W11018911', 'UTPEHP', 'IHC Hospice', NULL, NULL, 'IHC Hospice', 'GROUP', 'Hospice', NULL, NULL, NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435430', NULL, NULL, NULL, 'Millard', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006843', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018912', 'W11018912', 'UTPEHP', 'IHC Home Care of Utah County', '', '', 'IHC Home Care of Utah County', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '1165 S 800 E', 'Orem', 'Utah', 'UT', '84097', '8012250584', NULL, NULL, NULL, 'Utah', NULL, NULL, '8012250584', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006836', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018913', 'W11018913', 'UTPEHP', 'IHC Home Care of Heber ', '', '', 'IHC Home Care of Heber ', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', '175 N Main Ste 101', 'Heber City', 'Wasatch', 'UT', '84032', '4356574323', NULL, NULL, NULL, 'Wasatch', NULL, NULL, '4356574323', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006835', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018914', 'W11018914', 'UTPEHP', 'Logan Home Care', '', '', 'Logan Home Care', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1400 N 550 E Ste G', 'Logan', 'Cache', 'UT', '84341', '4357165477', NULL, '1400 N 550 E Ste G', 'Logan', 'Cache', 'UT', '84341', '4357165477', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558436980', 0, 'N', 0, '2012-02-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018915', 'W11018915', 'UTPEHP', 'IHC Hospice of Salt Lake', '', '', 'IHC Hospice of Salt Lake', 'GROUP', 'Hospice', '', '', NULL, 'O', '2250 S 1300 W Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019779900', NULL, '2250 S 1300 W Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019779900', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720153711', 0, 'N', 0, '2012-02-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018916', 'W11018916', 'UTPEHP', 'IHC Home Medical Equipment ', NULL, NULL, 'IHC Home Medical Equipment ', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '2250 S 1300 W Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019779900', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104912732', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018917', 'W11018917', 'UTPEHP', 'IHC Home Medical Equipment  - Ogden', NULL, NULL, 'IHC Home Medical Equipment  - Ogden', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '3376 Wall Ave', 'Ogden', 'Weber', 'UT', '84405', '8013991400', NULL, NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006840', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018918', 'W11018918', 'UTPEHP', 'IHC Home Medical Equipment  - Cedar City', NULL, NULL, 'IHC Home Medical Equipment  - Cedar City', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1277 N Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358685852', NULL, NULL, NULL, 'Iron', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006838', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018919', 'W11018919', 'UTPEHP', 'IHC Home Medical Equipment  - Logan', NULL, NULL, 'IHC Home Medical Equipment  - Logan', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '101 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357165477', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006839', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018920', 'W11018920', 'UTPEHP', 'IHC Home Medical Equipment  - Orem', NULL, NULL, 'IHC Home Medical Equipment  - Orem', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1165 S 800 E', 'Orem', 'Utah', 'UT', '84097', '8012250584', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006841', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018921', 'W11018921', 'UTPEHP', 'IHC Home Medical Equipment  - St George', NULL, NULL, 'IHC Home Medical Equipment  - St George', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1240 E 100 S Ste 119', 'St George', 'Washington', 'UT', '84790', '4356884554', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006842', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018922', 'W11018922', 'UTPEHP', 'IHC Hospice Cassia', NULL, NULL, 'IHC Hospice Cassia', 'GROUP', 'Hospice', NULL, NULL, NULL, 'O', '1501 Hiland', 'Burley', 'Cassia', 'ID', '83318', '2086788844', NULL, NULL, NULL, 'Cassia', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006844', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018923', 'W11018923', 'UTPEHP', 'IHC IV Therapy', NULL, NULL, 'IHC IV Therapy', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8019779900', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396852000', 0, 'Y', 0, '2010-04-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018924', 'W11018924', 'UTPEHP', 'IHC IV Therapy', NULL, NULL, 'IHC IV Therapy', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'O', '2250 S 1300 W Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019779900', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-01-01', '2010-03-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396852000', 0, 'N', 0, '2010-04-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018925', 'W11018925', 'UTPEHP', 'Heber Valley Medical Center', NULL, NULL, 'Heber Valley Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356542500', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316055205', 0, 'Y', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11018926', 'W11018926', 'UTPEHP', 'Heber Valley Medical Center', NULL, NULL, 'Heber Valley Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, NULL, NULL, 'Wasatch', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316055205', 0, 'n', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('263950606', 'W11019000', 'W11019000', 'UTDT01', NULL, 'Daniel', NULL, 'Nelson', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '104 W 200 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342394', NULL, NULL, NULL, 'Box Elder', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007811', 0, 'N', 0, '2009-07-09', 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
('261508946', 'W11019001', 'W11019001', 'UTDT01', 'Genesis Dental of Otem', 'Garry M', NULL, 'Brown', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '320 E 800 S', 'Orem', 'Utah', 'UT', '84097', '8012249555', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', NULL, 8, '2007-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'DEN|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870374099', 'W11019002', 'W11019002', 'UTDT01', NULL, 'George', NULL, 'Pearson', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '1955 S 1300 E Ste L-1', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014875805', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2008-04-01', '2008-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000008099', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('263950606', 'W11019003', 'W11019003', 'UTDT01', NULL, 'Howard R', NULL, 'Daines', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '104 W 200 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342394', NULL, NULL, NULL, 'Box Elder', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005876', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('208387634', 'W11019004', 'W11019004', 'UTDT01', NULL, 'Jaren D', NULL, 'Argyle', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '780 S 2000 W Ste 301', 'Syracuse', 'Davis', 'UT', '84075', '8017740600', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-06-01', '2009-06-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005078', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('900256605', 'W11019005', 'W11019005', 'UTDT01', NULL, 'Jeremy B', '', 'Matthews', 'DMD', 'Dentist', '', '', NULL, 'O', '1305 N Commerce Dr Ste 220', 'Saratoga Sprg', 'Utah', 'UT', '84043', '8017664944', NULL, '1305 N Commerce Dr Ste 220', 'Saratoga Sprg', 'Utah', 'UT', '84043', '8017664944', '', 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-31', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007474', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('260901549', 