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
('264333033', 'TX0121276', 'TX0121276', 'TXSATSTD', 'Consultants in Womens Health', 'Katherine', 'E', 'Cornforth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-30', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366760548', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('264333033', 'TX0121277', 'TX0121277', 'TXSATSTD', 'Consultants in Womens Health', 'Katherine', 'E', 'Cornforth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366760548', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0121514', 'ID0121514', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care ', 'Steven', 'J', 'Fonken', 'MD', 'Cardiology', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2088840036', '2088843805', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2088840036', '2088843805', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-03-03', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063437630', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('260553931', 'ID0121762', 'ID0121762', 'IDBOISTD', '', 'Steven', 'R', 'Casos', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-07-15', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1609849959', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'ID0121763', 'ID0121763', 'IDBOISTD', '', 'Billy', 'R', 'Morgan', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1891747663', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'ID0121764', 'ID0121764', 'IDBOISTD', '', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'ID0121765', 'ID0121765', 'IDBOISTD', '', 'Dale', '', 'Strawn', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12022049', 'W12022049', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Jesse', '', 'Doty', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083674052', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-02', '2013-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1851513931', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12022053', 'W12022053', 'ID01', 'Saint Alphonsus Express Care Inc', 'Mary', '', 'Jeffress', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083676597', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-02', '2013-06-24', 0, 0, 0, '', '', '', '', 'HCFA|', '1326003377', 0, 'N', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12022055', 'W12022055', 'ID01', 'Saint Alphonsus Medical Group Neurology Boise', 'Raymond', '', 'Ryan', 'MD', 'Psychiatry', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-02', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1154498152', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12022057', 'W12022057', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Barry', '', 'Smith', 'DO', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-02', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1083731103', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('263042851', 'W12022058', 'W12022058', 'WY01', 'Southwest Wyoming ENT', 'Jason', 'P', 'Haack', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '191 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', NULL, '191 Overthrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407832728', 0, 'N', 0, '2012-08-21', NULL, NULL, 41.2571, -110.985, NULL, NULL),
('263042851', 'W12022059', 'W12022059', 'WYT1', 'Southwest Wyoming ENT', 'Jason', 'P', 'Haack', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '191 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', NULL, '191 Overthrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407832728', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('452583476', 'W12022060', 'W12022060', 'WY01', 'Bear River Urology', 'Michael', 'E', 'Van Bibber', 'MD', 'Urology', '', '', NULL, 'O', '191 Overtrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '191 Overtrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598851503', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('452583476', 'W12022061', 'W12022061', 'WYT1', 'Bear River Urology', 'Michael', 'E', 'Van Bibber', 'MD', 'Urology', '', '', NULL, 'O', '191 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '191 Overthrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598851503', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('320361824', 'W12022062', 'W12022062', 'UT01', 'Internal Med-Interventional Cardiology Department of University of Utah', '', '', 'Internal Med-Interventional Cardiology Department of University of Utah', '', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184979460', 0, 'N', 0, '2012-08-21', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('320361824', 'W12022063', 'W12022063', 'UT01', 'Internal Med-Interventional Cardiology Department of University of Utah', '', '', 'Internal Med-Interventional Cardiology Department of University of Utah', '', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184979460', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('270624464', 'W12022064', 'W12022064', 'WY01', 'Unitah General Surgery', 'Jared', 'B', 'Barton', 'MD', 'General Surgery', '', '', NULL, 'O', '191 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '191 Overthrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WISEWYSTD', 'WYSTD', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1144328949', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.2571, -110.985, NULL, NULL),
('270624464', 'W12022065', 'W12022065', 'WYT1', 'Unitah General Surgery', 'Jared', 'B', 'Barton', 'MD', 'General Surgery', '', '', NULL, 'O', '191 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '191 Overthrust Rd  ', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WISEWYSTD', 'WYSTD', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1144328949', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12022066', 'W12022066', 'UT01', 'Foothill Family Clinic North Office', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '0000000000', '2295 S Foothill Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12022067', 'W12022067', 'UT01', 'Foothill Family Clinic North Office', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84341', '4357531600', '4357539521', '274 N Main St   ', 'Logan', 'Cache', 'UT', '84341', '4357531600', '4357539521', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830458867', 'W12022069', 'W12022069', 'UT01', 'UUHC Sugar House Health Center', '', '', 'University Primary Care Sports Med', '', 'Sports Medicine', '', '', NULL, 'O', '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699796706', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7233, -111.857, NULL, NULL),
('830458867', 'W12022072', 'W12022072', 'UT01', 'University Primary Care Sports Med', '', '', 'University Primary Care Sports Med', '', 'Sports Medicine', '', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699796706', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W12022073', 'W12022073', 'UT01', 'U Dept of Family & Preventative Medicine', '', '', 'U Dept of Family & Preventative Medicine', 'GROUP', 'Family Practice', 'Internal Medicine', 'Geriatrics', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133900', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009216', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W12022074', 'W12022074', 'UT01', 'U Dept of Family & Preventative Medicine', '', '', 'U Dept of Family & Preventative Medicine', 'GROUP', 'Family Practice', 'Internal Medicine', 'Geriatrics', NULL, 'O', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015855382', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015855382', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', '2013-02-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009216', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12022075', 'W12022075', 'UT01', 'U of U Medical Center - Psychiatry', '', '', 'U of U Medical Center - Psychiatry', 'GROUP', 'Mental Health', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009236', 0, 'N', 0, '2012-08-21', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870443046', 'W12022076', 'W12022076', 'UT01', 'U of U Medical Center - Psychiatry', '', '', 'U of U Medical Center - Psychiatry', 'GROUP', 'Mental Health', '', '', NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009236', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('710920170', 'W12022077', 'W12022077', 'UT01', 'Medical Neuroscience', '', '', 'Medical Neuroscience', 'GROUP', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007547', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('710920170', 'W12022078', 'W12022078', 'UT01', 'Medical Neuroscience', '', '', 'Medical Neuroscience', 'GROUP', 'Neurosurgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007547', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870541480', 'W12022079', 'W12022079', 'UT01', 'U of U Division of Pediatric Neurosurgery', '', '', 'U of U Division of Pediatric Neurosurgery', 'GROUP', 'Pediatric Neurosurgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625340', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625340', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009224', 0, 'N', 0, '2012-08-21', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870541480', 'W12022080', 'W12022080', 'UT01', 'U of U Division of Pediatric Neurosurgery', '', '', 'U of U Division of Pediatric Neurosurgery', 'GROUP', 'Pediatric Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009224', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W12022081', 'W12022081', 'UT01', 'University Neurosurgery Associates', '', '', 'University Neurosurgery Associates', 'GROUP', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUNEURO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009280', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W12022082', 'W12022082', 'UT01', 'UUHC South Jordan Health Center', '', '', 'University Neurosurgery Associates', 'GROUP', 'Neurosurgery', '', '', NULL, 'O', '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', NULL, '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', '          ', 'WUUNEURO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009280', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.5415, -112.013, NULL, NULL),
('870639098', 'W12022084', 'W12022084', 'UT01', 'After Hours Urgent Care American Fork', 'Karl', 'J', 'Barton', 'NP', 'Family Practice', '', '', NULL, 'O', '910 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012552000', NULL, '910 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8012552000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-21', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1306889522', 0, 'Y', 0, '2013-12-23', NULL, NULL, 40.0445, -111.717, NULL, NULL),
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('743040723', 'W12022104', 'W12022104', 'UT01', 'University of Utah Hospital Professional Services', '', '', 'University of Utah Hospital Professional Services', 'GROUP', 'Clinics', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012133900', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009312', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
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('205529469', 'W12022110', 'W12022110', 'UT01', 'University Health Care Park City Mountain Resort Urgent Care', '', '', 'University Health Care Park City Mountain Resort Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', NULL, 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795256', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12022129', 'W12022129', 'NM01', 'ABQ Health Partners', 'Sivakumar', '', 'Nagaraju', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '500 Walter St NE Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627223', '5052627450', '500 Walter St NE Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627223', '5052627450', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1952373235', 0, 'N', 0, '2012-08-28', NULL, NULL, 35.0863, -106.64, NULL, NULL),
('204043287', 'W12022131', 'W12022131', 'NM01', 'ABQ Health Partners', 'Sivakumar', '', 'Nagaraju', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1952373235', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W12022137', 'W12022137', 'UT01', 'University of Utah Orthopedic Consultants', '', '', 'University of Utah Orthopedic Consultants', '', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487680609', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7558, -111.833, NULL, NULL),
('870483582', 'W12022138', 'W12022138', 'UT01', 'University of Utah Orthopedic Consultants', '', '', 'University of Utah Orthopedic Consultants', '', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', NULL, 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487680609', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870551044', 'W12022140', 'W12022140', 'UT01', 'University Radiation Oncologists', '', '', 'University Radiation Oncologists', 'GROUP', 'Radiation Oncology', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818793', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818793', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009331', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('870551044', 'W12022141', 'W12022141', 'UT01', 'University Radiation Oncologists', '', '', 'University Radiation Oncologists', 'GROUP', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009331', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W12022142', 'W12022142', 'UT01', 'U-U Rehabilitation Medicine', '', '', 'U-U Rehabilitation Medicine', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812268', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812268', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009386', 0, 'N', 0, '2012-08-23', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870515631', 'W12022143', 'W12022143', 'UT01', 'U-U Rehabilitation Medicine', '', '', 'U-U Rehabilitation Medicine', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009386', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12022147', 'W12022147', 'UT01', 'Advanced Foot and Ankle ', 'Wade', 'A', 'Christiansen', 'DPM', 'Podiatry', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', '1551 Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', '2014-06-30', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1447482252', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('331064921', 'W12022148', 'W12022148', 'UT01', 'Advanced Foot and Ankle ', 'Wade', 'A', 'Christiansen', 'DPM', 'Podiatry', '', '', NULL, 'O', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '8012983987', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '8012983987', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', '2014-06-30', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1447482252', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('830182821', 'W12022153', 'W12022153', 'WY01', 'Gottsche Rehab Center ', 'Gayle', '', 'Cline', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023345824', 0, 'N', 1, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
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('830182821', 'W12022156', 'W12022156', 'WYT2', 'Gottsche Rehab Center ', 'Gayle', '', 'Cline', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3075689399', '3075689396', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3075689399', '3075689396', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023345824', 0, 'N', 1, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('260421988', 'W12022157', 'W12022157', 'UT01', 'Salt Lake Retina ', 'Christopher', 'J', 'Gee', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3855 W 7800 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', '3855 W 7800 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-28', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1831372499', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('260421988', 'W12022158', 'W12022158', 'UT01', 'Salt Lake Retina ', 'Christopher', 'J', 'Gee', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4155 W 3465 S #4 Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012600034', '8012600035', '4155 W 3465 S #4 Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012600034', '8012600035', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-26', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1831372499', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12022160', 'W12022160', 'UT01', 'After Hour Medical Company ', 'Jerry', 'G', 'Graves', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659651750', 0, 'Y', 0, '2012-10-12', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870639098', 'W12022159', 'W12022159', 'UT01', 'After Hour Medical Company ', 'Jerry', 'G', 'Graves', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'O', '3934 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018498500', '8018498502', '3934 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018498500', '8018498502', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659651750', 0, 'Y', 0, '2012-10-12', NULL, NULL, 40.686, -111.825, NULL, NULL),
('870639098', 'W12022161', 'W12022161', 'UT01', 'After Hour Medical Company ', 'Jerry', 'G', 'Graves', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8018498500', '8018498502', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8018498500', '8018498502', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659651750', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'W12022165', 'W12022165', 'UT01', 'Nephi Medical Clinic ', 'Emily', 'S', 'Poff', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4354453313', '275 W 300 S', 'Fountain Green', 'Sanpete', 'UT', '84632', '4354453301', '4354453313', '', '', '', '0.00', '11.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1720316714', 0, 'N', 0, '2012-10-26', NULL, NULL, 39.6276, -111.634, NULL, NULL),
('205917784', 'W12022162', 'W12022162', 'UTMH1', 'Brian J Taracana PSY PC', 'Shawn', 'M', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861605834', 0, 'N', 0, '2013-10-29', NULL, NULL, 0, 0, NULL, NULL),
