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
('870373083', 'W12033011', 'W12033011', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('870373083', 'W12033015', 'W12033015', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('830216782', 'W12033016', 'W12033016', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Jason', 'C', 'Kalan', 'MD', 'Pediatrics', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1932225356', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820513775', 'W12033017', 'W12033017', 'IDBOISTD', 'Bryan Anderson MD', 'Bryan', 'J', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', 'IDGENSURG', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811059264', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('201780406', 'W12033018', 'W12033018', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'O', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'W12033019', 'W12033019', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'M', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '7084920502', '7084920565', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12033020', 'W12033020', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12033021', 'W12033021', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'O', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 42.1888, -87.8075, NULL, NULL),
('201780406', 'W12033022', 'W12033022', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'O', '2600 Patriot Blvd Ste J', 'Glenview', 'Cook', 'IL', '60026', '8476774111', '8476773343', '2600 Patriot Blvd Ste J', 'Glenview', 'Cook', 'IL', '60026', '8476774111', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 42.0979, -87.8246, NULL, NULL),
('412212686', 'W12033026', 'W12033026', 'Test', '', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', '', '', 'ID01:412212686', '0.00', '0.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W12033473', 'W12033473', 'WY01', 'Yellowstone Behavioral Health Center', '', '', 'Yellowstone Behavioral Health Center', '', 'Mental Health', '', '', NULL, 'O', '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '3075276218', '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '3075276218', '', '', '', '0.00', '0.00', '0.00', 6, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014000', 0, 'Y', 0, '2013-05-28', NULL, NULL, 44.5334, -109.04, NULL, NULL),
('362171079', 'W12032962', 'W12032962', 'ILCHIGSTD', 'Presence Saints Mary & Elizabeth Medical Center', 'Rebecca', '', 'Nishimoto', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073624664', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'W12033032', 'W12033032', 'ILCHIGSTD', 'Presence Saints Mary & Elizabeth Medical Center', 'Rebecca', '', 'Nishimoto', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '3127703264', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '3127703264', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073624664', 0, 'Y', 0, '2013-11-04', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('260553931', 'W12033033', 'W12033033', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery MHP', 'Richard', '', 'Ballantyne', 'DO', 'General Surgery', '', '', NULL, 'O', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-06-01', '2013-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174745582', 0, 'N', 0, '2013-11-21', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12033034', 'W12033034', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery MHP', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084655949', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084655949', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12033035', 'W12033035', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Kristine', 'M', 'Reinhardt', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1639490006', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'W12033037', 'W12033037', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Christine', '', 'Shirazi', '', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1447598016', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W12033038', 'W12033038', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery MHP', 'Barry', '', 'Smith', 'DO', 'General Surgery', '', '', NULL, 'O', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1083731103', 0, 'N', 0, '2013-11-15', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12033039', 'W12033039', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-04-24', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('742743906', 'W12033041', 'W12033041', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Tahira', 'P', 'Alves', 'MD', 'Nephrology', '', '', NULL, 'O', '1008 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102280743', '2102289749', '1008 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102280743', '2102289749', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003913617', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.4377, -98.4891, NULL, NULL),
('742743906', 'W12033042', 'W12033042', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Tahira', 'P', 'Alves', 'MD', 'Nephrology', '', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '0000000000', '0000000000', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '0000000000', '0000000000', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003913617', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'W12033040', 'W12033040', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Tahira', 'P', 'Alves', 'MD', 'Nephrology', '', '', NULL, 'O', '9846 Westover Hills Ste 101', 'San Antonio', 'Bexar', 'TX', '78251', '2104030765', '2105479270', '9846 Westover Hills Ste 101', 'San Antonio', 'Bexar', 'TX', '78251', '2104030765', '2105479270', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003913617', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.4659, -98.6865, NULL, NULL),
('460629853', 'W12033043', 'W12033043', 'TXHOUSTD', '', 'David', 'W', 'Michalak', 'MD', 'Family Practice', '', '', NULL, 'O', '4840 W Panther Creek Ste 101', 'The Woodlands', 'Montgomery', 'TX', '77381', '2813671720', '2816813311', '4840 W Panther Creek Ste 101', 'The Woodlands', 'Montgomery', 'TX', '77381', '2813671720', '2816813311', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841325750', 0, 'N', 0, '2013-05-21', NULL, NULL, 30.1669, -95.5018, NULL, NULL),