'W11019006', 'W11019006', 'UTDT01', 'Neville Dental Care', 'Jeff', NULL, 'Neville', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '743 N King St Ste 300', 'Layton', 'Davis', 'UT', '84041', '8015432273', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007827', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11019042', 'W11019042', 'UTIHC04', NULL, 'Mark', 'William', 'Pulsipher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689631913', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W11019043', 'W11019043', 'UTIHC04', NULL, 'Kirk', 'G', 'Watkins', 'MD', 'Sleep Medicine', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326220559', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11019086', 'W11019086', 'UTIHC02', '', 'Brent', 'W', 'Snow', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625555', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625555', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-06-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275544454', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019087', 'W11019087', 'UTIHC02', '', 'Mark', 'C', 'Templeman', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-06-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922120468', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019088', 'W11019088', 'UTIHC02', '', 'Steven', 'H', 'Warnock', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-06-01', '2013-07-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457337594', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019089', 'W11019089', 'UTIHC02', NULL, 'Scott', 'B', 'Whittle', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015993938', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015993938', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-05-01', '2009-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346395795', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
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('870446925', 'W11019091', 'W11019091', 'UT01', 'University Health Care', 'Yuki', 'K', 'Rosenkoetter', 'PA', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487744009', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11019092', 'W11019092', 'UT01', 'University of Utah Dept of Ob/Gyn', 'Sandra', 'E', 'Whitney', 'CNM', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801823570', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('743040723', 'W11019094', 'W11019094', 'UT01', 'University of Utah Hospital Professional Services', 'Janice', 'E', 'Rinsky', 'GC', 'Genetic Counseling', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-17', '2012-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447238472', 0, 'Y', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('870443687', 'W11019096', 'W11019096', 'UT01', 'U-U Cardiology Division', 'Katherine', 'N', 'Meyers', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-09-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457509812', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019097', 'W11019097', 'UT01', 'University Health Care', 'Katherine', 'N', 'Meyers', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-09-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457509812', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W11019098', 'W11019098', 'UT01', 'University Health Care', 'Akiko', NULL, 'Okifuji', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367778', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367778', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386723856', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W11019099', 'W11019099', 'UT01', 'University Health Care', 'Akiko', NULL, 'Okifuji', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386723856', 0, 'N', 0, '2012-08-31', 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
('870616107', 'W11019100', 'W11019100', 'UT01', 'University Health Care', 'David', 'E', 'Anisman', 'MD', 'Family Practice', '', '', NULL, 'o', '26 S Main Street', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main Street', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-02', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346235793', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019101', 'W11019101', 'UT01', 'University Health Care', 'David', 'E', 'Anisman', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-02', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346235793', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019102', 'W11019102', 'UT01', 'University Radiology Associates', 'Vincent', 'B', 'Herlihy', 'MD', 'Radiologist', NULL, NULL, NULL, 'b', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558533356', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019103', 'W11019103', 'UT01', 'University Radiology Associates', 'Vincent', 'B', 'Herlihy', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558533356', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W11019104', 'W11019104', 'UT01', 'University Health Care', 'Barbara', 'M', 'Fisher', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-09-01', '2009-06-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679695050', 0, 'y', 0, '2009-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W11019105', 'W11019105', 'UT01', 'University Health Care', 'Barbara', 'M', 'Fisher', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-09-01', '2009-06-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679695050', 0, 'N', 0, '2009-07-14', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'W11019106', 'W11019106', 'UT01', 'Pediatric Emergency Medicine-Dept of University of Utah', 'Roni', 'D', 'Lane', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-08-01', '2012-07-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861510356', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'W11019107', 'W11019107', 'UT01', 'University Health Care', 'Roni', 'D', 'Lane', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-08-01', '2012-07-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861510356', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W11019108', 'W11019108', 'UT01', 'University of Utah Pediatric Rapid Treatment Unit', 'Roni', 'D', 'Lane', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-08-01', '2012-07-26', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861510356', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W11019109', 'W11019109', 'UT01', 'University Health Care', 'Roni', 'D', 'Lane', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-08-01', '2012-07-26', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861510356', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('141919178', 'W11019110', 'W11019110', 'UT01', 'University Health Care', 'Joseph', 'R', 'Sherbotie', 'MD', 'Pediatrics', 'Pediatric Nephrology', '', NULL, 'O', '50 N Medical Dr Ste PA 220', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015814561', NULL, '50 N Medical Dr Ste PA 220', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015814561', '', '', '', '', '0.00', '15.00', '0.00', 3, '2006-01-01', '2012-04-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1205915873', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('141919178', 'W11019111', 'W11019111', 'UT01', 'University Health Care', 'Joseph', 'R', 'Sherbotie', 'MD', 'Pediatrics', 'Pediatric Nephrology', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '', '', '', '', '0.00', '15.00', '0.00', 3, '2006-01-01', '2012-04-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1205915873', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11019112', 'W11019112', 'UT01', 'U Of U Dialysis Program', 'Joseph', 'R', 'Sherbotie', 'MD', 'Pediatrics', 'Pediatric Nephrology', '', NULL, 'O', '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', NULL, '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-07-24', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1205915873', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11019113', 