('870419324', 'W12022164', 'W12022164', 'UT01', 'Nephi Medical Clinic ', 'Emily', 'S', 'Poff', 'MD', 'Family Practice', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233211', '4356233631', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356233211', '4356233631', '', '', '', '0.00', '11.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1720316714', 0, 'N', 0, '2012-10-26', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870419324', 'W12022166', 'W12022166', 'UT01', 'Nephi Medical Clinic ', 'Emily', 'S', 'Poff', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233211', '4356233631', 'PO Box 120', 'Nephi', 'Juab', 'UT', '84648', '4356233211', '4356233631', '', '', '', '0.00', '11.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1720316714', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12022167', 'W12022167', 'IDREC', 'St Lukes Pediatric Surgery of Idaho', 'L', 'R', 'Scherer', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', NULL, '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005863', 0, 'Y', 0, '2012-08-23', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('452648973', 'W12022168', 'W12022168', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1230 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', NULL, '1230 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548349251', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7528, -111.829, NULL, NULL),
('452648973', 'W12022169', 'W12022169', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1448 N 2000 W Ste 12', 'Clearfield', 'Davis', 'UT', '84015', '8014798201', NULL, '1448 N 2000 W Ste 12', 'Clearfield', 'Davis', 'UT', '84015', '8014798201', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548349251', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.1349, -112.064, NULL, NULL),
('452648973', 'W12022170', 'W12022170', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1508 E Skyline Dr Ste 800', 'Ogden', 'Weber', 'UT', '84405', '8008606260', '8014793219', '1508 E Skyline Dr Ste 800', 'Ogden', 'Weber', 'UT', '84405', '8008606260', '8014793219', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548349251', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.1515, -111.941, 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
('452648973', 'W12022171', 'W12022171', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '40 W 100 N', 'Vernal', 'Uintah', 'UT', '84078', '8008606260', NULL, '40 W 100 N', 'Vernal', 'Uintah', 'UT', '84078', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548349251', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.4572, -109.529, NULL, NULL),
('452648973', 'W12022172', 'W12022172', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '30 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '8008606260', NULL, '30 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548349251', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.496, -112.016, NULL, NULL),
('264333033', 'W12022176', 'W12022176', 'TXSATSTD', 'Institute for Womens Health', 'Vincenzo', '', 'Sabella', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780601773', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'W12022177', 'W12022177', 'TXSATSTD', 'Institute for Womens Health', 'Celyna', 'D', 'Delgado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417946625', 0, 'N', 0, '2012-08-24', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'W12022178', 'W12022178', 'TXSATSTD', 'Institute for Womens Health', 'Camilo', 'A', 'Gonima', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316964745', 0, 'N', 0, '2012-08-24', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('621801973', 'W12022179', 'W12022179', 'UT01', 'West Valley Family Medicine ', 'Charles', 'W', 'Miller', '', 'Family Practice', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', 'WISESTD', '', '', '0.00', '35.00', '0.00', 6, '2012-09-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1144340530', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6985, -111.988, NULL, NULL),
('621801973', 'W12022180', 'W12022180', 'UT01', 'West Valley Family Medicine ', 'Charles', 'W', 'Miller', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WISESTD', '', '', '0.00', '35.00', '0.00', 6, '2012-09-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1144340530', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('455272070', 'W12022174', 'W12022174', 'UT01', 'General Surgery at Northpointe', 'Gail', '', 'Strindberg', 'MD', 'General Surgery', '', '', NULL, 'O', '2376 N 400 E Ste 205', 'Tooele', 'Tooele', 'UT', '84074', '4358828111', '4358822111', '2376 N 400 E Ste 205', 'Tooele', 'Tooele', 'UT', '84074', '4358828111', '4358822111', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB', '1104812395', 0, 'N', 0, '2014-02-26', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('455272070', 'W12022175', 'W12022175', 'UT01', 'General Surgery at Northpointe', 'Gail', '', 'Strindberg', 'MD', 'General Surgery', '', '', NULL, 'B', 'Dept 149 PO Box 30015', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4358828111', '4358822111', 'Dept 149 PO Box 30015', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4358828111', '4358822111', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB', '1104812395', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('383813267', 'W12022182', 'W12022182', 'UT01', 'Internal Med-MICU Department of University of Utah', '', '', 'Internal Med-MICU Department of University of Utah', '', 'Internal Medicine', '', '', 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, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457670788', 0, 'N', 0, '2012-08-24', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('383813267', 'W12022183', 'W12022183', 'UT01', 'Internal Med-MICU Department of University of Utah', '', '', 'Internal Med-MICU Department of University of Utah', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457670788', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12007258', 'W12007258', 'TX01', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('711052367', 'W12022187', 'W12022187', 'UT01', 'Myeloma Care Department of University of Utah', '', '', 'Myeloma Care Department of University of Utah', '', 'Hematology and Oncology', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUMYLO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215192026', 0, 'N', 0, '2012-08-24', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('711052367', 'W12022188', 'W12022188', 'UT01', 'Myeloma Care Department of University of Utah', '', '', 'Myeloma Care Department of University of Utah', '', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUMYLO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215192026', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('861168471', 'W12022190', 'W12022190', 'UT01', 'U of U Palliative Care', '', '', 'U of U Palliative Care', 'GROUP', 'Internal Medicine', '', '', 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, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009244', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('861168471', 'W12022191', 'W12022191', 'UT01', 'U of U Palliative Care', '', '', 'U of U Palliative Care', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009244', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('460730234', 'W12022198', 'W12022198', 'UT01', 'Desert Peak Orthopaedics & Sports Medicine  PC', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '210 Millpond Stansbury Pk', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', NULL, '210 Millpond Stansbury Pk', 'Tooele', 'Tooele', 'UT', '84074', '4358433642', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022199', 'W12022199', 'UT01', 'Central Utah Clinic dba NowCare of Ogden', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '698 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'Y', 0, '2013-11-26', NULL, NULL, 41.2442, -111.961, NULL, NULL),
('870281028', 'W12022200', 'W12022200', 'UT01', 'Ogden Family Medicine ', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022201', 'W12022201', 'UT01', 'Ogden Family Medicine ', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('455229720', 'W12022203', 'W12022203', 'UT01', 'Cottonwood Pediatric Gastroenterology', 'Louis', 'L', 'Mizell', 'MD', 'Pediatric Gastroenterology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 330', 'Murray', 'Salt Lake', 'UT', '84107', '8013144444', NULL, '5770 S 250 E Ste 330', 'Murray', 'Salt Lake', 'UT', '84107', '8013144444', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-09', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851396964', 0, 'N', 0, '2013-08-07', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870442755', 'W12022204', 'W12022204', 'UT01', 'U-U Pulmonary Division', '', '', 'U-U Pulmonary Division', 'GROUP', 'Pulmonary', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009385', 0, 'N', 0, '2012-08-27', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870442755', 'W12022205', 'W12022205', 'UT01', 'U-U Pulmonary Division', '', '', 'U-U Pulmonary Division', 'GROUP', 'Pulmonary', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009385', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022208', 'W12022208', 'UT01', 'Central Utah Clinic dba NowCare of Ogden', 'Scott', 'M', 'Stallings', 'MD', 'Family Practice', '', '', NULL, 'O', '698 E 12th St  ', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 E 12th St  ', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1700818259', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.2442, -111.961, NULL, NULL),
('870281028', 'W12022218', 'W12022218', 'UT01', 'Ogden Family Medicine ', 'Scott', 'M', 'Stallings', 'MD', 'Family Practice', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1700818259', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022209', 'W12022209', 'UT01', 'Central Utah Clinic dba NowCare of Ogden', 'Scott', 'M', 'Stallings', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1700818259', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12022220', 'W12022220', 'WY01', 'Wyoming Cardiopulmonary Services', 'Wendy', '', 'Price', 'PA-C', 'Cardiology', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', '2013-01-08', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1154654515', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12022221', 'W12022221', 'WYT1', 'Wyoming Cardiopulmonary Services', 'Wendy', '', 'Price', 'PA-C', 'Cardiology', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', '2013-01-08', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1154654515', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022222', 'W12022222', 'UT01', 'Central Utah Clinic dba NowCare of Ogden', 'Diane', 'E', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'O', '698 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'N', 0, '2013-12-18', NULL, NULL, 41.2442, -111.961, NULL, NULL),
('870281028', 'W12022223', 'W12022223', 'UT01', 'Central Utah Clinic PC', 'Diane', 'E', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022224', 'W12022224', 'UT01', 'Central Utah Clinic PC', 'Diane', 'E', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12022225', 'W12022225', 'ID02', 'Family Medicine Residency', 'Nikole', 'A', 'Shepherdson', '', 'Family Practice', '', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2083752217', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-12-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760610950', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022227', 'W12022227', 'UT01', 'Tooele Womens Care ', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '4358830204', '4358330205', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '4358830204', '4358330205', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-07-26', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12022226', 'W12022226', 'ID02', 'Family Medicine Health Center', 'Nikole', 'A', 'Shepherdson', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760610950', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022228', 'W12022228', 'UT01', 'Tooele Womens Care ', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-07-26', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12022230', 'W12022230', 'WY01', 'Wyoming Cardiopulmonary Services', 'Sarah', 'M', 'Adsit', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '0.00', '0.00', 3, '2012-07-15', '2013-04-01', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1629301080', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12022231', 'W12022231', 'WYT1', 'Wyoming Cardiopulmonary Services', 'Sarah', 'M', 'Adsit', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '0.00', '0.00', 3, '2012-07-15', '2013-04-01', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1629301080', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022232', 'W12022232', 'UT01', 'Salt Lake Regional Womens Center ', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('621801973', 'W12022233', 'W12022233', 'UT01', 'Salt Lake Regional Womens Center ', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12022234', 'W12022234', 'UT01', 'St Marks Primary Care', 'Lyndi', '', 'Miller', 'PA', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '3540 S 4000 W Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019690200', '8019690393', '3540 S 4000 W Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019690200', '8019690393', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477833366', 0, 'N', 0, '2014-04-10', NULL, NULL, 40.6955, -111.987, NULL, NULL),
('770701557', 'W12022235', 'W12022235', 'UT01', 'MountainStar Medical Group-St. Marks Hospital', 'Lyndi', '', 'Miller', 'PA', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477833366', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12022236', 'W12022236', 'TXSATSTD', 'Institute for Womens Health', 'Marcy', 'L', 'Rosen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3327 Research Plaza Ste 206', 'San Antonio', 'Bexar', 'TX', '78235', '2106535501', '2103331787', '3327 Research Plaza Ste 206', 'San Antonio', 'Bexar', 'TX', '78235', '2106535501', '2103331787', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1457644106', 0, 'N', 0, '2014-04-03', NULL, NULL, 29.3447, -98.4359, NULL, NULL),
('264333033', 'W12022237', 'W12022237', 'TXSATSTD', 'Consultants In Womens ', 'Marcy', 'L', 'Rosen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106535501', '2103331787', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106535501', '2103331787', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', '2014-04-03', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1457644106', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12022238', 'W12022238', 'IDBOISTD', 'Saint Alphonsus Medical Group Cardiothoracic Services Boise', 'Stephen', '', 'Fall', 'MD', 'Thoracic Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1366458085', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('260553931', 'W12022239', 'W12022239', 'IDBOISTD', 'Saint Alphonsus Medical Group Cardiothoracic Services Boise', 'Stephen', 'D', 'Jones', 'MD', 'Thoracic Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1124004510', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('264333033', 'W12022240', 'W12022240', 'TXSATSTD', 'Institute for Womens Health', 'Jessica', 'D', 'Diaz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78235', '2106158585', '2106163094', '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78235', '2106158585', '2106163094', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457532830', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5123, -98.5764, NULL, NULL),
('264333033', 'W12022241', 'W12022241', 'TXSATSTD', 'Institute for Womens Health', 'Jessica', 'D', 'Diaz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106158585', '2106163094', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106158585', '2106163094', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457532830', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12022242', 'W12022242', 'TXSATSTD', 'Consultants In Womens Health', 'Jessica', 'D', 'Diaz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78251', '2106844100', '2105216799', '3903 Wiseman Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78251', '2106844100', '2105216799', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', '2013-04-04', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457532830', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('203506626', 'W12022243', 'W12022243', 'UT01', 'FirstMed Urgent Care M-Sat 9am-9pm  Sun 1pm-9pm ', '', '', 'FirstMed Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1512 Renaissance Towne Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012956483', '8013350339', '1512 Renaissance Towne Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012956483', '8013350339', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000950509', 0, 'N', 0, '2013-06-12', NULL, NULL, 40.8745, -111.887, NULL, NULL),
('870622942', 'W12022244', 'W12022244', 'UT01', 'Utah Imaging Associates ', 'Ilyssa ', 'B', 'Golding ', '', 'Diagnostic Radiology', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', 'WUUTIMAGE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063448371', 0, 'N', 0, '2012-08-28', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870622942', 'W12022245', 'W12022245', 'UT01', 'Utah Imaging Associates ', 'Ilyssa ', 'B', 'Golding ', '', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012687111', NULL, 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012687111', '          ', 'WUUTIMAGE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063448371', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12022246', 'W12022246', 'UT01', 'Utah Imaging Associates ', 'Ilyssa ', 'B', 'Golding ', '', 'Diagnostic Radiology', '', '', NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8012687111', NULL, '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8012687111', '          ', 'WUUTIMAGE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-09', '2012-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063448371', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W12022247', 'W12022247', 'UT01', 'Huntsman Cancer Institute', '', '', 'Huntsman Cancer Institute', 'GROUP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006813', 0, 'N', 0, '2012-08-28', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('870442845', 'W12022248', 'W12022248', 'UT01', 'Huntsman Cancer Institute', '', '', 'Huntsman Cancer Institute', 'GROUP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006813', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