('010795822', 'W12033044', 'W12033044', 'TXDALSTD', 'Kusi Fordjour MD', 'Kusi', '', 'Fordjour', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2505 Bolton Boone Dr Ste 101', 'Desoto', 'Dallas', 'TX', '75115', '9722839100', '9722839104', '2505 Bolton Boone Dr Ste 101', 'Desoto', 'Dallas', 'TX', '75115', '9722839100', '9722839104', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780623074', 0, 'N', 0, '2013-05-31', NULL, NULL, 32.6404, -96.8785, NULL, NULL),
('010795822', 'W12033045', 'W12033045', 'TXDALSTD', 'Kusi Fordjour MD', 'Kusi', '', 'Fordjour', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 93597', 'Southlake', 'Tarrant', 'TX', '76092', '9722839100', '9722839104', 'PO Box 93597', 'Southlake', 'Tarrant', 'TX', '76092', '9722839100', '9722839104', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780623074', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('751693808', 'W12033046', 'W12033046', 'TXDALSTD', '', 'David', '', 'Rosenstock', 'MD', 'Rheumatology', '', '', NULL, 'O', '3443 W Wheatland Rd', 'Dallas', 'Dallas', 'TX', '75237', '9727098500', '9727098555', '3443 W Wheatland Rd', 'Dallas', 'Dallas', 'TX', '75237', '9727098500', '9727098555', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760451884', 0, 'N', 0, '2013-05-21', NULL, NULL, 32.6476, -96.8755, NULL, NULL),
('820497538', 'W12033048', 'W12033048', 'IDBOISTD', 'Family Care Clinic', 'Scott', 'A', 'Baldridge', 'DO', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '110 Rattle Snake Ste B', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875523', '2085875524', '110 Rattle Snake Ste B', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875523', '2085875524', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-10-20', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|UB|', '1295728897', 0, 'N', 0, '2013-10-18', NULL, NULL, 43.1377, -115.7, NULL, NULL),
('820497538', 'W12033049', 'W12033049', 'IDBOISTD', 'Family Care Clinic', 'Scott', 'A', 'Baldridge', 'DO', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2085875523', '2085875524', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2085875523', '2085875524', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-10-20', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|UB|', '1295728897', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('742068259', 'W12033050', 'W12033050', 'TXHOUSTD', 'Laeeq A. Khan MD', 'Laeeq', 'A', 'Khan', 'MD', 'Pediatrics', '', '', NULL, 'O', '17202 Red Oak Ste 303', 'Houston', 'Harris', 'TX', '77090', '2814409500', '2814409503', '17202 Red Oak Ste 303', 'Houston', 'Harris', 'TX', '77090', '2814409500', '2814409503', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235139031', 0, 'N', 0, '2013-05-21', NULL, NULL, 30.0203, -95.4461, NULL, NULL),
('721563251', 'W12033051', 'W12033051', 'NM01', 'Natural Life Acupuncture and Kinesiology Inc', 'Veronica', 'A', 'Joseph', 'DOM', 'Acupuncture', '', '', NULL, 'O', '1012 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052984325', '5052945407', '1012 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052984325', '5052945407', '', '', '', '0.00', '0.00', '75.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164797635', 0, 'N', 0, '2013-07-29', NULL, NULL, 35.0893, -106.533, NULL, NULL),
('752694558', 'W12033052', 'W12033052', 'TXDALSTD', 'Advanced Heart Care PA', '', '', 'Advanced Heart Care', '', 'Clinic', 'Cardiology', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '2142210022', '2146918292', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '2142210022', '2146918292', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1538197546', 0, 'N', 0, '2014-03-13', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'W12033053', 'W12033053', 'TXDALSTD', 'Advanced Heart Care PA', '', '', 'Advanced Heart Care', '', 'Clinic', 'Cardiology', '', NULL, 'B', '8150 N Central Expy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '2142210022', '2146918292', '8150 N Central Expy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '2142210022', '2146918292', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1538197546', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
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('461031347', 'W12033164', 'W12033164', 'ID02', 'Freedom Healthcare', '', '', 'Freedom Healthcare', '', 'Family Practice', '', '', NULL, 'O', '1097 N Rosario St Ste 101', 'Meridian', 'Ada', 'ID', '83642', '2088843387', '2088950250', '1097 N Rosario St Ste 101', 'Meridian', 'Ada', 'ID', '83642', '2088843387', '2088950250', 'IDSTDPPO', 'WUSTDHCPC', '', '0.00', '30.00', '0.00', 3, '2013-06-10', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1801133046', 0, 'Y', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'W12033167', 'W12033167', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Thushan', 'N', 'DeSilva', 'MD', 'Dermatology', '', '', NULL, 'O', '15900 La Cantera Pkwy Ste 20270', 'San Antonio', 'Bexar', 'TX', '78256', '2106419500', NULL, '15900 La Cantera Pkwy Ste 20270', 'San Antonio', 'Bexar', 'TX', '78256', '2106419500', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '0000005959', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.5892, -98.6196, NULL, NULL),
('202148889', 'W12033168', 'W12033168', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Carmen', '', 'Perez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '810 SE Military Dr', 'San Antonio', 'Bexar', 'TX', '78214', '2109214200', NULL, '810 SE Military Dr', 'San Antonio', 'Bexar', 'TX', '78214', '2109214200', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982670790', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.3567, -98.4881, NULL, NULL),
('202148889', 'W12033172', 'W12033172', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Aris', '', 'Nikas', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', NULL, '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093781890', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.4395, -98.4904, NULL, NULL),
('202148889', 'W12033173', 'W12033173', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Gabriel', '', 'Ortiz', 'MD', 'Family Practice', '', '', NULL, 'O', '7254 Blanco Road Ste 201', 'San Antonio', 'Bexar', 'TX', '78216', '2103848282', NULL, '7254 Blanco Road Ste 201', 'San Antonio', 'Bexar', 'TX', '78216', '2103848282', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1093795718', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5247, -98.505, NULL, NULL),