'W11019113', 'UT01', 'University Health Care', 'Gilbert', 'M', 'Jackson', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356421259', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11019114', 'W11019114', 'UT01', 'University Health Care', 'Gilbert', 'M', 'Jackson', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '801581    ', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '801581    ', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356421259', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870542585', 'W11019115', 'W11019115', 'UT01', 'Kolff Dialysis Center', 'Srinivasan', '', 'Beddhu', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '85  N Medical Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812121', NULL, '85  N Medical Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812121', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2009-01-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124118757', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11019116', 'W11019116', 'UT01', 'U Of U Dialysis Program', 'Srinivasan', '', 'Beddhu', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '85  N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812121', NULL, '85  N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-01-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124118757', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870645895', 'W11019146', 'W11019146', 'UT01', 'U of U Pediatric Orthopedics', 'Joshua', 'W', 'Klatt', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-15', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063683209', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
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('870645895', 'W11019149', 'W11019149', 'UT01', 'University Health Care', 'Joshua', 'W', 'Klatt', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, '100 Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-15', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063683209', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
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('202774842', 'W11019187', 'W11019187', 'UT01', 'Skin Pathology Consultants of Utah', 'Patricia', NULL, 'Vitale', 'MD', 'Pathology', NULL, NULL, NULL, 'B', '168 E 5900 S Ste C104', 'Murray', 'Salt Lake', 'UT', '84107', '8012613007', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558466177', 0, 'y', 0, '2009-07-17', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W11019188', 'W11019188', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Craig', 'W', 'Anderson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', NULL, '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1871541227', 0, 'y', 0, '2011-03-09', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W11019189', 'W11019189', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Craig', 'W', 'Anderson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014300', NULL, '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014300', '          ', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-01', '2011-01-27', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1871541227', 0, 'N', 0, '2011-03-09', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019190', 'W11019190', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Robyn', 'E', 'Boehmer', 'PA-C', 'Orthopedic Surgery', 'General Surgery', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-01', '2010-11-12', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619908092', 0, 'N', 0, '2009-07-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019191', 'W11019191', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Robyn', 'E', 'Boehmer', 'PA-C', 'Orthopedic Surgery', 'General Surgery', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015683480', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015683480', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-01', '2010-11-12', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619908092', 0, 'N', 0, '2009-07-17', 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
('450579015', 'W11019192', 'W11019192', 'UT01', 'St Marks South Jordan Family Practice', 'Matthew', 'M', 'Schellenberg', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', NULL, 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386855021', 0, 'y', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11019193', 'W11019193', 'UT01', 'St Marks South Jordan Family Practice', 'Matthew', 'M', 'Schellenberg', 'DO', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', NULL, '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386855021', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019194', 'W11019194', 'WYBILLINGS', 'Billings Clinic - Endocrinology', 'Kimberly', 'L', 'Ackerman', 'FNP', 'Endocrinology', 'Pediatrics', NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', NULL, 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-27', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922032861', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019195', 'W11019195', 'UT01', 'U-U Hematology / Oncology Division', 'Ryan', 'P', 'Ernst', 'PA', 'Physician Assistant', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-03-27', '2009-07-24', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396787289', 0, 'y', 0, '2009-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019196', 'W11019196', 'UT01', 'University Health Care', 'Ryan', 'P', 'Ernst', 'PA', 'Physician Assistant', NULL, NULL, NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-03-27', '2009-07-24', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396787289', 0, 'N', 0, '2009-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'W11019197', 'W11019197', 'UT01', 'University of Utah Cardiothoracic Surgeons', 'Wendy', NULL, 'Whitney', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-03-30', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164441226', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'W11019198', 'W11019198', 'UT01', 'University Health Care', 'Wendy', NULL, 'Whitney', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-03-30', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164441226', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11019199', 'W11019199', 'UT01', 'University Urology Associates', 'Jamie', NULL, 'Burnett', 'PA', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-05-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962418020', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11019200', 'W11019200', 'UT01', 'University Health Care', 'Jamie', NULL, 'Burnett', 'PA', 'Urology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015874888', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015874888', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-05-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962418020', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019201', 'W11019201', 'UT01', 'Huntsman Cancer Institute', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019202', 'W11019202', 'UT01', 'University Health Care', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('562627035', 'W11019203', 'W11019203', 'UT01', 'University Health Care', 'Rebecca', 'S', 'Hulinsky', 'LGC', 'Genetic Counseling', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750386132', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627035', 'W11019204', 'W11019204', 'UT01', 'University Health Care', 'Rebecca', 'S', 'Hulinsky', 'LGC', 'Genetic Counseling', '', '', NULL, 'O', '675 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015812719', NULL, '675 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750386132', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019205', 'W11019205', 'UT01', 'U of U Hospitals and Clinics', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019206', 'W11019206', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019207', 