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('870443152', 'W12022251', 'W12022251', 'UT01', 'U-U Endocrinology Division', '', '', 'U-U Endocrinology Division', 'GROUP', 'Endocrinology', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009376', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40008129', 'W40008129', 'UTMH1', 'Valley Mental Health  Inc', 'Odbayar', '', 'Parry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1841440906', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00327', 'SACN00327', 'SACN', 'Family Medicine Health Center', 'Jared', 'W', 'Papa', 'PA', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518047034', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12022255', 'W12022255', 'UT01', 'Bear Lake Community Health ', 'Janelle', 'M', 'Wells', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '26 W Main Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', '26 W Main Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528293339', 0, 'N', 0, '2013-04-02', NULL, NULL, 41.6341, -111.856, NULL, NULL),
('205934739', 'SACN00326', 'SACN00326', 'SACN', 'Family Medicine Health Center', 'Jared', 'W', 'Papa', 'PA', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518047034', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'ELRHC0327', 'ELRHC0327', 'ILCHIGSTD', '', 'Lawrence', NULL, 'Pankau', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8478258684', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8478258684', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497758114', 0, 'N', 0, '2014-01-23', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('273291370', 'W12022258', 'W12022258', 'ID02', 'Northwest Neurobehavioral Health', 'Jeffery ', 'D', 'Hall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053568816', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022259', 'W12022259', 'ID02', 'Northwest Neurobehavioral Health', 'Jeffery ', 'D', 'Hall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053568816', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12022262', 'W12022262', 'UTMH1', 'Centered Approach Counseling ', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '224 W 850 N', 'American Fork', 'Utah', 'UT', '84003', '8016489156', '8669238689', '224 W 850 N', 'American Fork', 'Utah', 'UT', '84003', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12022260', 'W12022260', 'UTMH1', 'Centered Approach Counseling ', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4055 S 700 E Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8016489156', '8669238689', '4055 S 700 E Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12022261', 'W12022261', 'UTMH1', 'Centered Approach Counseling ', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016489156', '8669238689', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870658625', 'W12022263', 'W12022263', 'UT01', 'Wasatch Peak Family Practice ', 'Courtney', 'R', 'Nelson', 'DO', 'Family Practice', '', '', NULL, 'O', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017734770', NULL, '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017734770', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205915410', 0, 'N', 0, '2012-10-12', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('273291370', 'W12022264', 'W12022264', 'ID02', 'Northwest Neurobehavioral Health', 'Laura', 'J', 'Curtis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245467620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022265', 'W12022265', 'ID02', 'Northwest Neurobehavioral Health', 'Laura', 'J', 'Curtis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245467620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'W12022266', 'W12022266', 'UT01', 'Circle of Life Womens Center ', 'Robin', '', 'Houpe', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375809', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375809', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1285843607', 0, 'N', 0, '2012-12-28', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870179340', 'W12022269', 'W12022269', 'UT01', 'Standard Optical', 'Mark', 'K', 'Nevers', 'OD', 'Optometry', '', '', NULL, 'O', '1901 Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '0000000000', '1901 Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366704959', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W12022271', 'W12022271', 'UT01', 'Standard Optical', 'Mark', 'K', 'Nevers', 'OD', 'Optometry', '', '', NULL, 'O', '4305 S Harrison Blvd Ste 9B', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014795060', '0000000000', '4305 S Harrison Blvd Ste 9B', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014795060', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366704959', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12022274', 'W12022274', 'WY01', 'Buffalo Physical Therapy', 'Bret', '', 'Zowada', 'PT', 'Physical Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013272475', 0, 'N', 0, '2012-10-09', NULL, NULL, 44.3548, -106.7, NULL, NULL),
('830326578', 'W12022272', 'W12022272', 'WY01', 'Sheridan Physical Therapy ', 'Bret', '', 'Zowada', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076736969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076736969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013272475', 0, 'N', 0, '2012-10-09', NULL, NULL, 44.8048, -106.956, NULL, NULL),
('830326578', 'W12022275', 'W12022275', 'WYT1', 'Buffalo Physical Therapy', 'Bret', '', 'Zowada', 'PT', 'Physical Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013272475', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12022273', 'W12022273', 'WYT1', 'Sheridan Physical Therapy ', 'Bret', '', 'Zowada', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076736969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076736969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013272475', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12022277', 'W12022277', 'UT01', 'Intermountain Ear Nose & Throat  Specialist ', 'Matthew', 'C', 'Jepsen', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WISEORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962486027', 0, 'N', 0, '2012-10-12', NULL, NULL, 40.7689, -111.865, NULL, NULL),
('680562677', 'W12022276', 'W12022276', 'UT01', 'Intermountain Ear Nose & Throat  Specialist ', 'Matthew', 'C', 'Jepsen', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', 'WISEORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962486027', 0, 'N', 0, '2012-10-12', NULL, NULL, 40.5288, -111.87, NULL, NULL),
('621762573', 'W12022278', 'W12022278', 'UT01', 'High Desert Orthopedics', 'Kelly ', 'D', 'Jensen', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '280 N Hospital Dr Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356372663', '4356372667', '280 N Hospital Dr Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356372663', '4356372667', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1497955330', 0, 'N', 0, '2012-10-12', NULL, NULL, 39.6047, -110.831, NULL, NULL),
('270968062', 'W12022280', 'W12022280', 'UTMH1', 'The Counseling Center ', 'Newel', '', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588927966', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W12022279', 'W12022279', 'UTMH1', 'The Counseling Center ', 'Newel', '', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588927966', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022281', 'W12022281', 'ID02', 'Northwest Neurobehavioral Health', 'Hamilton', '', 'Warren-Sutton', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730154345', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022282', 'W12022282', 'ID02', 'Northwest Neurobehavioral Health', 'Hamilton', '', 'Warren-Sutton', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730154345', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022283', 'W12022283', 'ID02', 'Northwest Neurobehavioral Health', 'Carolyn', 'S', 'Golden', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740314228', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12022284', 'W12022284', 'ID02', 'Northwest Neurobehavioral Health LLC ', 'Carolyn', 'S', 'Golden', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740314228', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('200324983', 'W12022285', 'W12022285', 'IDBOISTD', 'Idaho Sports Medicine Institute PA ', 'Mary Ann', '', 'Ozier', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083674278', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083674278', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811002900', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.601, -116.196, NULL, NULL),
('841394139', 'W12022287', 'W12022287', 'ID01', 'Southwest Idaho ENT ', 'Peter', 'J', 'Killian', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '2083673320', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '2083673320', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1821048091', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('841394139', 'W12022286', 'W12022286', 'ID01', 'Southwest Idaho ENT ', 'Peter', 'J', 'Killian', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1821048091', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('270968062', 'W12022289', 'W12022289', 'UTMH1', 'The Counseling Center', 'Aaron ', '', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952666232', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W12022288', 'W12022288', 'UTMH1', 'The Counseling Center', 'Aaron ', '', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952666232', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00357', 'SACN00357', 'SACN', 'Family Medicine Health Center', 'Todd', 'R', 'Palmer', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1568595270', 0, 'n', 0, '2013-02-28', 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
('870443687', 'W12022292', 'W12022292', 'UT01', 'U-U Cardiology Division', '', '', 'U-U Cardiology Division', 'MD', 'Cardiovascular Disease', 'Cardiology', '', 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, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003104', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('830326307', 'W12025709', 'W12025709', 'WYT1', 'Quick Care', '', '', 'Community Health Center of Central Wyoming ', '', 'Urgent Care', NULL, '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '0000000000', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '0000000000', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447480561', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12022301', 'W12022301', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Michael', 'W', 'Hennessy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3327 Research Plaza Ste 404', 'San Antonio', 'Bexar', 'TX', '78235', '2103965265', '2103965268', '3327 Research Plaza Ste 404', 'San Antonio', 'Bexar', 'TX', '78235', '2103965265', '2103965268', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770795387', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.3447, -98.4359, NULL, NULL),
('836000182', 'W12022303', 'W12022303', 'WY01', 'Big Horn Clinic', 'Kristi', 'B', 'Phillips', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962523126', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12022302', 'W12022302', 'WY01', 'Big Horn Clinic', 'Kristi', 'B', 'Phillips', 'PA-C', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962523126', 0, 'N', 0, '2013-03-14', NULL, NULL, 44.3811, -108.039, NULL, NULL),
('870446925', 'W12022304', 'W12022304', 'UT01', 'U-U Gastroenterology Division', '', '', 'U-U Gastroenterology Division', 'GROUP', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009377', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12022305', 'W12022305', 'UT01', 'U-U Gastroenterology Division', '', '', 'U-U Gastroenterology Division', 'GROUP', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009377', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('800502084', 'W12022311', 'W12022311', 'IDBOISTD', 'Eagle Health and Wellness', 'Katherine', 'M', 'Elstun', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089384040', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089384040', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114963717', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6884, -116.339, NULL, NULL),
('870453678', 'W12022307', 'W12022307', 'UT01', 'U-U Rheumatology Division', '', '', 'U-U Rheumatology Division', 'GROUP', 'Rheumatology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009387', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W12022308', 'W12022308', 'UT01', 'U-U Rheumatology Division', '', '', 'U-U Rheumatology Division', 'GROUP', 'Rheumatology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817724', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817724', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009387', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870467746', 'W12022309', 'W12022309', 'UT01', 'U-U Human Development Division', '', '', 'U-U Human Development Division', 'GROUP', 'Geriatrics', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812628', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812628', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009380', 0, 'N', 0, '2012-08-30', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870467746', 'W12022310', 'W12022310', 'UT01', 'U-U Human Development Division', '', '', 'U-U Human Development Division', 'GROUP', 'Geriatrics', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009380', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12022312', 'W12022312', 'UT01', 'Granger Medical West Jordan', 'Kyle', '', 'Harmer', 'PA-C', 'Pain Management', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982883856', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12022313', 'W12022313', 'UT01', 'Granger Medical Tooele', 'Kyle', '', 'Harmer', 'PA-C', 'Pain Management', '', '', NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', NULL, '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982883856', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870284475', 'W12022314', 'W12022314', 'UT01', 'Granger Medical Park City', 'Kyle', '', 'Harmer', 'PA-C', 'Pain Management', '', '', NULL, 'O', '1600 Snow Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', NULL, '1600 Snow Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982883856', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12022315', 'W12022315', 'UT01', 'Granger Medical West Jordan', 'Kyle', '', 'Harmer', 'PA-C', 'Pain Management', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982883856', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('870473288', 'W12022316', 'W12022316', 'UT01', 'U-U Infectious Disease Division', '', '', 'U-U Infectious Disease Division', 'GROUP', 'Infectious Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015852031', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015852031', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009381', 0, 'N', 0, '2012-08-30', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870473288', 'W12022317', 'W12022317', 'UT01', 'U-U Infectious Disease Division', '', '', 'U-U Infectious Disease Division', 'GROUP', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009381', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820200896', 'W12022318', 'W12022318', 'IDBOISTD', 'Saint Alphonsus Medical Center - Nampa', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '          ', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '          ', '', '', '', '0.00', '22.00', '0.00', 6, '2012-08-30', '2014-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200896', 'W12022319', 'W12022319', 'IDBOISTD', 'Saint Alphonsus Medical Center-Nampa Family Birthing Center', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '1603-c 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635940', '', '1603-c 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635940', '', '', '', '', '0.00', '22.00', '0.00', 6, '2012-08-30', '2013-11-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.5534, -116.573, NULL, NULL),
('820200896', 'W12022320', 'W12022320', 'IDBOISTD', 'Saint Alphonsus Medical Center Nampa ER', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884520', '          ', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884520', '          ', '', '', '', '0.00', '22.00', '0.00', 6, '2012-08-30', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200896', 'W12022321', 'W12022321', 'IDBOISTD', 'Mercy Medical Center Billing', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'B', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2084635038', '          ', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2084635038', '          ', '', '', '', '0.00', '22.00', '0.00', 6, '2012-08-30', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022322', 'W12022322', 'IDBOISTD', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', 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', '0.00', '0.00', 8, '2012-08-30', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022323', 'W12022323', 'IDBOISTD', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8016621000', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8016621000', '', '', '', '', '0.00', '0.00', '0.00', 8, '2012-08-30', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12022324', 'W12022324', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center', '', '', 'Saint Alphonsus Regional Medical Center ', 'Group', 'Hospital', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'UB|', '1861676298', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('760714523', 'W12022325', 'W12022325', 'TXSATSTD', 'Baptist Medical Center', '', '', 'Baptist Medical Center', '', 'Hospital', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005181', 0, 'N', 0, '2013-07-26', NULL, NULL, 29.4329, -98.4928, NULL, NULL),
('760714523', 'W12022326', 'W12022326', 'TXSATSTD', 'Baptist Medical Center', '', '', 'Baptist Medical Center', '', 'Hospital', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005181', 0, 'Y', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12022327', 'W12022327', 'IDBOISTD', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '1717 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '          ', '1717 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '          ', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'N', 0, '2014-04-22', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('363525049', 'W12022328', 'W12022328', 'IDBOISTD', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', NULL, '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', '', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'N', 0, '2014-04-22', NULL, NULL, 43.6593, -116.659, NULL, NULL),