('202148889', 'W12033176', 'W12033176', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Luis', 'N', 'Torres', 'MD', 'Family Practice', '', '', NULL, 'O', '1920 S W Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109242337', NULL, '1920 S W Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109242337', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245206911', 0, 'N', 0, '2013-06-21', NULL, NULL, 29.3566, -98.5234, NULL, NULL),
('202148889', 'W12033177', 'W12033177', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'O', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '          ', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', '2014-06-23', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 29.5079, -98.4797, NULL, NULL),
('870284475', 'W12033195', 'W12033195', 'UT01', 'Granger Medical Clinic ', 'Holly', 'M', 'Shillington', 'MD', 'Pediatrics', '', '', 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, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1477878825', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('751755218', 'W12033183', 'W12033183', 'TXDALSTD', 'Bernard Adami MD', 'Bernard', '', 'Adami', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2225 Peggy Ln', 'Garland', 'Dallas', 'TX', '75042', '9722428525', '9724876481', '2225 Peggy Ln', 'Garland', 'Dallas', 'TX', '75042', '9722428525', '9724876481', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|', '1952491722', 0, 'N', 0, '2013-05-29', NULL, NULL, 32.9169, -96.6589, NULL, NULL),
('272799195', 'W12033184', 'W12033184', 'TXDALSTD', 'Elite Primary Care', 'Asif', '', 'Aziz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9034501515', '9034509466', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9034501515', '9034509466', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, NULL, '', '', '', 'HCFA|U', '1922194992', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1268, -96.1239, NULL, NULL),
('264664897', 'W12033185', 'W12033185', 'UT01', 'Advanced Family Healthcare', 'Rox', 'C', 'Burkett', 'MD', 'Family Practice', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2013-11-01', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB', '1629393509', 0, 'Y', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('264664897', 'W12033186', 'W12033186', 'UT01', 'Advanced Family Healthcare', 'Rox', 'C', 'Burkett', 'MD', 'Family Practice', '', '', NULL, 'O', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '4358670644', '4358670645', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '4358670644', '4358670645', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2013-11-01', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB', '1629393509', 0, 'Y', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('271365684', 'W12033187', 'W12033187', 'UTMH1', 'Salt Lake Behavior Health', 'Joan', '', 'Magill', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'O', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646062', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646062', 'SLBEHAVE', '', '', '0.00', '100.00', '0.00', 8, '2013-08-01', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477520252', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W12033188', 'W12033188', 'UT01', 'Western Anesthesia Associates LLC', 'Jeffrey', '', 'Heinemann', 'MD', 'Anesthesia', '', '', NULL, 'O', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA', '1356392138', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.765, -111.898, NULL, NULL),
('460962249', 'W12033189', 'W12033189', 'UT01', '', 'Scott', 'A', 'Leckman', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 3G', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012684924', NULL, '1220 E 3900 S Ste 3G', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012684924', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588637730', 0, 'N', 0, '2013-08-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('460962249', 'W12033190', 'W12033190', 'UT01', '', 'Scott', 'A', 'Leckman', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012684924', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012684924', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588637730', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12033191', 'W12033191', 'UT01', 'Ogden Clinic', 'Jessica', '', 'Wozab', 'PA', 'Family Practice', '', '', NULL, 'O', '3485 W 5200 S', 'Ogden', 'Weber', 'UT', '84403', '8014753900', '0000000000', '3485 W 5200 S', 'Ogden', 'Weber', 'UT', '84403', '8014753900', '0000000000', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093084295', 0, 'N', 0, '2013-05-13', NULL, NULL, 0, 0, NULL, NULL),
('264664897', 'W12033192', 'W12033192', 'UT01', 'Advanced Family Health Care Inc', 'Randy', '', 'Delcore', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670645', '4358670644', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670645', '4358670644', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205926748', 0, 'Y', 0, '2013-09-23', NULL, NULL, 37.7088, -113.062, NULL, NULL),
('264664897', 'W12033193', 'W12033193', 'UT01', 'Advanced Family Health Care Inc', 'Randy', '', 'Delcore', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '8884027260', '8662657922', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '8884027260', '8662657922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205926748', 0, 'Y', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12033194', 'W12033194', 'UT01', 'Granger Medical Clinic', 'Holly', 'M', 'Shillington', 'MD', 'Pediatrics', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '0000000000', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1477878825', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12033196', 'W12033196', 'UT01', 'Granger Medical Clinic', 'Holly', 'M', 'Shillington', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1477878825', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12033197', 'W12033197', 'UT01', 'Ogden Clinic', 'Robert', 'H', 'Ziegler', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', NULL, '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-05-17', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972591790', 