'W11019207', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012348600', NULL, '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012348600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019208', 'W11019208', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019209', 'W11019209', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '1091 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, '1091 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019210', 'W11019210', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '220 Millpond Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', NULL, '220 Millpond Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019211', 'W11019211', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', NULL, '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019212', 'W11019212', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019213', 'W11019213', 'UT01', 'University Health Care', 'Tracy', 'R', 'Syddall', 'PAC', 'General Surgery', 'Family Practice', NULL, NULL, 'O', '7495 S State st', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State st', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-04-17', '2012-09-16', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205070091', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11019228', 'W11019228', 'ID01', 'Saint Alphonsus Inpatient Medicine', 'Tarik', '', 'Qasim', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-07-01', '2010-04-06', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1962608646', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('621801973', 'W11019214', 'W11019214', 'UT01', 'Rock Run Medical', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', NULL, '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-07-01', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('621801973', 'W11019215', 'W11019215', 'UT01', 'Rock Run Medical', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017732838', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017732838', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-07-01', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'y', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('870517255', 'W11019253', 'W11019253', 'UT01', 'U of U Pediatric Orthopedics', 'Kristen', 'L', 'Carroll', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366407488', 0, 'y', 0, '2009-10-28', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11019254', 'W11019254', 'UT01', 'University Health Care', 'Jacques', 'L', 'D''Astous', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'o', '100 N Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', '2010-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104881499', 0, 'N', 0, '2009-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11019255', 'W11019255', 'UT01', 'Pediatric Orthopedic Associates', 'Jacques', 'L', 'D''Astous', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '          ', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', '2010-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104881499', 0, 'N', 0, '2009-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870517255', 'W11019256', 'W11019256', 'UT01', 'University Health Care', 'Jacques', 'L', 'D''Astous', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104881499', 0, 'N', 0, '2009-11-02', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870517255', 'W11019257', 'W11019257', 'UT01', 'U of U Pediatric Orthopedics', 'Jacques', 'L', 'D''Astous', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104881499', 0, 'y', 0, '2009-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019258', 'W11019258', 'UT01', 'University Health Care', 'Mary', 'P', 'Byam-Smith', 'PA-C', 'Obstetrics and Gynecology', 'Physician Assistant', NULL, NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-05-21', '2009-09-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528153863', 0, 'N', 0, '2010-04-13', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019259', 'W11019259', 'UT01', 'U-U Hematology / Oncology Division', 'Mary', 'P', 'Byam-Smith', 'PA-C', 'Obstetrics and Gynecology', 'Physician Assistant', NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-05-21', '2009-09-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528153863', 0, 'y', 0, '2010-04-13', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019260', 'W11019260', 'UT01', 'University Health Care', 'Elie', 'P', 'Elovic', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-15', '2012-08-22', 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1306835145', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019261', 'W11019261', 'UT01', 'U-U Rehabilitation Medicine', 'Elie', 'P', 'Elovic', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-15', '2012-08-22', 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1306835145', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11019262', 'W11019262', 'UT01', 'University Health Care', 'James', 'W', 'Roach', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '8016625600', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', '2010-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598720898', 0, 'N', 0, '2009-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11019263', 'W11019263', 'UT01', 'U of U Pediatric Orthopedics', 'James', 'W', 'Roach', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '          ', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', '2010-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598720898', 0, 'N', 0, '2009-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870517255', 'W11019264', 'W11019264', 'UT01', 'University Health Care', 'James', 'W', 'Roach', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598720898', 0, 'Y', 0, '2014-01-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870517255', 'W11019265', 'W11019265', 'UT01', 'Pediatric Orthopedic Associates', 'James', 'W', 'Roach', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598720898', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019266', 'W11019266', 'UT01', 'University Health Care', 'Lou', NULL, 'Rudolf', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205977998', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019267', 'W11019267', 'UT01', 'University Radiology Associates', 'Lou', NULL, 'Rudolf', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015850520', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015850520', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205977998', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11019268', 'W11019268', 'UT01', 'Dialysis Program Physicians', 'Andrea', 'L', 'Clark', 'MD', 'Dietician, Renal', '', '', NULL, 'O', '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', NULL, '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710198528', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870542583', 'W11019269', 'W11019269', 'UT01', 'Dixie Dialysis Clinic', 'Andrea', 'L', 'Clark', 'MD', 'Dietician, Renal', '', '', NULL, 'O', '720 S River Rd Ste D-1100', 'St George', 'Washington', 'UT', '84770', '4356560857', NULL, '720 S River Rd Ste D-1100', 'St George', 'Washington', 'UT', '84770', '4356560857', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2006-08-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710198528', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('260354800', 'W11019270', 'W11019270', 'UT01', 'Hurricane Dialysis Center', 'Andrea', 'L', 'Clark', 'MD', 'Dietician, Renal', '', '', NULL, 'O', '48 S 2500 W', 'Hurricane', 'Washington', 'UT', '84737', '4356350399', NULL, '48 S 2500 W', 'Hurricane', 'Washington', 'UT', '84737', '4356350399', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2006-08-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710198528', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870687050', 'W11019271', 'W11019271', 'UT01', 'Iron Mission Dialysis Center', 'Andrea', 'L', 'Clark', 'MD', 'Dietician, Renal', '', '', NULL, 'O', '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', NULL, '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2006-08-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710198528', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('208890662', 'W11019272', 'W11019272', 'UT01', 'Desert Valley Dialysis Center', 'Andrea', 'L', 'Clark', 'MD', 'Dietician, Renal', '', '', NULL, 'O', '350 Falcon Ridge Pkwy', 'Mesquite', 'Clark', 'NV', '89027', '7023454144', NULL, '350 Falcon Ridge Pkwy', 'Mesquite', 'Clark', 'NV', '89027', '7023454144', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2006-08-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710198528', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870635460', 'W11019273', 'W11019273', 'UT01', 'Comfort Care Pediatrics', 'Maggie', 'S', 'Hull', 'MD', 'Pediatrics', '', '', NULL, 'O', '4546 S 815 W Ste 204', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015958844', '8015951133', '4546 S 815 W Ste 204', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015958844', '8015951133', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-15', '2014-03-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013999622', 0, 'N', 0, '2014-07-02', NULL, NULL, 40.6597, -111.924, NULL, NULL),