('363525049', 'W12022329', 'W12022329', 'IDBOISTD', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', NULL, 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', '', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12022330', 'W12022330', 'IDBOISTD', 'University Health Care Huntsman Cancer Hospital', '', '', 'University Health Care Huntsman Cancer Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877000', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877000', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2012-08-30', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009276', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12022331', 'W12022331', 'TXSATSTD', 'North Central Baptist Hospital', '', '', 'North Central Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', NULL, '520 Madision', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007900', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.6213, -98.4912, NULL, NULL),
('760714523', 'W12022332', 'W12022332', 'TXSATSTD', 'North Central Baptist Hospital', '', '', 'North Central Baptist Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007900', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12022333', 'W12022333', 'TXSATSTD', 'North East Baptist Hospital', '', '', 'North East Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007903', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('760714523', 'W12022335', 'W12022335', 'TXSATSTD', 'North East Baptist Hospital', '', '', 'North East Baptist Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007903', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12022336', 'W12022336', 'TXSATSTD', 'Mission Trail Baptist Hospital', '', '', 'South East Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '1150 Brussels St', 'San Antonio', 'Bexar', 'TX', '78219', '2102973000', NULL, '1150 Brussels St', 'San Antonio', 'Bexar', 'TX', '78219', '2102973000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', '2012-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008828', 0, 'N', 0, '2012-11-06', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12022337', 'W12022337', 'TXSATSTD', 'South East Baptist Hospital', '', '', 'South East Baptist Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008828', 0, 'Y', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12022338', 'W12022338', 'TXSATSTD', 'St Lukes Baptist Hospital', '', '', 'St Lukes Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '7930 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2102975000', NULL, '7930 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2102975000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008874', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.5119, -98.5759, NULL, NULL),
('760714523', 'W12022340', 'W12022340', 'TXSATSTD', 'St Lukes Baptist Hospital', '', '', 'St Lukes Baptist Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008874', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12022341', 'W12022341', 'WYT1', 'Big Horn Clinic', 'Kristi', 'B', 'Phillips', 'PA-C', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962523126', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12022342', 'W12022342', 'WYT1', 'Big Horn Clinic', 'Kristi', 'B', 'Phillips', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962523126', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W12022343', 'W12022343', 'UT01', 'U-U General Medicine Division', '', '', 'U-U General Medicine Division', 'GROUP', 'Internal Medicine', 'General Practice', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009378', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870478993', 'W12022344', 'W12022344', 'UT01', 'U-U General Medicine Division', '', '', 'U-U General Medicine Division', 'GROUP', 'Internal Medicine', 'General Practice', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009378', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W12022345', 'W12022345', 'UT01', 'U-U Division of Nephrology', '', '', 'Division of Nephrology University of Utah', 'GROUP', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '0000000000', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005984', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870542586', 'W12022346', 'W12022346', 'UT01', 'U-U Division of Nephrology', '', '', 'Division of Nephrology University of Utah', 'GROUP', 'Internal Medicine', 'Nephrology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '0000000000', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005984', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W12022347', 'W12022347', 'UT01', 'U of U Pain Management Physicians Group', '', '', 'U of U Pain Management Physicians Group', 'GROUP', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-31', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009243', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W12022348', 'W12022348', 'UT01', 'U of U Pain Management Physicians Group', '', '', 'U of U Pain Management Physicians Group', 'GROUP', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850157', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850157', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-31', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009243', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12022349', 'W12022349', 'UT01', 'Advanced Foot and Ankle ', 'Wade', 'A', 'Christiansen', 'DPM', 'Podiatry', '', '', NULL, 'O', '11762 S State St Ste 340', 'Draper', 'Salt Lake', 'UT', '84020', '8015667297', '8013162389', '11762 S State St Ste 340', 'Draper', 'Salt Lake', 'UT', '84020', '8015667297', '8013162389', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-01', '2014-06-30', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1447482252', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.5389, -111.891, NULL, NULL),
('455466593', 'W12022395', 'W12022395', 'UT01', 'Dinosaurland Pediatrics Group LLC ', 'Shawn', 'M', 'Cooper', 'DO', 'Pediatrics', '', '', NULL, 'O', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84076', '4357899060', '4357813048', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84076', '4357899060', '4357813048', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1730313412', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('826003449', 'W12022352', 'W12022352', 'UT01', 'Franklin County Medical Center ', '', '', 'Franklin County Medical Center ', '', 'Hospital', '', '', NULL, 'O', '44 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088520137', '2088523812', '44 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088520137', '2088523812', '', '', '', '0.00', '5.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548355811', 0, 'N', 0, '2013-06-13', NULL, NULL, 42.0971, -111.874, NULL, NULL),
('455466593', 'W12022353', 'W12022353', 'UT01', 'Dinosaurland Pediatrics Group LLC ', 'Ethan ', 'C', 'Pettit', 'DO', 'Pediatrics', '', '', NULL, 'O', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84076', '4357899060', '4357813048', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84076', '4357899060', '4357813048', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1518193184', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('870550275', 'W12022354', 'W12022354', 'UT01', 'Cottonwood Pediatrics', 'Nathan', 'R', 'McArthur', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-08-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1487881660', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12022355', 'W12022355', 'UT01', 'Cottonwood Pediatrics', 'Nathan', 'R', 'McArthur', 'MD', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017478700', '8017478701', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017478700', '8017478701', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-08-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1487881660', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12022356', 'W12022356', 'UT01', 'Cottonwood Pediatrics', 'Nathan', 'R', 'McArthur', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8017478700', '8017478701', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8017478700', '8017478701', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-08-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1487881660', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12022357', 'W12022357', 'WY01', 'West Park Hospital District Primary Care', 'Rachael ', '', 'Bracke', 'MD', 'Internal Medicine', '', '', NULL, 'O', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075785657', '3075782979', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075785657', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487815742', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.517, -109.083, NULL, NULL),
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('870635889', 'W12022362', 'W12022362', 'UT01', 'Tooele Clinic Corp', 'Megan ', 'M', 'Shutts Karjola', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433678', '0000000000', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433678', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437143351', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12022364', 'W12022364', 'UT01', 'Tooele Clinic Corp', 'Megan ', 'M', 'Shutts Karjola', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437143351', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('830207671', 'W12022366', 'W12022366', 'WY01', 'West Park Hospital District ', 'Matthew', 'M', 'Gaines', 'DO', 'Psychiatry', 'Mental Health', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782282', '3075782325', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782282', '3075782325', '', '', '', '0.00', '12.00', '0.00', 3, '2013-06-01', '2013-06-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1275771453', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
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('870635889', 'W12022371', 'W12022371', 'UT01', 'Tooele Clinic Corp ', 'Dawn ', 'L', 'Powell', 'NP', 'Pediatrics', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37067', '4358433647', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37067', '4358433647', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1083977391', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('264696078', 'W12022374', 'W12022374', 'UT01', 'Mountain Springs Family Medicine PLLC', 'Shelly', 'P', 'Messerly', 'PA', 'General Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8015046117', '8015046328', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8015046117', '8015046328', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073868550', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('830330554', 'W12022299', 'W12022299', 'WY01', 'Evanston Clinic', 'Daniel', '', 'Broadbent', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838190', '3077838191', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838190', '3077838191', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699901231', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('830330554', 'W12022300', 'W12022300', 'WYT1', 'Evanston Clinic', 'Daniel', '', 'Broadbent', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838190', '3077838191', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838190', '3077838191', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699901231', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022377', 'W12022377', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Douglas', 'C', 'Barnhart', 'MD', 'General Surgery', 'Pediatric Surgery', '', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750398517', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022378', 'W12022378', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Earl', 'C', 'Downey', 'MD', 'Pediatric Surgery', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225119019', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022379', 'W12022379', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'James', 'L', 'Hoffman', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760687974', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022380', 'W12022380', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Rebecka', 'L', 'Meyers', 'MD', 'Pediatric Surgery', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902996515', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022381', 'W12022381', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Russell', 'J', 'Osguthorpe', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-15', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285656322', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022382', 'W12022382', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'David', 'E', 'Skarda', 'MD', 'Pediatric Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356398010', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022383', 'W12022383', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Thomas', 'L', 'Sutton', 'MD', 'Gastroenterology', 'Pediatrics', 'Pediatric Gastroenterology', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750319232', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022384', 'W12022384', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Marquelle', '', 'Wilkinson', 'APRN', 'Pediatrics', '', '', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477812691', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12022386', 'W12022386', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Amy', 'B', 'Arriola', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447534169', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12022387', 'W12022387', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Amy', 'B', 'Arriola', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447534169', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022388', 'W12022388', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022389', 'W12022389', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Shari', 'L', 'Bloom', 'PA', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053564179', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6623, -111.5, NULL, NULL),
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('942854057', 'W12022392', 'W12022392', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('820161600', 'W12022974', 'W12022974', 'IDREC', 'St Lukes Pediatrics Endocrinology (Recognized PPO but not contracted pre-auth required)', 'Daniel', '', 'Flynn', '', 'Pediatric Endocrinology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817340', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817340', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2012-09-01', '2014-03-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447449574', 0, 'N', 0, '2014-03-26', NULL, NULL, 43.6123, -116.194, 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
('942854057', 'W12022401', 'W12022401', 'UTIHCPHY', 'Provo Radiation Oncology', 'George', 'M', 'Cannon', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376593020', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12022402', 'W12022402', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'George', 'M', 'Cannon', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '5131 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', '5131 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376593020', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W12022403', 'W12022403', 'UTIHCPHY', 'McKay Dee Radiation Oncology', 'George', 'M', 'Cannon', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', '8014423263', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376593020', 0, 'N', 0, '2012-09-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12022404', 'W12022404', 'UTIHCPHY', 'Logan Radiation Oncology', 'George', 'M', 'Cannon', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', '8014423263', '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376593020', 0, 'N', 0, '2012-09-06', NULL, NULL, 41.7574, -111.822, NULL, NULL),
('942854057', 'W12022407', 'W12022407', 'UTIHCPHY', 'Utah Heart', 'Jonathan', 'R', 'Cox', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720341555', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022408', 'W12022408', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022409', 'W12022409', 'UTIHCPHY', 'Park City Clinic-Canyons', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', '0000000000', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', '0000000000', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6839, -111.553, NULL, NULL),
('942854057', 'W12022410', 'W12022410', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12022412', 'W12022412', 'UTIHCPHY', 'Mt Pleasant-Delta', 'Christopher', 'R', 'Gordon', 'MD', 'Family Medicine', '', '', NULL, 'O', '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4354623354', '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922232867', 0, 'N', 0, '2012-09-06', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12022413', 'W12022413', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12022414', 'W12022414', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022416', 'W12022416', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'Grant', 'K', 'Hunter', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '5131 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', '5131 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1972776342', 0, 'N', 0, '2012-09-10', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W12022417', 'W12022417', 'UTIHCPHY', 'Logan Radiation Oncology', 'Grant', 'K', 'Hunter', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', '8014423263', '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1972776342', 0, 'N', 0, '2012-09-10', NULL, NULL, 41.7574, -111.822, NULL, NULL),