0, 'N', 0, '2013-05-13', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'W12033198', 'W12033198', 'UT01', 'Ogden Clinic', 'Larry', 'O', 'Smithing', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014790370', '0000000000', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014790370', '0000000000', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609864461', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('870286381', 'W12033199', 'W12033199', 'UT01', 'Ogden Clinic', 'Marilyn', 'B', 'Wise', 'APRN', 'Family Practice', '', '', NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '8014753101', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '8014753101', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720098189', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('364210615', 'W12033200', 'W12033200', 'ILCHIGSTD', 'Lopez Marcos A MD', 'Marcos', 'A', 'Lopez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9005 W Cermak Rd', 'Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', '9005 W Cermak Rd', 'Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-02', '2013-04-02', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417967308', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('364210615', 'W12033201', 'W12033201', 'ILCHIGSTD', 'Lopez Marcos A MD', 'Marcos', 'A', 'Lopez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2425 W 22nd St', 'Elgin', 'Kane', 'IL', '60123', '6305713333', '6305713340', '2425 W 22nd St', 'Elgin', 'Kane', 'IL', '60123', '6305713333', '6305713340', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-02', '2013-04-02', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417967308', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12033204', 'W12033204', 'UT01', 'Central Utah Clinic PC', 'David', 'M', 'Wall', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', '2014-08-08', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720393812', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12033202', 'W12033202', 'UT01', 'Central Utah Clinic PC', 'David', 'M', 'Wall', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', '2014-08-08', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720393812', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.3722, -111.769, NULL, NULL),
('870281028', 'W12033203', 'W12033203', 'UT01', 'Central Utah Clinic PC', 'David', 'M', 'Wall', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', '2014-08-08', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720393812', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12033206', 'W12033206', 'UT01', 'Central Utah Clinic PC', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014298191', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014298191', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12033208', 'W12033208', 'UT01', 'Central Utah Clinic PC', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
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('453136848', 'W12033211', 'W12033211', 'ILCHIGSTD', '', 'Trent', '', 'Smith', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '0000000000', '0000000000', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '0000000000', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1689781486', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('870502207', 'W12033222', 'W12033222', 'UT01', 'Wasatch Therapy Inc', 'Ashlee', '', 'Cresswell', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1811201817', 0, 'N', 0, '2013-05-13', NULL, NULL, 41.1597, -112.028, NULL, NULL),
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('271789847', 'W12033227', 'W12033227', 'IDONTSTD', 'Saint Alphonsus Medical Group Urgent Care Ontario', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0255, -116.975, NULL, NULL),
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('820200895', 'W12033228', 'W12033228', 'ID01', 'Saint Alphonsus Billing', '', '', 'Saint Alphonsus Billing', 'Group', '', '', '', NULL, 'B', 'PO Box 3527', 'Portland', 'Multnomah', 'OR', '97208', '2083672130', '', 'PO Box 3527', 'Portland', 'Multnomah', 'OR', '97208', '2083672130', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-05-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008537', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('751465533', 'W12033505', 'W12033505', 'TXDALSTD', '', 'Jarvis', 'L', 'Bull', 'MD', 'Family Practice', '', '', NULL, 'O', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-09-14', 0, 0, 0, 'Baylor Regional Medical Center At Grapevine', 'Baylor All Saints Medical Center', '', '', 'HCFA|UB|', '1649277914', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8426, -97.1869, 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
('760309170', 'W12033240', 'W12033240', 'TXHOUSTD', 'Neeta Bhardwaj MD', 'Kristen', 'M', 'Adams', '', 'Pediatrics', '', '', NULL, 'O', '11710 FM 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2814696097', '2814697670', '11710 FM 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2814696097', '2814697670', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1508103425', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.9265, -95.5955, NULL, NULL),
('061643747', 'W12033241', 'W12033241', 'TXDALSTD', 'Saleem Akbar MD', 'Saleem', '', 'Akbar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1105 Central Expy N Ste 2230', 'Allen', 'Collin', 'TX', '75013', '2145470650', '2145470658', '1105 Central Expy N Ste 2230', 'Allen', 'Collin', 'TX', '75013', '2145470650', '2145470658', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', '', '', '', 'HCFA|UB|', '1417925298', 0, 'N', 0, '2014-05-12', NULL, NULL, 33.1161, -96.6711, NULL, NULL),
('533307329', 'W12033242', 'W12033242', 'TXHOUSTD', '', 'Jimmie', 'L', 'Bergeron', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17070 Red Oak Dr Ste 209', 'Houston', 'Harris', 'TX', '77090', '2814441715', '2815376080', '17070 Red Oak Dr Ste 209', 'Houston', 'Harris', 'TX', '77090', '2814441715', '2815376080', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1932109725', 0, 'N', 0, '2013-06-03', NULL, NULL, 30.0181, -95.4445, NULL, NULL),