('450541117', 'W11019274', 'W11019274', 'WY01', 'Valley X-ray', 'Donald', 'H', 'Guear', 'AART', 'Diagnostic Radiology', '', '', NULL, 'O', '124 Peterson Pwky Ste 2', 'Thayne', 'Lincoln', 'WY', '83127', '3078839729', NULL, '124 Peterson Pwky Ste 2', 'Thayne', 'Lincoln', 'WY', '83127', '3078839729', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710097647', 0, 'Y', 0, '2012-07-19', NULL, NULL, 42.944, -111.008, NULL, NULL),
('900347306', 'W11019275', 'W11019275', 'WY01', 'Evanston Surgical Center', 'Amanda', 'M', 'Barnes', 'PA', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '          ', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '          ', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1841435385', 0, 'N', 0, '2014-05-13', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('870419324', 'W11019276', 'W11019276', 'UT01', 'Nephi Medical Clinic', 'Marc', 'F', 'Jones', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1962572487', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'W11019277', 'W11019277', 'UT01', 'Nephi Medical Clinic', 'Marc', 'F', 'Jones', 'DO', 'Family Practice', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1962572487', 0, 'N', 0, '2012-06-21', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'W11019278', 'W11019278', 'UT01', 'Fountain Green Medical Clinic', 'Marc', 'F', 'Jones', 'DO', 'Family Practice', '', '', NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4356233180', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1962572487', 0, 'N', 0, '2012-06-21', NULL, NULL, 39.6276, -111.634, NULL, NULL),
('870546501', 'W11019279', 'W11019279', 'UT01', 'Alpine Pediatrics PC', 'Christopher', 'C', 'Foster', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639399439', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W11019280', 'W11019280', 'UT01', 'Alpine Pediatrics PC', 'Christopher', 'C', 'Foster', 'MD', 'Pediatrics', '', '', NULL, 'O', '1307 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', NULL, '1307 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639399439', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870617263', 'W11019281', 'W11019281', 'UT01', 'St Marks Family Medicine', 'Patrick', 'N', 'Green', 'MD', 'Family Practice', '', '', NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-05', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1144431800', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W11019282', 'W11019282', 'WY01', 'Lander Medical Clinic', 'James', '', 'Brubaker', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245326867', 0, 'N', 0, '2012-04-30', 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
('870492272', 'W11019283', 'W11019283', 'UT01', 'Utah Cardiology', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', NULL, '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'W11019284', 'W11019284', 'UT01', 'Utah Cardiology', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', NULL, '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'N', 0, '2012-08-17', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('870492272', 'W11019285', 'W11019285', 'UT01', 'Utah Cardiology', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', NULL, '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'N', 0, '2012-08-17', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('820477852', 'W11019286', 'W11019286', 'ID01', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Tarik', '', 'Qasim', 'MD', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675180', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-07-22', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003053', 0, 'N', 0, '2012-03-07', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('520582578', 'W11019287', 'W11019287', 'UT01', 'Alternative Counseling Associates', 'Cheryl', 'C', 'Portwood', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '315 Main St Ste 6', 'Lander', 'Fremont', 'WY', '82520', '3073324515', NULL, '315 Main St Ste 6', 'Lander', 'Fremont', 'WY', '82520', '3073324515', '', 'WYMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639246044', 0, 'n', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('870427052', 'W11019290', 'W11019290', 'UT01', 'Plastic Surgery Associates', 'Jason', 'M', 'Blocksom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', NULL, '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-02-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144488495', 0, 'N', 0, '2010-06-03', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W11019291', 'W11019291', 'WY01', 'Memorial Hospital of Sweetwater County', 'Amy', '', 'Dolce', 'PA', 'Internal Medicine', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2009-08-01', '2010-07-07', 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1588791826', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11019292', 'W11019292', 'UT01', 'Tanner Memorial Clinic', 'Mohamed', 'H', 'Sadiq', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164410403', 0, 'Y', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11019293', 'W11019293', 'UT01', 'Tanner Memorial Clinic', 'Mohamed', 'H', 'Sadiq', 'MD', 'Neurology', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164410403', 0, 'N', 0, '2012-07-18', NULL, NULL, 41.0893, -111.997, NULL, NULL),
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('260213288', 'W11019296', 'W11019296', 'UT01', 'Sandy Vision Care', 'Ryan', 'J', 'Mortensen', 'OD', 'Optometry', '', '', NULL, 'O', '9035 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015664119', '8015683844', '9035 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015664119', '8015683844', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003818576', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.5871, -111.853, NULL, NULL),