('942854057', 'W12022418', 'W12022418', 'UTIHCPHY', 'McKay Dee Radiation Oncology', 'Grant', 'K', 'Hunter', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', '8014423263', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1972776342', 0, 'N', 0, '2012-09-10', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12022419', 'W12022419', 'UTIHCPHY', 'Provo Radiation Oncology', 'Grant', 'K', 'Hunter', 'MD', 'Radiation/Oncology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1972776342', 0, 'N', 0, '2012-09-10', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12022421', 'W12022421', 'UTIHCPHY', 'Sunset Clinic & InstaCare', 'Timothy', 'C', 'Larsen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306070222', 0, 'Y', 0, '2013-03-08', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12022422', 'W12022422', 'UTIHCPHY', 'Redrock Pediatrics', 'Timothy', 'C', 'Larsen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306070222', 0, 'N', 0, '2013-03-08', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12022423', 'W12022423', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022424', 'W12022424', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12022425', 'W12022425', 'UTIHCPHY', 'Park City Clinic-Canyons', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', NULL, '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6839, -111.553, NULL, NULL),
('942854057', 'W12022426', 'W12022426', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12022427', 'W12022427', 'UTIHCPHY', 'Park City Clinic-Bonanza', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12022428', 'W12022428', 'UTIHCPHY', 'Logan InstaCare', 'John', 'J', 'Murdock', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-04-01', '2013-11-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1891786968', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022430', 'W12022430', 'UTIHCPHY', 'Heart Rhythm Specialists', 'Jessica', '', 'Dunn', 'APRN', 'Family Practice', '', '', NULL, 'O', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-01', '2012-09-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396024618', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12022431', 'W12022431', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'N', 0, '2012-09-10', NULL, NULL, 40.6855, -111.466, NULL, NULL),
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('263720511', 'W12022490', 'W12022490', 'UT01', 'Stacy R Smith MD', 'Stacy', 'R', 'Smith', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4568 S Highland Dr Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', '4568 S Highland Dr Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1639348899', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.6725, -111.841, NULL, NULL),
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('202630141', 'W12022495', 'W12022495', 'ID02', 'Primary Health Medical Group-State St', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-11-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022497', 'W12022497', 'UT01', 'Davis Urgent Care', 'Ernest', '', 'Severn', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-04', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1326080847', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12022505', 'W12022505', 'ID02', 'Family Medicine Health Center', 'Sarah Grace', '', 'Galinato Gerrish', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982832176', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12022506', 'W12022506', 'ID02', 'Family Medicine Health Center', 'Sarah Grace', '', 'Galinato Gerrish', '', 'Family Practice', '', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982832176', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12022517', 'W12022517', 'NM01', 'ABQ Health Partners', 'Paul', 'M', 'Tapia', 'PA-C', 'Allergy and Immunology', 'Urgent Care', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968687', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968687', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-21', '2014-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740507177', 0, 'Y', 0, '2014-04-29', NULL, NULL, 35.2284, -106.66, NULL, NULL),
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('204043287', 'W12022518', 'W12022518', 'NM01', 'ABQ Health Partners', 'Paul', 'M', 'Tapia', 'PA-C', 'Allergy and Immunology', 'Urgent Care', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-21', '2014-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740507177', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12022521', 'W12022521', 'NM01', 'ABQ Health Partners', 'Brooke', '', 'Martin', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1902831985', 0, 'Y', 0, '2013-01-25', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('271635493', 'W12021240', 'W12021240', 'UTMH1', 'Early Life Child Psychology and Education Center', 'Frances', 'L', 'Thompson', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '10808 Riverfront Pkwy Ste 314', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019842877', '8015767540', '10808 Riverfront Pkwy Ste 314', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019842877', '8015767540', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760532162', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12022523', 'W12022523', 'UTMH1', 'Utah Behavior Services Inc', 'Marsha', '', 'Hardman-Lundell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245248368', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.6418, -111.939, NULL, NULL),
('731654693', 'W12022524', 'W12022524', 'UTMH1', 'Lighthouse Recovery Center', '', '', 'Light House Recovery Center', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '7602 S Main St', 'Midvale', 'Salt Lake', 'UT', '84047', '8016317122', '8778409122', '7602 S Main St', 'Midvale', 'Salt Lake', 'UT', '84047', '8016317122', '8778409122', '', '', '8', '0.00', '50.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386871853', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12022529', 'W12022529', 'IDBOISTD', 'West Valley Therapy Services', '', '', 'West Valley Therapy Services', '', 'Hospital', '', '', NULL, 'O', '1717 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '          ', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009579', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('363525049', 'W12022530', 'W12022530', 'IDBOISTD', 'West Valley Therapy Services', '', '', 'West Valley Therapy Services', '', 'Hospital', '', '', NULL, 'O', '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', NULL, '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', '          ', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009579', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6593, -116.659, NULL, NULL),
('363525049', 'W12022531', 'W12022531', 'IDBOISTD', 'West Valley Therapy Services', '', '', 'West Valley Therapy Services', '', 'Hospital', '', '', NULL, 'B', 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', NULL, 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', '          ', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009579', 0, 'Y', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
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('205450649', 'W12022537', 'W12022537', 'UTDT01', 'Borg Brian', 'Brett', '', 'Richins', 'DMD', 'Dentist', '', '', NULL, 'O', '3693 W 13400 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8018783111', NULL, '3693 W 13400 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8018783111', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009911', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('205863661', 'W12022539', 'W12022539', 'UTDT01', 'Cornerstone Dental Care', 'K', 'John', 'Liddiard', 'DMD', 'Dentist', '', '', NULL, 'O', '10458 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028989', NULL, '10458 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028989', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009912', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('208964043', 'W12022541', 'W12022541', 'UTDT01', 'Pitt Family Dental', 'Pitt', '', 'Ammon', 'DDS', 'Dentist', '', '', NULL, 'O', '281 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8012956192', NULL, '281 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8012956192', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009913', 0, 'N', 0, '2012-09-10', 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
('260560693', 'W12022543', 'W12022543', 'UTDT01', 'Gentle Dentistry', 'Derek', 'R', 'Evans', '', 'Dentist', '', '', NULL, 'O', '720 S River Rd', 'St George', 'Washington', 'UT', '84790', '4359869799', NULL, '720 S River Rd', 'St George', 'Washington', 'UT', '84790', '4359869799', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009914', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('911753075', 'W12022664', 'W12022664', 'WYT1', 'Northwest Emergency Physicians', 'Neil', 'P', 'Wang', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662276', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('911753075', 'W12022670', 'W12022670', 'WYT1', 'Northwest Emergency Physicians', 'Amy', 'T', 'Kenworthy', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346335254', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022671', 'W12022671', 'WY01', 'Northwest Emergency Physicians', 'Amy', 'T', 'Kenworthy', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346335254', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022672', 'W12022672', 'WYT1', 'Northwest Emergency Physicians', 'Amy', 'T', 'Kenworthy', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346335254', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022673', 'W12022673', 'WY01', 'Northwest Emergency Physicians', 'Amy', 'T', 'Kenworthy', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346335254', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.0337, -108.418, NULL, NULL),
('911753075', 'W12022674', 'W12022674', 'WYT1', 'Northwest Emergency Physicians', 'Ethan', 'T', 'OConnell', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306097928', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022675', 'W12022675', 'WY01', 'Northwest Emergency Physicians', 'Ethan', 'T', 'OConnell', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306097928', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.0337, -108.418, NULL, NULL),
('911753075', 'W12022676', 'W12022676', 'WYT1', 'Northwest Emergency Physicians', 'Ethan', 'T', 'OConnell', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306097928', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022677', 'W12022677', 'WY01', 'Northwest Emergency Physicians', 'Ethan', 'T', 'OConnell', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306097928', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022678', 'W12022678', 'WYT1', 'Northwest Emergency Physicians', 'Jeffery', '', 'Haskell', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073535506', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022679', 'W12022679', 'WY01', 'Northwest Emergency Physicians', 'Jeffery', '', 'Haskell', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073535506', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.0337, -108.418, NULL, NULL),
('911753075', 'W12022680', 'W12022680', 'WYT1', 'Northwest Emergency Physicians', 'Jeffery', '', 'Haskell', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073535506', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022681', 'W12022681', 'WY01', 'Northwest Emergency Physicians', 'Jeffery', '', 'Haskell', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073535506', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022682', 'W12022682', 'WY01', 'Northwest Emergency Physicians', 'Bradley', '', 'North', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023057874', 0, 'N', 0, '2013-07-09', NULL, NULL, 43.0337, -108.418, NULL, NULL),
('911753075', 'W12022683', 'W12022683', 'WYT1', 'Northwest Emergency Physicians', 'Bradley', '', 'North', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023057874', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022684', 'W12022684', 'WYT1', 'Northwest Emergency Physicians', 'Bradley', '', 'North', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023057874', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12022685', 'W12022685', 'WY01', 'Northwest Emergency Physicians', 'Bradley', '', 'North', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023057874', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12022686', 'W12022686', 'UT01', 'Lakeview Internal Medicine', 'Brian', 'A', 'Gray', 'DO', 'Internal Medicine', '', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '8012947558', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '8012947558', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942438098', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('900512734', 'W12022687', 'W12022687', 'UT01', 'Lakeview Internal Medicine', 'Brian', 'A', 'Gray', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 402381', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 402381', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942438098', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('454189323', 'W12022690', 'W12022690', 'UTDT01', 'Oral & Facial Reconstructive Surgery of UT', 'Michael', '', 'Gladwell', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', NULL, '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'DEN|', '1639250673', 0, 'N', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('454189323', 'W12022692', 'W12022692', 'UTDT01', 'Oral & Facial Reconstructive Surgery of UT', 'Nathan', '', 'Adams', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', NULL, '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', '|DEN|', '1174604128', 0, 'N', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('454829336', 'W12022694', 'W12022694', 'UTDT01', 'Vernal Smiles', 'Morrie', '', 'Talbot', '', 'Dentist', '', '', NULL, 'O', '333 W 350 S', 'Vernal', 'Uintah', 'UT', '84078', '4357897711', NULL, '333 W 350 S', 'Vernal', 'Uintah', 'UT', '84078', '4357897711', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009926', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('455254454', 'W12022696', 'W12022696', 'UTDT01', 'Kanab Dental Center', 'Peter', 'V', 'Banks', 'DDS', 'Dentist', '', '', NULL, 'O', '181 W Ctr', 'Kanab', 'Kane', 'UT', '84741', '4356442211', NULL, '181 W Ctr', 'Kanab', 'Kane', 'UT', '84741', '4356442211', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009927', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('455361876', 'W12022697', 'W12022697', 'UTDT01', 'Focus Dental Group', 'Craig', '', 'Van Alfen', 'DDS', 'Dentist', '', '', NULL, 'O', '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', NULL, '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009415', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('455361876', 'W12022698', 'W12022698', 'UTDT01', 'Focus Dental Group', 'Raymond J', '', 'Curtis', 'DDS', 'Dentist', '', '', NULL, 'O', '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', NULL, '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083703649', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('455361876', 'W12022699', 'W12022699', 'UTDT01', 'Focus Dental Group', 'Steven', '', 'Duke', 'DMD', 'Dentist', '', '', NULL, 'O', '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', NULL, '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009868', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('455506732', 'W12022702', 'W12022702', 'UTDT01', 'Jamison S Cox, DMD', 'Jamison', '', 'Cox', '', 'Dentist', '', '', NULL, 'O', '736 S 900 E Ste 105', 'St George', 'Washington', 'UT', '84790', '4356732491', NULL, '736 S 900 E Ste 105', 'St George', 'Washington', 'UT', '84790', '4356732491', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009929', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('460485978', 'W12022704', 'W12022704', 'UTDT01', 'Glassett Nelson, DDS', 'Donald', '', 'Allred', '', 'Dentist', '', '', NULL, 'O', '11576 S State St Ste 1203', 'Draper', 'Salt Lake', 'UT', '84020', '8016198664', NULL, '11576 S State St Ste 1203', 'Draper', 'Salt Lake', 'UT', '84020', '8016198664', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009930', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('710938777', 'W12022705', 'W12022705', 'UTDT01', 'Lakeview Dental Roy', 'Brett', '', 'Richins', 'DMD', 'Dentist', '', '', NULL, 'O', '3626 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8019852273', NULL, '3626 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8019852273', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009911', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('753051218', 'W12022707', 'W12022707', 'UTDT01', 'A Kids Place Dentistry', 'Elise', '', 'Kobe', 'DDS', 'Dentist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009931', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('841402075', 'W12022709', 'W12022709', 'UTDT01', 'Duncan Dental', 'Brian', '', 'Duncan', 'DMD', 'Dentist', '', '', NULL, 'O', '6183 S Prairie View Dr Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019690881', NULL, '6183 S Prairie View Dr Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019690881', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009932', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870362661', 'W12022726', 'W12022726', 'UTDT01', 'Steven B. Lowe DDS', 'Steven', '', 'Lowe', 'DDS', 'Dentist', '', '', NULL, 'O', '7138 Highland Dr Ste 212', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019430901', NULL, '7138 Highland Dr Ste 212', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019430901', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009934', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870517659', 'W12022728', 'W12022728', 'UTDT01', 'Rock Hotel Dental', 'Nicholas', '', 'Peterson', '', 'Dentist', '', '', NULL, 'O', '88 E State St', 'Farmington', 'Davis', 'UT', '84025', '8014512341', NULL, '88 E State St', 'Farmington', 'Davis', 'UT', '84025', '8014512341', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009935', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12022730', 'W12022730', 'UTDT01', 'North View Dental', 'Candice', '', 'Fresques', '', 'Dentist', '', '', NULL, 'O', '2201 N 400 E Ste 3', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E Ste 3', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009936', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870550501', 'W12022732', 'W12022732', 'UTDT01', 'Rod T. Gardner DDS', 'Rod', '', 'Gardner', 'DDS', 'Dentist', '', '', NULL, 'O', '814 E Main St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573880', NULL, '814 E Main St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573880', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009937', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12022734', 'W12022734', 'UTDT01', 'Monarch Dental', 'Mark', '', 'McGowan', 'DMD', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1659661288', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12022735', 'W12022735', 'UTDT01', 'Monarch Dental', 'Shane', '', 'Taylor', 'DDS', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009017', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