('760309170', 'W12033244', 'W12033244', 'TXHOUSTD', 'Neeta Bhardwaj MD', 'Neeta', 'R', 'Bhardwaj', 'MD', 'Pediatrics', '', '', NULL, 'O', '11710 FM 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2814696097', '2814697670', '11710 FM 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2814696097', '2814697670', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1932187853', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.9265, -95.5955, NULL, NULL),
('461956684', 'W12033245', 'W12033245', 'UT01', 'On Call Doc LLC', 'Charles', 'O', 'Canfield', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '125 E Main St Ste 135', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', '125 E Main St Ste 135', 'American Fork', 'Utah', 'UT', '84003', '8016109159', '8016575815', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Salt Lake Behavioral Health', '', '', '', 'HCFA|UB', '1023199825', 0, 'Y', 0, '2013-09-25', NULL, NULL, 40.3768, -111.795, NULL, NULL),
('461956684', 'W12033246', 'W12033246', 'UT01', 'On Call Doc LLC', 'Charles', 'O', 'Canfield', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '5406 W 11000 N Ste 103-412', 'Highland', 'Utah', 'UT', '84003', '8016109159', '8016575815', '5406 W 11000 N Ste 103-412', 'Highland', 'Utah', 'UT', '84003', '8016109159', '8016575815', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Salt Lake Behavioral Health', '', '', '', 'HCFA|UB', '1023199825', 0, 'Y', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'W12033248', 'W12033248', 'UT01', 'Millcreek Anesthesia', 'Timothy', 'R', 'Dance', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 3690', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272059', '8014322668', 'PO Box 3690', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272059', '8014322668', '', '', '', '0.00', '20.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1811135981', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W12033249', 'W12033249', 'UT01', 'Western Anesthesia Associates', 'Adrain', 'W C', 'Yee', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA', '1295831329', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('850379297', 'W12033250', 'W12033250', 'NM01', 'Southwest Womens Health PA', '', '', 'Southwest Womens Health', '', 'Gynecology', '', '', NULL, 'O', '883 Lead Ave SE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058437131', '5052469421', '883 Lead Ave SE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058437131', '5052469421', 'NMSTD+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932269073', 0, 'Y', 0, '2014-02-18', NULL, NULL, 35.0798, -106.638, NULL, NULL),
('830326307', 'W12033253', 'W12033253', 'WY01', 'Community Health Center of Central Wyoming', 'Alicja', 'K', 'Iznerowicz', '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, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316183841', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('830326307', 'W12033254', 'W12033254', 'WYT1', 'Community Health Center of Central Wyoming', 'Alicja', 'K', 'Iznerowicz', '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, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316183841', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12033255', 'W12033255', 'WY01', 'Wyoming Health Medical Group', 'Donna', 'J', 'Smith', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '3075770479', '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '3075770479', '', '', '', '0.00', '18.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053456269', 0, 'N', 0, '2014-06-20', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('800307419', 'W12033256', 'W12033256', 'WYT1', 'Wyoming Health Medical Group', 'Donna', 'J', 'Smith', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '3075770479', '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '3075770479', '', '', '', '0.00', '18.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053456269', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12033257', 'W12033257', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Nampa', 'David', 'F', 'Oakes', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083642987', 0, 'Y', 0, '2014-02-07', NULL, NULL, 43.5537, -116.573, NULL, NULL),
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('263100201', 'W12033298', 'W12033298', 'UT01', 'Lake View Hospital Lab', 'Hu', '', 'Ding', 'MD', 'Pathology', '', '', NULL, 'B', '5700 Southwyck Blvd', 'Toledo', 'Lucas', 'OH', '43614', '8012992124', NULL, '5700 Southwyck Blvd', 'Toledo', 'Lucas', 'OH', '43614', '8012992124', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710923552', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12033360', 'W12033360', 'UTIHC04', 'PCMC Rehab Ogden', 'Lori', 'A', 'Maughan', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316031289', 0, 'N', 0, '2013-05-17', NULL, NULL, 41.1922, -111.949, NULL, NULL),
('942854057', 'W12033361', 'W12033361', 'UTIHC01', 'PCMC Rehab Sandy', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033362', 'W12033362', 'UTIHC02', 'PCMC Rehab Sandy', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033363', 'W12033363', 'UTIHC03', 'PCMC Rehab Sandy', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033364', 'W12033364', 'UTIHC04', 'PCMC Rehab Sandy', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 40.5806, -111.867, NULL, NULL),
('942854057', 'W12033365', 'W12033365', 'UTIHC01', 'Emergency Room', 'Dennis', '', 'Mitchell', 'PA-C', 'Urology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', '0000000000', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1629005715', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12033373', 'W12033373', 'UTIHC01', 'PCMC Rehab Ogden', 'Megan', '', 'Moss', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932487899', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12033378', 'W12033378', 'UTIHC01', '', 'Stephanie', 'A', 'Polukoff', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624900', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1235467317', 0, 'Y', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12033383', 'W12033383', 'UTIHC01', '', 'Leslie', 'K', 'Rasch', 'APRN', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Dixie Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1962784504', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033384', 'W12033384', 'UTIHC03', '', 'Leslie', 'K', 'Rasch', 'APRN', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Dixie Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1962784504', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033385', 'W12033385', 'UTIHC04', '', 'Leslie', 'K', 'Rasch', 'APRN', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512448', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Dixie Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1962784504', 0, 'N', 0, '2013-07-23', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12033388', 'W12033388', 'UTIHCPHY', 'Bountiful KidsCare', 'Marcus', '', 'Blackburn', 'MD', 'Pediatrics', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598919409', 0, 'Y', 0, '2013-05-17', NULL, NULL, 40.8935, -111.881, NULL, NULL),