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('621801973', 'W11019298', 'W11019298', 'UT01', 'Endocrinology of Utah', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643697', NULL, '3336 S Pioneer Pkwy Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643697', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'N', 0, '2012-06-08', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W11019299', 'W11019299', 'UT01', 'Lakeside Comprehensive Health', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643697', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643697', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'Y', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019300', 'W11019300', 'UT01', 'Jordan Valley Hospital', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-07-01', '2010-03-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019301', 'W11019301', 'UT01', 'Jordan Valley Hospital', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015618888', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015618888', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-07-01', '2010-03-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019302', 'W11019302', 'UT01', 'Pioneer Valley Hospital', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '3460 S Pioneer Parkway', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Parkway', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-07-01', '2010-03-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019303', 'W11019303', 'UT01', 'Pioneer Valley Hospital Physicians', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '3336 S Pioneer Parkway Ste 203', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643697', NULL, '3336 S Pioneer Parkway Ste 203', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643697', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-15', '2011-01-11', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019304', 'W11019304', 'UT01', 'Davis Hospital', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-15', '2011-01-11', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019305', 'W11019305', 'UT01', 'Davis Hospital', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-15', '2011-01-11', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11019306', 'W11019306', 'UT01', 'Tanner Memorial Clinic', 'Bradley', 'G', 'Neuenschwander', 'DO', 'Dermatology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174740799', 0, 'Y', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'W11019309', 'W11019309', 'UT01', 'Tanner Memorial Clinic', 'Bradley', 'G', 'Neuenschwander', 'DO', 'Dermatology', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174740799', 0, 'N', 0, '2012-07-18', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'W11019310', 'W11019310', 'UT01', 'Tanner Memorial Clinic', 'Laura', 'M', 'Foot', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831385244', 0, 'Y', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11019311', 'W11019311', 'UT01', 'Tanner Memorial Clinic', 'Laura', 'M', 'Foot', 'MD', 'Urology', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831385244', 0, 'N', 0, '2013-03-11', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'W11019312', 'W11019312', 'UT01', 'Tanner Memorial Clinic', 'Laura', 'M', 'Foot', 'MD', 'Urology', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '8017749219', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831385244', 0, 'N', 0, '2013-03-11', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'W11019313', 'W11019313', 'UT01', 'Tanner Memorial Clinic', 'Laura', 'M', 'Foot', 'MD', 'Urology', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831385244', 0, 'N', 0, '2013-03-11', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870419324', 'W11019314', 'W11019314', 'UT01', 'Nephi Medical Clinic', 'James', 'F', 'Rosenbeck', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1437329281', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'W11019315', 'W11019315', 'UT01', 'Nephi Medical Clinic', 'James', 'F', 'Rosenbeck', 'DO', 'Family Practice', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233200', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1437329281', 0, 'N', 0, '2012-06-21', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'W11019316', 'W11019316', 'UT01', 'Fountain Green Medical Clinic', 'James', 'F', 'Rosenbeck', 'DO', 'Family Practice', '', '', NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4356233180', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4356233180', '', NULL, NULL, '0.00', '11.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1437329281', 0, 'N', 0, '2012-06-21', NULL, NULL, 39.6276, -111.634, NULL, NULL),
('870716858', 'W11019317', 'W11019317', 'WY01', 'Yellowstone Sports Medicine And Bone & Joint Clinic ', 'Sheri', 'L', 'Chacon', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497925424', 0, 'Y', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'W11019318', 'W11019318', 'WY01', 'Yellowstone Sports Medicine And Bone & Joint Clinic ', 'Sheri', 'L', 'Chacon', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497925424', 0, 'N', 0, '2012-07-30', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('870639098', 'W11019319', 'W11019319', 'UT01', 'After Hours Medical Company - American Fork', 'Greg', 'E', 'Halliday', 'PA-C', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366431918', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11019320', 'W11019320', 'UT01', 'After Hours Medical Company - Draper', 'Greg', 'E', 'Halliday', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8014921611', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366431918', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('800405814', 'W11019321', 'W11019321', 'ID02', 'Boise Spine Center', 'Noah', 'B', 'Edvalson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', NULL, '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2011-01-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275767519', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'W11019322', 'W11019322', 'UT01', 'Foothill Family Clinic', 'Heather', 'A', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', NULL, '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023237088', 0, 'N', 0, '2012-10-23', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('841411398', 'W11019323', 'W11019323', 'UT01', 'Foothill Family Clinic', 'Heather', 'A', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', NULL, '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023237088', 0, 'N', 0, '2012-10-23', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870609622', 'W11019324', 'W11019324', 'UT01', 'Snow Canyon Clinic', 'Vernon', 'H', 'Kirk', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750343372', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('841367175', 'W11019325', 'W11019325', 'UT01', 'Canyon View Medical Group', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', NULL, 'B', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-07-14', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1265609929', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11019326', 'W11019326', 'UT01', 'Canyon View Medical Group', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', NULL, 'O', '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', NULL, '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-07-14', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1265609929', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11019327', 'W11019327', 'UT01', 'Canyon View Medical Group', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', NULL, 'O', '15 S 1000 E Ste 100', 'Payson', 'Utah', 'UT', '84651', '8014659480', NULL, '15 S 1000 E Ste 100', 'Payson', 'Utah', 'UT', '84651', '8014659480', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-07-14', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1265609929', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'W11019328', 'W11019328', 'UT01', 'Snow Canyon Clinic', 'Carl', 'P', 'Hallenborg', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508978651', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('352332742', 'W11019329', 'W11019329', 'ID01', 'Healthy Habits Wellness Clinic', 'Deborah', 'F', 'Hollingsworth', 'DC', 'Chiropractic', '', '', NULL, 'O', '5216 E Cleveland Blvd Ste G', 'Caldwell', 'Canyon', 'ID', '83607', '2084548111', NULL, '5216 E Cleveland Blvd Ste G', 'Caldwell', 'Canyon', 'ID', '83607', '2084548111', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871591339', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('352332742', 'W11019330', 'W11019330', 'ID01', 'Healthy Habits Wellness Clinic', 'Deborah', 'F', 'Hollingsworth', 'DC', 'Chiropractic', '', '', NULL, 'O', '27 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83642', '2088874872', NULL, '27 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871591339', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('800223062', 'W11019331', 'W11019331', 'UT01', 'Brigham Center for Womens Health', 'Stephen', 'E', 'Starr', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', NULL, 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2010-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043220445', 0, 'N', 0, '2012-12-12', NULL, NULL, 0, 0, NULL, NULL),