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('870678698', 'W12022762', 'W12022762', 'UTDT01', 'Stansbury Park Dental Care, Inc.', 'David J', '', 'Clonts', 'DDS', 'Dentist', '', '', NULL, 'O', '263 Country Club Ste 103', 'Tooele', 'Tooele', 'UT', '84074', '4358822850', NULL, '263 Country Club Ste 103', 'Tooele', 'Tooele', 'UT', '84074', '4358822850', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2012-08-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'DEN|', '1104132869', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W12022764', 'W12022764', 'UTDT01', 'Stonehaven Dental', 'Kiley', '', 'Boss', 'DDS', 'Dentist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2012-08-06', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009940', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
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('261603887', 'W12022767', 'W12022767', 'UTDT01', 'Alpenglow Dental', 'Tyson', '', 'Pickett', 'DDS', 'Dentist', '', '', NULL, 'O', '3672 W S Jordan Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018781700', NULL, '3672 W S Jordan Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018781700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009941', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('270827499', 'W12022769', 'W12022769', 'UTDT01', 'Grandpas Dental Care Inc', 'Louis', '', 'Erickson', 'DDS', 'Dentist', '', '', NULL, 'O', '53 W 10600 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015761444', NULL, '53 W 10600 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015761444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006146', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('453161026', 'W12022770', 'W12022770', 'UTDT01', 'Sunset Dental Group', 'George', '', 'Hatsis', 'DDS', 'Dentist', '', '', NULL, 'O', '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', NULL, '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006616', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('453161026', 'W12022772', 'W12022772', 'UTDT01', 'Sunset Dental Group', 'Kevin', '', 'Dorius', 'DMD', 'Dentist', '', '', NULL, 'O', '929 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356565900', NULL, '929 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356565900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009942', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('453161026', 'W12022773', 'W12022773', 'UTDT01', 'Sunset Dental Group', 'Kevin', '', 'Dorius', 'DMD', 'Dentist', '', '', NULL, 'O', '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', NULL, '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009942', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('453161026', 'W12022775', 'W12022775', 'UTDT01', 'Sunset Dental Group', 'Louis', '', 'Christensen', 'DDS', 'Dentist', '', '', NULL, 'O', '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', NULL, '1404 W Sunriver Pkwy Ste 125', 'St George', 'Washington', 'UT', '84790', '4352566167', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009943', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('460695332', 'W12022777', 'W12022777', 'UTDT01', 'Silver Creek Dental', 'Russell', '', 'Smith', 'DMD', 'Dentist', '', '', NULL, 'O', '6415 N Business Park Loop Rd Ste J', 'Park City', 'Summit', 'UT', '84098', '4356580032', NULL, '6415 N Business Park Loop Rd Ste J', 'Park City', 'Summit', 'UT', '84098', '4356580032', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009944', 0, 'N', 0, '2012-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12022779', 'W12022779', 'UTDT01', 'Mountain View Dental', 'Jennifer', '', 'Phillips', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009945', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('271343391', 'W12022783', 'W12022783', 'ID01', 'Treasure Valley Psychological Services', 'Emily "Connie"', 'Constance', 'Karcher', 'LPC', 'Mental Health', 'Marriage and Family Therapy', 'Counseling', NULL, 'O', '1502 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2089497531', NULL, '1502 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2089497531', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245470244', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
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('200221785', 'W12022839', 'W12022839', 'ILCHIGSTD', 'Chicago Pediatric and Neonatology', 'Anna', 'P', 'Sienkiewicz', 'MD', 'Pediatrics', '', '', NULL, 'O', '7447 W Talcott Ave Ste 561', 'Chicago', 'Cook', 'IL', '60631', '7734678866', '7734678886', '7447 W Talcott Ave Ste 561', 'Chicago', 'Cook', 'IL', '60631', '7734678866', '7734678886', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689801185', 0, 'N', 0, '2013-09-16', NULL, NULL, 41.9902, -87.8159, NULL, NULL),
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('870299862', 'W40019174', 'W40019174', 'UTMH1', 'LDS Family Services', 'Ken', '', 'Folsom', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558573923', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.072, -111.981, NULL, NULL),
('260598432', 'W12022855', 'W12022855', 'ILCHIGSTD', 'Comprehensive Pediatric Care', 'Mariola', '', 'Jackowski', 'MD', 'Pediatrics', '', '', NULL, 'O', '7447 W Talcott Ave Ste 248', 'Chicago', 'Cook', 'IL', '60631', '7737746547', '7737740019', '7447 W Talcott Ave Ste 248', 'Chicago', 'Cook', 'IL', '60631', '7737746547', '7737740019', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295937662', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('711002175', 'W12022856', 'W12022856', 'ID01', 'Copper Creek Counseling ', 'John', 'S', 'Hochhalter', 'PC', 'Mental Health', 'Counseling', '', NULL, 'O', '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', '2083765690', '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', '2083765690', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-29', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366681934', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('203547384', 'W12022857', 'W12022857', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Nicholas', '', 'Joyce Clarke', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643971', 0, 'N', 0, '2013-03-07', NULL, NULL, 42.0522, -88.1102, NULL, NULL),
('203547384', 'W12022859', 'W12022859', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Nicholas', '', 'Joyce Clarke', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '901 Biesterfield Ste 105', 'Elk Grove Village', 'Cook', 'IL', '60007', '8472289898', '8472289899', '901 Biesterfield Ste 105', 'Elk Grove Village', 'Cook', 'IL', '60007', '8472289898', '8472289899', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643971', 0, 'N', 0, '2013-03-07', NULL, NULL, 42.0033, -88.0202, NULL, NULL),
('203547384', 'W12022858', 'W12022858', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Nicholas', '', 'Joyce Clarke', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'B', 'PO Box 958935', 'Hoffman Estates', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'PO Box 958935', 'Hoffman Estates', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643971', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('261286085', 'W12022860', 'W12022860', 'WY01', 'Rehab Solutions', 'Brittany', 'J', 'Hagen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Boxelder Rd Ste U', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', '1103 E Boxelder Rd Ste U', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417202706', 0, 'N', 0, '2012-10-09', NULL, NULL, 44.2767, -105.487, NULL, NULL),
('261286085', 'W12022861', 'W12022861', 'WYT1', 'Rehab Solutions', 'Brittany', 'J', 'Hagen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Boxelder Rd Ste U', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', '1103 E Boxelder Rd Ste U', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417202706', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('363954552', 'W12022862', 'W12022862', 'ILCHIGSTD', 'Sage Medical Group', '', '', 'Sage Medical Group SC', '', 'Internal Medicine', 'Mental Health', '', NULL, 'O', '1150 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', '1150 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009957', 0, 'Y', 0, '2013-05-10', NULL, NULL, 41.9253, -87.6576, NULL, NULL),
('760581778', 'W12029602', 'W12029602', 'TXHOUSTD', 'Pediatric Center', '', '', 'Pediatric Center LTD ', '', 'Pediatrics', '', '', NULL, 'O', '1300 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813419696', '2813416218', '1300 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813419696', '2813416218', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053492306', 0, 'Y', 0, '2013-06-10', NULL, NULL, 29.5773, -95.7675, NULL, NULL),
('200324983', 'W12029504', 'W12029504', 'ID01', 'Idaho Sports Medicine Institute', 'Bradford', 'R', 'Page', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639175276', 0, 'N', 0, '2013-01-28', NULL, NULL, 43.601, -116.196, NULL, NULL),
('363383867', 'W12029499', 'W12029499', 'ILCHIGSTD', 'Little Company of Mary Affilliated Services', '', '', 'Little Company of Mary Affilliated Services', '', 'Clinics', '', '', NULL, 'B', '2800 W 87th St', 'Roggen', 'Weld', 'CO', '80652', '7086369205', '7084225505', '2800 W 87th St', 'Roggen', 'Weld', 'CO', '80652', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588617260', 0, 'Y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363954552', 'W12022875', 'W12022875', 'ILCHIGSTD', 'Sage Medical Group', 'Paulette', 'C', 'Wilson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1150 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', '1150 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1326068487', 0, 'N', 0, '2014-02-06', NULL, NULL, 41.9253, -87.6576, NULL, NULL),
('363766527', 'W12022878', 'W12022878', 'ILCHIGSTD', 'Mohammed A Hussain MD', 'Mohammed', '', 'Hussain', 'MD', 'Cardiology', '', '', NULL, 'O', '3960 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7735891008', '7736257449', '3960 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7735891008', '7736257449', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649339441', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.952, -87.8072, 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
('363766527', 'W12022879', 'W12022879', 'ILCHIGSTD', '', 'Mohammed', '', 'Hussain', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 59436', 'Chicago', 'Cook', 'IL', '60659', '7735891008', '7736257449', 'PO Box 59436', 'Chicago', 'Cook', 'IL', '60659', '7735891008', '7736257449', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649339441', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362936936', 'W12022880', 'W12022880', 'ILCHIGSTD', 'Enayatollah Rezvani MD', 'Enayatollah', '', 'Rezvani', 'MD', 'Pediatrics', '', '', NULL, 'O', '605 W Central Rd Ste 204', 'Arlington Heights', 'Cook', 'IL', '60005', '8472592620', '8472596409', '605 W Central Rd Ste 204', 'Arlington Heights', 'Cook', 'IL', '60005', '8472592620', '8472596409', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679662472', 0, 'N', 0, '2013-03-07', NULL, NULL, 42.0665, -87.9899, NULL, NULL),
('383644193', 'W12022881', 'W12022881', 'ILCHIGSTD', 'SW Pediatrics', 'Anthony', '', 'Delach', 'MD', 'Pediatrics', '', '', NULL, 'O', '16622 S 107 Ct', 'Orland Park', 'Cook', 'IL', '60467', '7084032900', '7084032228', '16622 S 107 Ct', 'Orland Park', 'Cook', 'IL', '60467', '7084032900', '7084032228', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801823307', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5748, -87.8767, NULL, NULL),
('205934739', 'SACN00356', 'SACN00356', 'SACN', 'Family Medicine Health Center', 'Todd', 'R', 'Palmer', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1568595270', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('203547384', 'W12022885', 'W12022885', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Carmen', '', 'Griza', 'MD', 'Family Practice', '', '', NULL, 'O', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861658460', 0, 'N', 0, '2013-02-27', NULL, NULL, 42.0522, -88.1102, NULL, NULL),
('203547384', 'W12022886', 'W12022886', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Carmen', '', 'Griza', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Biesterfield Ste 105', 'Elk Grove Village', 'Cook', 'IL', '60007', '8472289898', '8472289899', '901 Biesterfield Ste 105', 'Elk Grove Village', 'Cook', 'IL', '60007', '8472289898', '8472289899', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861658460', 0, 'N', 0, '2013-02-27', NULL, NULL, 42.0033, -88.0202, NULL, NULL),
('203547384', 'W12022887', 'W12022887', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Carmen', '', 'Griza', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 958935', 'Schaumburg', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'PO Box 958935', 'Schaumburg', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861658460', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('203547384', 'W12022889', 'W12022889', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Anwar', '', 'Al Kunani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', '1260 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932175908', 0, 'N', 0, '2013-04-26', NULL, NULL, 42.0522, -88.1102, NULL, NULL),
('203547384', 'W12022888', 'W12022888', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Anwar', '', 'Al Kunani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '901 Biesterfield Ste 105', 'Elk Grove', 'Cook', 'IL', '60017', '8472289898', '8472289899', '901 Biesterfield Ste 105', 'Elk Grove', 'Cook', 'IL', '60017', '8472289898', '8472289899', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932175908', 0, 'N', 0, '2013-04-26', NULL, NULL, 42.0033, -88.0202, NULL, NULL),
('203547384', 'W12022890', 'W12022890', 'ILCHIGSTD', 'Multi Specialty Clinic', 'Anwar', '', 'Al Kunani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 958935', 'Schaumburg', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'PO Box 958935', 'Schaumburg', 'Cook', 'IL', '60195', '8478391111', '8478391123', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932175908', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('363403240', 'W12022893', 'W12022893', 'ILCHIGSTD', '', 'Seth ', 'Reuel', 'Tanenbaum', 'MD', 'Cardiology', '', '', NULL, 'B', '1 TransAm Plaza Dr Ste 490', 'Villa Park', 'Dupage', 'IL', '60181', '7738717384', '7733371766', '1 TransAm Plaza Dr Ste 490', 'Villa Park', 'Dupage', 'IL', '60181', '7738717384', '7733371766', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1912902933', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('363403240', 'W12022891', 'W12022891', 'ILCHIGSTD', '', 'Seth ', 'Reuel', 'Tanenbaum', 'MD', 'Cardiology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 400', 'Chicago', 'Cook', 'IL', '60657', '7738717384', '7733371766', '2800 N Sheridan Rd Ste 400', 'Chicago', 'Cook', 'IL', '60657', '7738717384', '7733371766', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1912902933', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363403240', 'W12022892', 'W12022892', 'ILCHIGSTD', 'Saint Joseph Hospital', 'Seth ', 'Reuel', 'Tanenbaum', 'MD', 'Cardiology', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7738717384', '7733371766', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7738717384', '7733371766', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1912902933', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('300710857', 'W12022894', 'W12022894', 'UTMH1', 'Professional Counsleing Services', 'Lani', '', 'Ete', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4174 W 4570 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017064026', '8012631265', '4174 W 4570 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017064026', '8012631265', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255518080', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('300710857', 'W12022895', 'W12022895', 'UTMH1', 'Center for Family Evaluation and Treatment', 'Lani', '', 'Ete', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5691 S Redwood Rd Ste 16', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012653895', '8012631265', '5691 S Redwood Rd Ste 16', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012653895', '8012631265', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255518080', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022896', 'W12022896', 'WYT1', 'Community Health Center of Central Wyoming', 'Danijela', '', 'Janes', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952607640', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022897', 'W12022897', 'WY01', 'Community Health Center of Central Wyoming', 'Danijela', '', 'Janes', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952607640', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022899', 'W12022899', 'WY01', 'Community Health Center of Central Wyoming', 'Ryan', '', 'Bair', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720385669', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022898', 'W12022898', 'WYT1', 'Community Health Center of Central Wyoming', 'Ryan', '', 'Bair', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720385669', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022900', 'W12022900', 'WY01', 'Community Health Center of Central Wyoming', 'Jungsook', '', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720061658', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022901', 'W12022901', 'WYT1', 'Community Health Center of Central Wyoming', 'Jungsook', '', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720061658', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022902', 'W12022902', 'WY01', 'Community Health Center of Central Wyoming', 'Vaughn', '', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy 26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', NULL, '5647 US Hwy 26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679516744', 0, 'N', 0, '2012-10-09', NULL, NULL, 43.5157, -109.569, NULL, NULL),