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('611630276', 'W12033397', 'W12033397', 'ILCHIGSTD', 'Wellgroup Health Partners', 'Leonard', '', 'Robinson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', '20939 S Cicero Ave', 'Matteson', 'Cook', 'IL', '60443', '7087099375', '7082831137', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225078264', 0, 'N', 0, '2013-05-17', NULL, NULL, 41.5091, -87.7324, NULL, NULL),
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('830182821', 'W12033400', 'W12033400', 'WY01', 'Gottsche Rehabilitation Center', 'Vicki', '', 'Bernard ', 'SLP', 'Speech 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, '2013-06-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437413465', 0, 'N', 0, '2014-04-02', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830182821', 'W12033402', 'W12033402', 'WY01', 'Gottsche Rehabilitation Center', 'Vicki', '', 'Bernard ', 'SLP', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437413465', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
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('830182821', 'W12033403', 'W12033403', 'WYT2', 'Gottsche Rehabilitation Center', 'Vicki', '', 'Bernard ', 'SLP', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437413465', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W12033405', 'W12033405', 'UT01', 'Intermountain Anesthesia Consultants LLC', 'Angela', '', 'Salerno', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8013272086', '8014322668', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8013272086', '8014322668', '', '', '1000', '41.23', '0.00', '0.00', 6, '2013-06-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA', '1538423058', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('571201170', 'W12033413', 'W12033413', 'TXHOUSTD', 'TMH Physician Organization', 'Jenny', '', 'Lai', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '6560 Fannin St Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', '6560 Fannin St Ste 1878', 'Houston', 'Harris', 'TX', '77030', '7134415189', '7137906604', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-05-20', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578507182', 0, 'N', 0, '2013-05-20', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12033414', 'W12033414', 'TXHOUSTD', 'TMH Physician Organization', 'Keith', '', 'Reeves', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6560 Fannin St Ste 2201', 'Houston', 'Harris', 'TX', '77030', '7137979498', '7137970661', '6560 Fannin St Ste 2201', 'Houston', 'Harris', 'TX', '77030', '7137979498', '7137970661', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-05-20', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1750329587', 0, 'N', 0, '2013-05-20', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('760442909', 'W12033415', 'W12033415', 'TXHOUSTD', 'Southeast Houston Cardiology', 'Michelle', '', 'Onorato', 'MD', 'Infectious Disease', '', '', NULL, 'O', '532 Orchard St', 'Webster', 'Harris', 'TX', '77598', '2813384004', '2815549380', '532 Orchard St   ', 'Webster', 'Harris', 'TX', '77598', '2813384004', '2815549380', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1417991795', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.5426, -95.1307, NULL, NULL),
('760454609', 'W12033416', 'W12033416', 'TXHOUSTD', 'Renal Specialists of Houston', 'Henry', '', 'Muniz', 'MD', 'Nephrology', '', '', NULL, 'O', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '2814649681', '2814647593', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1023034014', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7698, -94.982, NULL, NULL),
('760454609', 'W12033417', 'W12033417', 'TXHOUSTD', 'Renal Specialists of Houston', 'Salman', 'A', 'Khan', 'MD', 'Nephrology', '', '', NULL, 'O', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1104842095', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7698, -94.982, NULL, NULL),
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('760454609', 'W12033419', 'W12033419', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7698, -94.982, NULL, NULL),
('760454609', 'W12033420', 'W12033420', 'TXHOUSTD', 'Renal Specialists of Houston', 'Whitson', 'B', 'Etheridge', 'MD', 'Nephrology', '', '', NULL, 'O', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1710906680', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7698, -94.982, NULL, NULL),
('760454609', 'W12033421', 'W12033421', 'TXHOUSTD', 'Renal Specialists of Houston', 'Camilo', 'G', 'Barcenas', 'MD', 'Nephrology', '', '', NULL, 'O', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', '1690 W Baker Ste A', 'Baytown', 'Harris', 'TX', '77521', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist Hospital', 'Houston Methodist San Jacinto Hospital', NULL, 'HCFA|UB|', '1932125929', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7698, -94.982, NULL, NULL),
('760458614', 'W12033422', 'W12033422', 'TXHOUSTD', 'Clincia Hispana I', 'Oscar', 'L', 'De Valle', 'MD', 'Family Practice', '', '', NULL, 'O', '9720 Jones Rd Ste 240', 'Houston', 'Harris', 'TX', '77065', '2818978142', '2814698094', '9720 Jones Rd Ste 240', 'Houston', 'Harris', 'TX', '77065', '2818978142', '2814698094', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-20', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669415196', 0, 'N', 0, '2013-05-20', NULL, NULL, 29.9144, -95.5846, NULL, NULL),
('800522450', 'W12033433', 'W12033433', 'UT01', 'Omega Interventional Pain', 'Scott', '', 'Hadfield', 'PA-C', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012614988', '8012699425', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770836397', 0, 'N', 0, '2013-06-25', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12033434', 'W12033434', 'UT01', 'Omega Interventional Pain', 'Scott', '', 'Hadfield', 'PA-C', 'Pain Management', '', '', NULL, 'O', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770836397', 0, 'N', 0, '2013-06-25', NULL, NULL, 40.6651, -111.888, NULL, NULL),