('800223062', 'W11019332', 'W11019332', 'UT01', 'Brigham Center for Womens Health', 'Stephen', 'E', 'Starr', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', NULL, '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2010-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043220445', 0, 'N', 0, '2012-12-12', NULL, NULL, 0, 0, NULL, NULL),
('820373248', 'W11019333', 'W11019333', 'ID02', 'Chiropractic Center', 'Glenn', 'W', 'Moldenhauer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '228 Holly St', 'Nampa', 'Canyon', 'ID', '83686', '2084675759', NULL, '228 Holly St', 'Nampa', 'Canyon', 'ID', '83686', NULL, NULL, 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073609087', 0, 'n', 0, '2009-07-27', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'W11019334', 'W11019334', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '269 E 400 S Ste 102', 'Springville', 'Utah', 'UT', '84663', '8014891006', NULL, '269 E 400 S Ste 102', 'Springville', 'Utah', 'UT', '84663', '8014891006', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('264801620', 'W11019335', 'W11019335', 'ID02', 'Chiropractic Center', 'Jared', 'L', 'Jensen', 'DC', 'Chiropractic', '', '', NULL, 'O', '228 Holly St', 'Nampa', 'Canyon', 'ID', '83686', '2084675759', '          ', '228 Holly St', 'Nampa', 'Canyon', 'ID', '83686', '2084675759', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2009-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922262336', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019336', 'W11019336', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Sidney', NULL, 'Rubinow', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', 'PO Box 37000', 'Billings', 'Custer', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-29', '2009-09-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396747093', 0, 'N', 0, '2009-07-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019337', 'W11019337', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Christopher', '', 'Montville', 'MD', 'Reproductive Endocrinology & Infertility', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437195484', 0, 'N', 0, '2010-07-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019338', 'W11019338', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Janelle', NULL, 'Sunvold-Palmer', 'NP', 'Internal Medicine', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-14', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508826082', 0, 'N', 0, '2009-07-27', NULL, NULL, 0, 0, NULL, NULL),
('826003449', 'W11019339', 'W11019339', 'IDNUCOR1', 'Franklin County Medical Center', NULL, NULL, 'Franklin County Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '44 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088521037', NULL, '44 N 1st E', 'Preston', 'Franklin', 'ID', '83263', NULL, NULL, '', NULL, NULL, '0.00', '5.00', '0.00', 3, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006303', 0, 'n', 0, '2009-07-29', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11019340', 'W11019340', 'UT01', 'Pinnacle Home Health Inc', '', '', 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', 'Phone Number Only', NULL, 'Davis', 'UT', '84010', '8012740299', NULL, 'Phone Number Only', '', 'Davis', 'UT', '84010', '8012740299', '', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851303390', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11019341', 'W11019341', 'UT01', 'Pinnacle Home Health Inc', '', '', 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', 'Phone Number Only Zip 84074', NULL, 'Tooele', 'UT', '84074', '8012740299', NULL, 'Phone Number Only Zip 84074', '', 'Tooele', 'UT', '84074', '8012740299', '', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851303390', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11019342', 'W11019342', 'UT01', 'Pinnacle Home Health Inc', '', '', 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', 'Phone Number Only Zip 84601', NULL, 'Utah', 'UT', '84601', '8012740299', NULL, 'Phone Number Only Zip 84601', '', 'Utah', 'UT', '84601', '8012740299', '', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851303390', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11019343', 'W11019343', 'UT01', 'Pinnacle Home Health Inc', '', '', 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', 'Phone Number Only Zip 84098', NULL, 'Summit', 'UT', '84098', '8012740299', NULL, 'Phone Number Only Zip 84098', '', 'Summit', 'UT', '84098', '8012740299', '', '', NULL, '4', '0.00', '100.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851303390', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('203444719', 'W11019344', 'W11019344', 'UT01', 'Pinnacle Home Health Inc', NULL, NULL, 'Pinnacle Home Health Inc', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', 'Phone Number Only 8012740299', NULL, NULL, 'UT', NULL, '8012740299', NULL, '2040 E Murray Holladay Rd', 'Holladay', NULL, 'UT', '84117', NULL, NULL, NULL, NULL, '4', '0.00', '100.00', NULL, 3, '2000-06-15', '2000-06-15', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851303390', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('263252282', 'W11019345', 'W11019345', 'UTMH1', 'SLC Body Mind Fitness', 'Leann', 'G', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1615 S State', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014672072', NULL, '1615 S State', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014672072', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-07-29', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962569426', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019346', 'W11019346', 'UT01', 'Ogden Clinic', 'Randy', 'S', 'Alejo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-12-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1922204775', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019347', 'W11019347', 'UT01', 'Ogden Clinic', 'Randy', 'S', 'Alejo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1100 W 2700 N', 'Pleasant View', 'Weber', 'UT', '84414', '8014753600', NULL, '1100 W 2700 N', 'Pleasant View', 'Weber', 'UT', '84414', '8014753600', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-12-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1922204775', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019348', 'W11019348', 'ID02', 'Family Medicine Health Center', 'Heather', 'E', 'Quinn', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386698744', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019349', 'W11019349', 'ID02', 'Family Medicine Health Center', 'Heather', 'E', 'Quinn', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386698744', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019350', 'W11019350', 'UT01', 'Ogden Clinic', 'Tyler', 'L', 'Christensen', 'MD', 'Urology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014573000', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014573000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-14', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811097629', 0, 'N', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019351', 'W11019351', 'UT01', 'Ogden Clinic', 'Mari', 'R', 'Stuart', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619121738', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W11019352', 'W11019352', 'UT01', 'Ogden Clinic', 'Mari', 'R', 'Stuart', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', NULL, '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619121738', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.1689, -112.064, NULL, NULL),