('830326307', 'W12022903', 'W12022903', 'WYT1', 'Community Health Center of Central Wyoming', 'Vaughn', '', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy 26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', NULL, '5647 US Hwy 26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679516744', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022904', 'W12022904', 'WY01', 'Community Health Center of Central Wyoming', 'Michael', '', 'Owens', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1568768455', 0, 'N', 0, '2013-07-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022905', 'W12022905', 'WYT1', 'Community Health Center of Central Wyoming', 'Michael', '', 'Owens', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1568768455', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022908', 'W12022908', 'WYT1', 'Community Health Center of Central Wyoming', 'Lynda', '', 'Green', 'NP', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3072336000', NULL, '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3072336000', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538141221', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022906', 'W12022906', 'WY01', 'Community Health Center of Central Wyoming', 'Lynda', '', 'Green', 'NP', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3072336000', NULL, '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3072336000', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538141221', 0, 'N', 0, '2012-10-09', NULL, NULL, 43.5157, -109.569, NULL, NULL),
('830326307', 'W12022909', 'W12022909', 'WYT1', 'Community Health Center of Central Wyoming', 'Paul', 'M', 'Harnetty', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1881649374', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022910', 'W12022910', 'WY01', 'Community Health Center of Central Wyoming', 'Paul', 'M', 'Harnetty', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1881649374', 0, 'N', 0, '2013-07-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022911', 'W12022911', 'WY01', 'Community Health Center of Central Wyoming', 'Ronny', '', 'Santosa', 'MD', 'Internal Medicine', '', '', NULL, 'O', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346317005', 0, 'N', 0, '2012-10-09', NULL, NULL, 43.0286, -108.376, NULL, NULL),
('830326307', 'W12022912', 'W12022912', 'WYT1', 'Community Health Center of Central Wyoming', 'Ronny', '', 'Santosa', 'MD', 'Internal Medicine', '', '', NULL, 'O', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346317005', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022913', 'W12022913', 'WY01', 'Community Health Center of Central Wyoming', 'Stephanie', '', 'Keeney', 'PA', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184802951', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022914', 'W12022914', 'WYT1', 'Community Health Center of Central Wyoming', 'Stephanie', '', 'Keeney', 'PA', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184802951', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022915', 'W12022915', 'WY01', 'Community Health Center of Central Wyoming', 'Richard', '', 'Rygiel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-05-13', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1164648333', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12022916', 'W12022916', 'WYT1', 'Community Health Center of Central Wyoming', 'Richard', '', 'Rygiel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-05-13', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1164648333', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022917', 'W12022917', 'WY01', 'Community Health Center of Central Wyoming', 'Pamela', '', 'Namenyi', 'APRN', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013164771', 0, 'N', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12022918', 'W12022918', 'WYT1', 'Community Health Center of Central Wyoming', 'Pamela', '', 'Namenyi', 'APRN', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013164771', 0, 'N', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('455590332', 'W12022927', 'W12022927', 'UT01', 'Benjamin J Veltri', 'Benjamin', '', 'Veltri', 'MD', 'General Surgery', '', '', NULL, 'O', '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357898720', '4357898725', '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357898720', '4357898725', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1558317016', 0, 'N', 0, '2012-09-17', NULL, NULL, 40.4571, -109.531, NULL, NULL),
('870659338', 'W12022930', 'W12022930', 'UT01', 'U-U Pediatric Dermatology', '', '', 'U-U Pediatric Dermatology', 'GROUP', 'Pediatric Dermatology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621603', NULL, '100 N Mario Capecchi Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621603', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009384', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870659338', 'W12022931', 'W12022931', 'UT01', 'U-U Pediatric Dermatology', '', '', 'U-U Pediatric Dermatology', 'GROUP', 'Pediatric Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', NULL, 'PO Box 3208  ', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009384', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W12022932', 'W12022932', 'UT01', 'University of Utah Surgical Intensive Care Unit', '', '', 'University of Utah Surgical Intensive Care Unit', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '0000000000', 'PO Box 413035  ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009323', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W12022933', 'W12022933', 'UT01', 'University of Utah Surgical Intensive Care Unit', '', '', 'University of Utah Surgical Intensive Care Unit', 'GROUP', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '0000000000', '50 N Medical Dr   ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009323', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('810574312', 'W12022934', 'W12022934', 'UT01', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('810574312', 'W12022935', 'W12022935', 'UT01', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 413068', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413068   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W12022936', 'W12022936', 'UT01', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', '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', '25.00', '0.00', 3, '2012-09-17', '2013-02-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W12022940', 'W12022940', 'UT01', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413035   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', '2013-02-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870460977', 'W12022938', 'W12022938', 'UT01', 'U-U Non-Invasive Vascular Lab', '', '', 'U-U Non-Invasive Vascular Lab', 'GROUP', 'Vascular Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812082', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812082', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009382', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870460977', 'W12022939', 'W12022939', 'UT01', 'U-U Non-Invasive Vascular Lab', '', '', 'U-U Non-Invasive Vascular Lab', 'GROUP', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413035   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009382', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W12022941', 'W12022941', 'UT01', 'University of Utah Surgical Associates', '', '', 'University of Utah Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009322', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870490866', 'W12022942', 'W12022942', 'UT01', 'University of Utah Surgical Associates', '', '', 'University of Utah Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'b', 'Po Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'Po Box 413035   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009322', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870516127', 'W12022943', 'W12022943', 'UT01', 'University of Utah Pediatric Surgeons', 'Douglas', 'C', 'Barnhart', 'MD', 'General Surgery', 'Pediatric Surgery', '', NULL, 'B', 'PO Box 413068', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015883353', '0000000000', 'PO Box 413068  ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015883353', '0000000000', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750398517', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12022944', 'W12022944', 'UT01', 'UUHC Centerville Clinic', '', '', 'U of U Hospitals and Clinics', 'GROUP', 'Family Practice', 'Optometry', 'Internal Medicine', 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', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009233', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.917, -111.879, NULL, NULL),
('870616107', 'W12022945', 'W12022945', 'UT01', 'U of U Hospitals and Clinics', '', '', 'U of U Hospitals and Clinics', 'GROUP', 'Family Practice', 'Optometry', 'Internal Medicine', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133900', NULL, 'PO Box 510708   ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009233', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810232125', 'W12022947', 'W12022947', 'UT01', 'Easter Seals Goodwill Northern Rocky Mountain Inc', 'Katharine', '', 'Street', 'OT', 'Physical Therapy', '', '', NULL, 'O', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019461860', '8015825540', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019461860', '8015825540', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-10-01', '2014-06-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356697205', 0, 'N', 0, '2014-07-18', NULL, NULL, 40.7618, -111.88, NULL, NULL),
('810232125', 'W12022948', 'W12022948', 'UT01', 'Easter Seals Goodwill Northern Rocky Mountain Inc', 'Katharine', '', 'Street', 'OT', 'Physical Therapy', '', '', NULL, 'B', '4400 Central Ave', 'Great Falls', 'Cascade', 'MT', '59405', '8019461860', '8015825540', '4400 Central Ave', 'Great Falls', 'Cascade', 'MT', '59405', '8019461860', '8015825540', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-10-01', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356697205', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12022951', 'W12022951', 'UT01', 'Mountain Land West Jordan ', 'Scott', 'Blaine', 'Maw', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1755 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012822200', '8012822220', '1755 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012822200', '8012822220', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710945233', 0, 'N', 0, '2012-09-17', NULL, NULL, 40.6095, -111.94, NULL, NULL),
('870574059', 'W12022950', 'W12022950', 'UT01', 'Mountain Land West Jordan ', 'Scott', 'Blaine', 'Maw', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8012822200', '8012822220', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8012822200', '8012822220', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710945233', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('870526462', 'W12022954', 'W12022954', 'UT01', 'University of Utah Plastic Surgery Associates', '', '', 'University of Utah Plastic Surgery Associates', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009320', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
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('870619552', 'W12022960', 'W12022960', 'UT01', 'University Andrology Associates', '', '', 'University Andrology Associates', '', 'none', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813740', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813740', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205998259', 0, 'N', 0, '2012-09-18', NULL, NULL, 40.7685, -111.837, NULL, NULL),
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('352381020', 'W12022981', 'W12022981', 'UT01', 'Division of Occupational Therapy University of Utah', '', '', 'Division of Occupational Therapy University of Utah', 'Group', 'Clinics', '', '', NULL, 'O', '540 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', NULL, '540 Arapeen Dr.', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700186699', 0, 'N', 0, '2012-09-19', NULL, NULL, 40.757, -111.829, NULL, NULL),
('870619420', 'W12022982', 'W12022982', 'UT01', 'College of Nursing, University of Utah', '', '', 'College of Nursing, University of Utah', 'GROUP', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '4535 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019637335', NULL, '4535 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019637335', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005767', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W12022983', 'W12022983', 'UT01', 'College of Nursing, University of Utah', '', '', 'College of Nursing, University of Utah', 'GROUP', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005767', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870675415', 'W12022984', 'W12022984', 'UT01', 'U of U Rehabilitation & Wellness Program', '', '', 'U of U Rehabilitation & Wellness Program', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', NULL, '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009256', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870675415', 'W12022985', 'W12022985', 'UT01', 'U of U Rehabilitation & Wellness Program', '', '', 'U of U Rehabilitation & Wellness Program', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 581002', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 581002', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009256', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870659347', 'W12022988', 'W12022988', 'UT01', 'Pediatric Pathology Associates', '', '', 'Pediatric Pathology Associates', 'GROUP', 'Pathology', 'Pediatric Pathology', '', NULL, 'O', '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622150', NULL, '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622150', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008125', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870659347', 'W12022987', 'W12022987', 'UT01', 'Pediatric Pathology Associates', '', '', 'Pediatric Pathology Associates', 'GROUP', 'Pathology', 'Pediatric Pathology', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008125', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12022995', 'W12022995', 'IDBOISTD', 'Dept of Neurology School of Medicine U of U', '', '', 'Dept of Neurology School of Medicine U of U', 'GROUP', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', '2012-08-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005954', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('352395602', 'W12022997', 'W12022997', 'UT01', 'University of Utah Pediatric Adolescent Professional Services', '', '', 'University of Utah Pediatric Adolescent Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407155591', 0, 'N', 0, '2012-09-19', 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
('300655693', 'W12022998', 'W12022998', 'UT01', 'University of Utah Adult Professional Services', '', '', 'University of Utah Adult Professional Services', 'Group', 'Mental Health', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699074781', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870567427', 'W12022999', 'W12022999', 'UT01', 'University of Utah Emergency Physicians', '', '', 'University of Utah Emergency Physicians', 'GROUP', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009310', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12023018', 'W12023018', 'IDBOISTD', 'Saint Alphonsus Outpatient Surgery', '', '', 'Saint Alphonsus Outpatient Surgery ', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008546', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('371679068', 'W12023019', 'W12023019', 'IDBOISTD', 'Treasure Valley Surgery Center', '', '', 'Treasure Valley Surgery Center ', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', NULL, '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972861375', 0, 'N', 0, '2013-07-08', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('741967809', 'W12023020', 'W12023020', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio Ambulatory Surgery', '', '', 'Gastroenterology Consultants of San Antonio Ambulatory Surgery', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', '', '', 'OP-1', '0.00', '0.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006384', 0, 'Y', 0, '2013-02-06', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('820200895', 'W12023021', 'W12023021', 'IDBOISTD', 'Meridian Health Plaza Surgery Center', '', '', 'Meridian Health Plaza Surgery Center', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'o', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678550', NULL, '3025 W Cherry Ln  ', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2012-09-20', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '0000007576', 0, 'N', 0, '2014-01-17', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('742857926', 'W12023022', 'W12023022', 'TXSATSTD', 'NorthEast Baptist Surgery Center', '', '', 'NorthEast Baptist Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '8715 Village Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '2104771775', NULL, '8715 Village Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '2104771775', '          ', '', '', 'OP-1', '0.00', '100.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007905', 0, 'Y', 0, '2012-11-02', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('742863505', 'W12023023', 'W12023023', 'TXSATSTD', 'Specialty Surgical Center of San Antonio', '', '', 'Specialty Surgical Center of San Antonio', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '5255 Prue Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78240', '2106146059', NULL, '5255 Prue Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78240', '2106146059', '          ', '', '', 'OP-1', '0.00', '0.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008859', 0, 'N', 0, '2012-11-02', NULL, NULL, 29.5436, -98.585, NULL, NULL),