('462584800', 'W12033435', 'W12033435', 'UTMH1', 'Mind Your Nature LLC', 'Janice', 'M', 'Speicher', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1700 Park Ave Ste 2065', 'Park City', 'Summit', 'UT', '84060', '4356594508', '4352142529', '1700 Park Ave Ste 2065', 'Park City', 'Summit', 'UT', '84060', '4356594508', '4352142529', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427191311', 0, 'N', 0, '2013-05-20', NULL, NULL, 40.6577, -111.507, NULL, NULL),
('462584800', 'W12033436', 'W12033436', 'UTMH1', 'Mind Your Nature LLC', 'Janice', 'M', 'Speicher', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '860 E 4500 S Ste 302', 'Murray', 'Salt Lake', 'UT', '84107', '4356594508', '4352142529', '860 E 4500 S Ste 302', 'Murray', 'Salt Lake', 'UT', '84107', '4356594508', '4352142529', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427191311', 0, 'N', 0, '2013-05-20', NULL, NULL, 40.6743, -111.867, NULL, NULL),
('462584800', 'W12033437', 'W12033437', 'UTMH1', 'Mind Your Nature LLC', 'Janice', 'M', 'Speicher', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', 'PO Box 981145', 'Park City', 'Summit', 'UT', '84098', '4356594508', '4352142529', 'PO Box 981145', 'Park City', 'Summit', 'UT', '84098', '4356594508', '4352142529', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427191311', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('760434450', 'W12033438', 'W12033438', 'TXHOUSTD', '', 'Joseph', 'C', 'Gathe', 'MD', 'Infectious Disease', '', '', NULL, 'O', '4900 Fannin St', 'Houston', 'Harris', 'TX', '77004', '7135269821', '7135260614', '4900 Fannin St', 'Houston', 'Harris', 'TX', '77004', '7135269821', '7135260614', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366436263', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.7299, -95.3851, NULL, NULL),
('611442064', 'W12033440', 'W12033440', 'TXHOUSTD', 'Alief Geriatrics Associates PA', 'Chris', 'H', 'Ojeih', 'MD', 'Family Practice', '', '', NULL, 'O', '1801 N Loop W Ste 40', 'Houston', 'Harris', 'TX', '77008', '8322037784', '8322037787', '1801 N Loop W Ste 40', 'Houston', 'Harris', 'TX', '77008', '8322037784', '8322037787', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1164490470', 0, 'N', 0, '2013-08-08', NULL, NULL, 29.8119, -95.4326, NULL, NULL),
('611442064', 'W12033439', 'W12033439', 'TXHOUSTD', 'Alief Geriatrics Associates PA', 'Chris', 'H', 'Ojeih', 'MD', 'Family Practice', '', '', NULL, 'O', '8300 Bissonnet St Ste 510', 'Houston', 'Harris', 'TX', '77074', '7137724377', '7137724379', '8300 Bissonnet St Ste 510', 'Houston', 'Harris', 'TX', '77074', '7137724377', '7137724379', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1164490470', 0, 'N', 0, '2013-08-08', NULL, NULL, 0, 0, NULL, NULL),
('611442064', 'W12033441', 'W12033441', 'TXHOUSTD', 'Alief Geriatrics Associates PA', 'Chris', 'H', 'Ojeih', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 36467', 'Houston', 'Harris', 'TX', '77236', '7137724377', '7137724379', 'PO Box 36467', 'Houston', 'Harris', 'TX', '77236', '7137724377', '7137724379', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1164490470', 0, 'N', 0, '2013-08-08', NULL, NULL, 0, 0, NULL, NULL),
('760231597', 'W12033451', 'W12033451', 'TXHOUSTD', 'Womens Healthcare Associates', 'Vian', 'H', 'Nguyen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1315 St Joseph Pkwy Ste 1818', 'Houston', 'Harris', 'TX', '77002', '7136548128', '7136547426', '1315 St Joseph Pkwy Ste 1818', 'Houston', 'Harris', 'TX', '77002', '7136548128', '7136547426', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1083851299', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.7486, -95.3675, NULL, NULL),
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('760689977', 'W12033465', 'W12033465', 'TXHOUSTD', '', 'Michael', 'G', 'Casagrande', 'MD', 'Family Practice', '', '', NULL, 'O', '506 Graham Dr Ste 290', 'Tomball', 'Harris', 'TX', '77375', '2813571934', '2813571230', '506 Graham Dr Ste 290', 'Tomball', 'Harris', 'TX', '77375', '2813571934', '2813571230', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB', '1427163955', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0915, -95.6127, NULL, NULL),
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('201780406', 'W12033481', 'W12033481', 'ILCHIGSTD', 'UroPartners', 'Matthew', 'A', 'Meadows', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7738787555', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7738787555', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1275599219', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
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('201780406', 'W12033483', 'W12033483', 'ILCHIGSTD', 'UroPartners', 'Kelly', 'M', 'Maxwell', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528216108', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033484', 'W12033484', 'ILCHIGSTD', 'UroPartners', 'Richard', 'G', 'Harris', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7084505055', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7084505055', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346290673', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL);
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('201780406', 'W12033485', 'W12033485', 'ILCHIGSTD', 'UroPartners', 'William', 'W', 'Lin', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396776209', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033486', 'W12033486', 'ILCHIGSTD', 'UroPartners', 'Laurence', 'A', 'Levine', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3125635000', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3125635000', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922072131', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033487', 'W12033487', 'ILCHIGSTD', 'UroPartners', 'Jerome', '', 'Hoeksema', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3125635000', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3125635000', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235102328', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033489', 'W12033489', 'ILCHIGSTD', 'UroPartners', 