('870649259', 'W11019353', 'W11019353', 'UT01', 'Alpine Orthopaedic Specialists', 'Jacob', 'B', 'Pugsley', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1902065824', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'W11019354', 'W11019354', 'UT01', 'Alpine Orthopaedic Specialists', 'Jacob', 'B', 'Pugsley', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357872000', NULL, '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1902065824', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.4751, -112.025, NULL, NULL),
('202717899', 'W11019355', 'W11019355', 'UT01', 'Evolutionary Healthcare', 'Jennifer', 'L', 'Bell', 'MD', 'Family Practice', '', '', NULL, 'O', '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', NULL, '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942390570', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.765, -111.878, NULL, NULL),
('870635889', 'W11019356', 'W11019356', 'UT01', 'All Seasons Obstetrics & Gynecology', 'Sandra', 'V', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'Po Box 848416', 'Boston', '', 'MA', '02284', '6174021000', '6174021099', 'Po Box 848416', 'Boston', '', 'MA', '02284', '6174021000', '6174021099', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356319842', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11019357', 'W11019357', 'UT01', 'All Seasons Obstetrics & Gynecology', 'Sandra', 'V', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '196 E 2000 N Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358432576', NULL, '196 E 2000 N Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358432576', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-07-31', 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356319842', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11019358', 'W11019358', 'UT01', 'Tooele Clinic Corp', 'Cullen', 'J', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 848416', 'Boston', NULL, 'MA', '02284', '4358434930', NULL, 'PO Box 848416', 'Boston', '', 'MA', '02284', '4358434930', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1376534875', 0, 'Y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11019359', 'W11019359', 'UT01', 'Tooele Clinic Corp', 'Cullen', 'J', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '210 Millpond Rd', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', NULL, '210 Millpond Rd', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-12-31', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1376534875', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11019360', 'W11019360', 'UT01', 'Tooele Clinic Corp', 'Cullen', 'J', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358433647', NULL, '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358433647', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2011-10-17', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1376534875', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('263903795', 'W11019361', 'W11019361', 'UT01', 'Oral & Maxillofacial Surgeons of Utah', 'Jason', 'G', 'Chandler', 'DMD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '2297 N Hillfield Rd Ste 105', 'Layton', 'Davis', 'UT', '84041', '8017790506', NULL, '2297 N Hillfield Rd Ste 105', 'Layton', 'Davis', 'UT', '84041', '8017790506', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114134004', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.0934, -111.974, NULL, NULL),
('263903795', 'W11019362', 'W11019362', 'UT01', 'Oral & Maxillofacial Surgeons of Utah', 'Jason', 'G', 'Chandler', 'DMD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '469 E Medical Dr Ste 202', 'Bountiful', 'Davis', 'UT', '84010', '8012998531', NULL, '469 E Medical Dr Ste 202', 'Bountiful', 'Davis', 'UT', '84010', '8012998531', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114134004', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.8873, -111.871, NULL, NULL),
('200198361', 'W11019363', 'W11019363', 'UT01', 'West Valley & Preventative Medicine', 'Ryan', 'D', 'Wight', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 302', 'West Valley', 'Salt Lake', 'UT', '84120', '8019648726', '8019642527', '3336 Pioneer Pkwy Ste 302', 'West Valley', 'Salt Lake', 'UT', '84120', '8019648726', '8019642527', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609028943', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870286381', 'W11019364', 'W11019364', 'UT01', 'Ogden Clinic', 'Brian', 'S', 'Vincent', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753301', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753301', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1487806485', 0, 'N', 0, '2012-06-28', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W11019365', 'W11019365', 'UT01', 'Ogden Clinic', 'Brian', 'S', 'Vincent', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', NULL, '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753300', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-01-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1487806485', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('742885976', 'W11019366', 'W11019366', 'TX01', 'Creedmoor Orthopedics PA', 'Frank', 'W', 'Schroeder', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 210', 'San Antonio', 'Bexar', 'TX', '78222', '2104481140', NULL, '4212 E Southcross Blvd Ste 210', 'San Antonio', 'Bexar', 'TX', '78222', '2104481140', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528167368', 0, 'n', 0, '2014-03-13', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
('820200895', 'W11019367', 'W11019367', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Boise 503', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '8013771000', NULL, '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '8013771000', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'N', 0, '2012-02-27', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('680517981', 'W11019368', 'W11019368', 'UT01', 'Crossroads  Family Medicine', 'Janice', 'H', 'Robinson', 'FNP', 'Family Practice', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662121', NULL, '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662121', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184800047', 0, 'N', 0, '2013-07-02', NULL, NULL, 40.3849, -111.914, NULL, NULL),
('680517981', 'W11019369', 'W11019369', 'UT01', 'Rock Canyon Family Medicine', 'Janice', 'H', 'Robinson', 'FNP', 'Family Practice', '', '', NULL, 'O', '811 N 900 W', 'Orem', 'Utah', 'UT', '84057', '8018123200', NULL, '811 N 900 W', 'Orem', 'Utah', 'UT', '84057', '8018123200', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184800047', 0, 'Y', 0, '2013-07-02', NULL, NULL, 40.3122, -111.717, NULL, NULL),
('202777185', 'W11019370', 'W11019370', 'ID02', 'Kinectic Chiropractic', 'James', 'B', 'Trapp', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1819 W State St', 'Boise', 'Ada', 'ID', '83702', '2083892225', '2083362827', '1819 W State St', 'Boise', 'Ada', 'ID', '83702', '2083892225', '2083362827', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194895276', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11019371', 'W11019371', 'ID01', 'Saint Alphonsus Addiction Recovery Center', 'Kenneth', 'E', 'Chandler', 'CADC', 'Mental Health', 'Counseling', '', NULL, 'O', '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', '6138 Emerald Ste B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2010-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1629205570', 0, 'N', 0, '2009-12-09', NULL, NULL, 0, 0, NULL, NULL),
('263031859', 'W11019372', 'W11019372', 'ID02', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', '8883098143', '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', '8883098143', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2011-04-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019373', 'W11019373', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'B', 'Campbell', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1790981025', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W11019374', 'W11019374', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'B', 'Campbell', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1790981025', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL);