('911394965', 'W12023024', 'W12023024', 'IDBOISTD', 'Pacific Cataract & Laser', 'Susan', 'G', 'Taylor', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', '', '', '', '1000', '44.65', '100.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1023017043', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12023025', 'W12023025', 'IDBOISTD', 'Pacific Cataract & Laser', 'Susan', 'G', 'Taylor', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'B', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2012-09-20', '2012-09-20', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1023017043', 0, 'Y', 0, '2014-05-08', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('911394965', 'W12023026', 'W12023026', 'IDBOISTD', 'Pacific Cataract & Laser', 'Theodore', 'W', 'Bogsrud', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '', '', '', '1000', '44.65', '100.00', '0.00', 6, '2012-09-20', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1215968961', 0, 'Y', 0, '2014-06-05', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('911394965', 'W12023027', 'W12023027', 'IDBOISTD', 'Pacific Cataract & Laser', 'Christopher', 'M', 'Whaley', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2012-09-20', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1235246141', 0, 'Y', 0, '2014-06-05', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('911394965', 'W12023028', 'W12023028', 'IDBOISTD', 'Pacific Cataract & Laser', 'Nancy', 'L', 'Anderson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, '2822 S Vista Ave  ', 'Boise', 'Ada', 'ID', '83705', '2083857576', '', '', '', '1000', '44.65', '100.00', '0.00', 6, '2012-09-20', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1386679199', 0, 'Y', 0, '2014-06-05', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('911394965', 'W12023029', 'W12023029', 'IDBOISTD', 'Pacific Cataract & Laser', 'Paul', 'K', 'Anderson', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'B', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave  ', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2012-09-20', '2013-05-31', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1952304198', 0, 'Y', 0, '2014-05-08', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('820491110', 'W12023030', 'W12023030', 'IDBOISTD', 'Humphreys Diabetes Center', '', '', 'Humphreys Diabetes Center', '', 'Diabetic Education', 'Diabetes', '', NULL, 'O', '1226 River St', 'Boise', 'Ada', 'ID', '83702', '2083311155', NULL, '1226 River St', 'Boise', 'Ada', 'ID', '83702', '2083311155', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-20', '2013-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306984729', 0, 'Y', 0, '2013-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820491110', 'W12023031', 'W12023031', 'IDBOISTD', 'Humphreys Diabetes Center', '', '', 'Humphreys Diabetes Center', '', 'Diabetic Education', 'Diabetes', '', NULL, 'O', '520 S Eagle Rd Ste 1229', 'Meridian', 'Ada', 'ID', '83642', '2088844220', NULL, '520 S Eagle Rd Ste 1229', 'Meridian', 'Ada', 'ID', '83642', '2088844220', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-20', '2013-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306984729', 0, 'Y', 0, '2013-05-15', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('760194878', 'W12028200', 'W12028200', 'TXHOUSTD', 'Gastroenterology Consultants', '', '', 'Gastroenterology Consultants PA', '', 'Gastroenterology', '', '', NULL, 'O', '10905 Memorial Hermann Ste 211', 'Pearland', 'Brazoria', 'TX', '77584', '2814819400', '2814819490', '10905 Memorial Hermann Ste 211', 'Pearland', 'Brazoria', 'TX', '77584', '2814819400', '2814819490', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295728632', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.5603, -95.3892, NULL, NULL),
('270996353', 'W12023032', 'W12023032', 'IDBOISTD', 'Idaho Endoscopy Center', '', '', 'Idaho Endoscopy Center', 'GROUP', 'Endoscopy Center', '', '', NULL, 'O', '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', NULL, '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', '          ', '', '', 'ID02', '0.00', '20.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750616249', 0, 'N', 0, '2012-11-26', NULL, NULL, 43.6118, -116.258, NULL, NULL),
('200075829', 'W12023033', 'W12023033', 'TXSATSTD', 'San Antonio Gastroenterology Endoscopy Center ', '', '', 'San Antonio Gastroenterology Endoscopy Center', 'Group', 'Endoscopy Center', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', NULL, '150 E Sonterra Blvd Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', '          ', '', '', 'OP-1', '0.00', '100.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008566', 0, 'Y', 0, '2013-04-30', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('200075829', 'W12023034', 'W12023034', 'TXSATSTD', 'San Antonio Gastroenterology Endoscopy Center ', '', '', 'San Antonio Gastroenterology Endoscopy Center', 'Group', 'Endoscopy Center', '', '', NULL, 'O', '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102710606', NULL, '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102710606', '          ', '', '', 'OP-1', '0.00', '100.00', '0.00', 3, '2012-09-20', '2013-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008566', 0, 'Y', 0, '2014-02-20', NULL, NULL, 29.4394, -98.4894, NULL, NULL),
('200075829', 'W12023035', 'W12023035', 'TXSATSTD', 'San Antonio Gastroenterology Endoscopy Center', '', '', 'San Antonio Gastroenterology Endoscopy Center', 'Group', 'Endoscopy Center', '', '', NULL, 'B', 'Po Box 849932', 'Dallas', 'Dallas', 'TX', '75284', '2102710606', NULL, 'Po Box 849932', 'Dallas', 'Dallas', 'TX', '75284', '2102710606', '          ', '', '', 'OP-1', '0.00', '100.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008566', 0, 'N', 0, '2014-02-20', NULL, NULL, 0, 0, NULL, NULL),
('562397284', 'W12023036', 'W12023036', 'TXSATSTD', 'Sonterra Endoscopy Center', '', '', 'Sonterra Endoscopy Center', 'Group', 'Endoscopy Center', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104817477', NULL, '225 E Sonterra Blvd Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104817477', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008810', 0, 'N', 0, '2012-11-02', NULL, NULL, 29.6164, -98.492, NULL, NULL),
('562397284', 'W12023037', 'W12023037', 'TXSATSTD', 'Sonterra Endoscopy Center', '', '', 'Sonterra Endoscopy Center', 'Group', 'Endoscopy Center', '', '', NULL, 'B', 'Po Box 41027', 'Houston', 'Harris', 'TX', '77241', '2104817477', NULL, 'Po Box 41027', 'Houston', 'Harris', 'TX', '77241', '2104817477', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008810', 0, 'N', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('826003542', 'W12023038', 'W12023038', 'IDBOISTD', 'Trinity Mountain Medical Clinic', 'Michael', 'S', 'Charme', 'MD', 'Gynecology', '', '', NULL, 'o', '465 Mckenna Dr Ste ', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', NULL, '465 Mckenna Dr Ste ', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-09-20', '2012-09-20', 0, 0, 0, '', '', '', '', 'HCFA|', '1770510166', 0, 'Y', 0, '2012-10-11', NULL, NULL, 43.139, -115.695, NULL, NULL),
('742529053', 'W12023039', 'W12023039', 'TXSATSTD', 'Sunbelt Obgyn', 'Lillian', 'M', 'Jones', 'MD', 'Gynecology', '', '', NULL, 'O', '7922 Ewing Halsell Ste 160', 'San Antonio', 'Bexar', 'TX', '78229', '2106145665', NULL, '7922 Ewing Halsell Ste 160', 'San Antonio', 'Bexar', 'TX', '78229', '2106145665', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1149249921', 0, 'N', 0, '2013-08-09', NULL, NULL, 29.5126, -98.5738, NULL, NULL),
('820200896', 'W12023040', 'W12023040', 'IDBOISTD', 'Saint Alphonsus Medical Group Inpatient Pain Boise', 'Teresa', '', 'Morgan', 'CNS', 'Nurse SpecialistCertified', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83707', '2083672121', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83707', '2083672121', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225336118', 0, 'Y', 0, '2012-11-27', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200896', 'W12023041', 'W12023041', 'IDBOISTD', 'Saint Alphonsus Pain Management', 'Teresa', '', 'Morgan', 'CNS', 'Nurse SpecialistCertified', '', '', NULL, 'B', 'Po Box 190931', 'Boise', 'Ada', 'ID', '83720', '2083672394', '2083674051', 'Po Box 190931  ', 'Boise', 'Ada', 'ID', '83720', '2083672394', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225336118', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12023042', 'W12023042', 'IDBOISTD', 'Saint Alphonsus Medical Group Palliative Care', 'Sarah', '', 'Nelson', 'CNS', 'Hospice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674051', '1055 N Curtis Rd  ', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1619274727', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12023043', 'W12023043', 'IDBOISTD', 'Saint Alphonsus Glycemic Management', 'Catherine', '', 'Prinzing', 'CNS', 'Nurse SpecialistCertified', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674051', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1932331626', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12023044', 'W12023044', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center', 'Jane', 'K', 'Spencer', 'CNS', 'Neurology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674030', '          ', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674030', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962709550', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12023045', 'W12023045', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'Jane', 'K', 'Spencer', 'CNS', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962709550', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820526861', 'W12023046', 'W12023046', 'IDBOISTD', 'Caldwell  Cancer Care Center Radiation Oncology', '', '', 'Caldwell  Cancer Care Center - Radiation Oncology', 'Group', 'Radiation Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', NULL, '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '          ', 'IDHOSPOP', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053522961', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6594, -116.659, NULL, NULL),
('870551044', 'W12023047', 'W12023047', 'IDBOISTD', 'University Radiation Oncologists', '', '', 'University Radiation Oncologists', 'GROUP', 'Radiation Oncology', '', '', NULL, 'B', 'Po Box 413031 Ste ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'Po Box 413031 Ste ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-20', '2012-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009331', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('205506855', 'W12023048', 'W12023048', 'IDBOISTD', 'Northwest Radiation Oncology', 'Jennifer', 'L', 'Suida', 'NP', 'Radiation Oncology', 'Hematology and Oncology', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1316046972', 0, 'N', 0, '2013-01-04', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('205506855', 'W12023049', 'W12023049', 'IDBOISTD', 'Northwest Radiation Oncology', 'Jennifer', 'L', 'Suida', 'NP', 'Radiation Oncology', 'Hematology and Oncology', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1316046972', 0, 'Y', 0, '2013-01-04', NULL, NULL, 43.5999, -116.359, NULL, NULL),
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('460500210', 'W12023082', 'W12023082', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', NULL, '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', '2013-01-21', 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1063601177', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W12023083', 'W12023083', 'IDBOISTD', '', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-20', '2013-05-01', 0, 0, 0, '', NULL, '', '', 'HCFA|', '1063601177', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
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('271365691', 'W12023093', 'W12023093', 'UTMH1', 'Salt Lake Behavioral Health ', 'Susan', 'A', 'Short', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646070', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646070', 'SLBEHAVE', '', '', '0.00', '100.00', '0.00', 3, '2013-01-01', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861743866', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
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('452863167', 'W12023095', 'W12023095', 'TXDALSTD', 'Cumbre Medical Center', 'Cesar', 'B', 'Pena Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '710 E Centerville Rd', 'Garland', 'Dallas', 'TX', '75041', '9729053520', '9722783485', '710 E Centerville Rd', 'Garland', 'Dallas', 'TX', '75041', '9729053520', '9722783485', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073576435', 0, 'N', 1, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('204907057', 'W12023096', 'W12023096', 'TXDALSTD', 'Sunset Clinic', 'Javier', 'A', 'Valadez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1922 W 10th St', 'Dallas', 'Dallas', 'TX', '75208', '2149423113', '2145726888', '1922 W 10th St', 'Dallas', 'Dallas', 'TX', '75208', '2149423113', '2145726888', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083628879', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.7452, -96.8505, NULL, NULL),
('900879401', 'W12023098', 'W12023098', 'WY01', 'Move On Physical Therapy', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1201 E 7th St', 'Powell', 'Park', 'WY', '82435', '3077644115', '3077644116', '1201 E 7th St', 'Powell', 'Park', 'WY', '82435', '3077644115', '3077644116', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-18', '2014-01-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('900879401', 'W12023099', 'W12023099', 'WYT1', 'Move On Physical Therapy', 'Kenneth', 'J', 'Rodeman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1201 E 7th St', 'Powell', 'Park', 'WY', '82435', '3077644115', '3077644116', '1201 E 7th St', 'Powell', 'Park', 'WY', '82435', '3077644115', '3077644116', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-18', '2014-01-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710182464', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('200618439', 'W12023103', 'W12023103', 'TXDALSTD', 'PGV Pediatrics', 'Anuradha', '', 'Agrawal', 'MD', 'Pediatrics', '', '', NULL, 'O', '3310 Live Oak St Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148232552', '2148232551', '3310 Live Oak St Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148232552', '2148232551', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083675912', 0, 'N', 1, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('203774683', 'W12023104', 'W12023104', 'TXDALSTD', 'Methodist Hospital', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', '8174535503', '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', '8174535503', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093012668', 0, 'N', 0, '2013-02-27', NULL, NULL, 32.5684, -97.0945, NULL, NULL),
('203774683', 'W12023105', 'W12023105', 'TXDALSTD', 'Methodist Hospital', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8174775500', '8174535503', '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8174775500', '8174535503', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093012668', 0, 'N', 0, '2013-02-27', NULL, NULL, 32.581, -97.3081, NULL, NULL),
('203774683', 'W12023106', 'W12023106', 'TXDALSTD', 'Methodist Hospital', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 845917', 'Dallas', 'Dallas', 'TX', '75284', '8174775500', '8174535503', 'PO Box 845917', 'Dallas', 'Dallas', 'TX', '75284', '8174775500', '8174535503', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093012668', 0, 'N', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('203236957', 'W12023107', 'W12023107', 'TXHOUSTD', 'Jason Miller DPM', 'Jason ', '', 'Miller', 'DPM', 'Podiatry', '', '', NULL, 'O', '22999 Hwy 59 N Ste 264', 'Kingwood', 'Harris', 'TX', '77339', '2813482166', '2813582153', '22999 Hwy 59 N Ste 264', 'Kingwood', 'Harris', 'TX', '77339', '2813482166', '2813582153', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164411021', 0, 'N', 0, '2013-07-08', NULL, NULL, 30.048, -95.2535, NULL, NULL),
('291828347', 'W12023108', 'W12023108', 'TXDALSTD', 'Robert Alan Lyons', 'Robert', 'Alan', 'Lyons', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1980 E State Hwy 114', 'Southlake', 'Tarrant', 'TX', '76092', '8173292700', '8173298322', '1980 E State Hwy 114', 'Southlake', 'Tarrant', 'TX', '76092', '8173292700', '8173298322', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205807716', 0, 'N', 1, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('061763417', 'W12023110', 'W12023110', 'TXHOUSTD', 'East Belt Family Medicine', 'Daniel', '', 'Garcia', 'MD', 'Family Practice', '', '', NULL, 'O', '5402 E Sam Houston Pkwy N', 'Houston', 'Harris', 'TX', '77015', '2814576535', '2814576409', '5402 E Sam Houston Pkwy N', 'Houston', 'Harris', 'TX', '77015', '2814576535', '2814576409', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1245235043', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.8035, -95.163, NULL, NULL),
('752845933', 'W12023111', 'W12023111', 'TXDALSTD', 'Procare Medcal Clinic', 'Subuhi', '', 'Naghmi', 'MD', 'Family Practice', '', '', NULL, 'O', '126 N International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', '126 N International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1417913443', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('203780648', 'W12023112', 'W12023112', 'TXDALSTD', 'Kalpana Thakur', 'Kalpana', '', 'Thakur', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 Coit Rd Ste 306', 'Plano', 'Collin', 'TX', '75075', '9725990400', '9725990410', '1600 Coit Rd Ste 306', 'Plano', 'Collin', 'TX', '75075', '9725990400', '9725990410', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427234079', 0, 'N', 1, '2013-02-27', NULL, NULL, 33.0207, -96.7669, NULL, NULL),
('203780648', 'W12023113', 'W12023113', 'TXDALSTD', 'Kalpana Thakur', 'Kalpana', '', 'Thakur', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 250902', 'Plano', 'Collin', 'TX', '75025', '9725990400', '9725990410', 'PO Box 250902', 'Plano', 'Collin', 'TX', '75025', '9725990400', '9725990410', '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427234079', 0, 'N', 1, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('201782604', 'W12023114', 'W12023114', 'TXDALSTD', 'Rodgers Dermatology', 'Timothy', 'Gale', 'Rodgers', 'MD', 'Dermatology', '', '', NULL, 'O', '3880 Parkwood Blvd Ste 102', 'Frisco', 'Denton', 'TX', '75034', '9727042400', '9727042255', '3880 Parkwood Blvd Ste 102', 'Frisco', 'Denton', 'TX', '75034', '9727042400', '9727042255', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009962', 0, 'N', 0, '2013-02-27', NULL, NULL, 33.112, -96.8158, NULL, NULL),
('752845931', 'W12023115', 'W12023115', 'TXDALSTD', 'Baylor Medical Center', 'Rifat', '', 'Naghmi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '126 N International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', '126 N International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1508822537', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL);