'H Merrill', '', 'Matschke', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629032115', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033490', 'W12033490', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Kim', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1447451554', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033491', 'W12033491', 'ILCHIGSTD', 'UroPartners', 'Kalyan', 'C', 'Latchamsetty', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129428484', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129428484', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699724138', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033492', 'W12033492', 'ILCHIGSTD', 'UroPartners', 'David', 'L', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1417917006', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033493', 'W12033493', 'ILCHIGSTD', 'UroPartners', 'Steven', 'E', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1427019611', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033494', 'W12033494', 'ILCHIGSTD', 'UroPartners', 'John', '', 'Milner', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8476774111', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589776', 0, 'Y', 0, '2013-09-05', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033495', 'W12033495', 'ILCHIGSTD', 'UroPartners', 'David', 'M', 'Shore', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1184823163', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033496', 'W12033496', 'ILCHIGSTD', 'UroPartners', 'Michael', 'J', 'Young', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1861488892', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033497', 'W12033497', 'ILCHIGSTD', 'UroPartners', 'Paul', 'M', 'Yonover', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '7732811011', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1558356253', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033498', 'W12033498', 'ILCHIGSTD', 'UroPartners', 'Kristopher', 'N', 'Atzeff', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073577045', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033499', 'W12033499', 'ILCHIGSTD', 'UroPartners', 'Justin', 'J', 'Cohen', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '8472950010', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700060704', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033500', 'W12033500', 'ILCHIGSTD', 'UroPartners', 'Christopher', 'L', 'Coogan', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129428484', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129428484', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568412716', 0, 'Y', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033501', 'W12033501', 'ILCHIGSTD', 'UroPartners', 'John', 'J', 'Cudecki', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3128424400', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3128424400', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053397851', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033502', 'W12033502', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'P', 'Dalton', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669403432', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033503', 'W12033503', 'ILCHIGSTD', 'UroPartners', 'John', 'E', 'Garnett', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', '2014-03-08', 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134150048', 0, 'N', 0, '2013-12-12', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'W12033504', 'W12033504', 'ILCHIGSTD', 'UroPartners', 'Michael', 'S', 'Gomez', 'MD', 'Urology', '', '', NULL, 'O', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3128424400', '7084920565', '160 E Illinois St', 'Chicago', 'Cook', 'IL', '60611', '3128424400', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922277268', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201428952', 'W12033471', 'W12033471', 'UT01', 'Western Anesthesia Associates', 'Julie', '', 'Dee', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1063633295', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'W12033519', 'W12033519', 'ILCHIGSTD', 'Nuclear Oncology', 'Nicholas', '', 'Galanopoulos', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '15 Salt Creek Ln Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '0000000000', '0000000000', '15 Salt Creek Ln Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '0000000000', '0000000000', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-06-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1922289347', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'W12033517', 'W12033517', 'ILCHIGSTD', 'Nuclear Oncology', 'Nicholas', '', 'Galanopoulos', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-06-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1922289347', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362704738', 'W12033518', 'W12033518', 'ILCHIGSTD', 'Nuclear Oncology', 'Nicholas', '', 'Galanopoulos', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653803', '7736653102', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653803', '7736653102', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-06-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1922289347', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('201857850', 'W12033520', 'W12033520', 'ILCHIGSTD', 'Prairie Path Foot and Ankle ', 'Misty', '', 'McNeill', 'DPM', 'Podiatry', '', '', NULL, 'O', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6308344015', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6308344015', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-06-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922085505', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8835, -87.9416, NULL, NULL),
('201780406', 'W12033523', 'W12033523', 'ILCHIGSTD', 'UroPartners', 'Jonas', '', 'Benson', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841450525', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12033522', 'W12033522', 'ILCHIGSTD', 'UroPartners', 'Jonas', '', 'Benson', 'MD', 'Urology', '', '', NULL, 'M', '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '7084920502', '7084920565', '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841450525', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12033521', 'W12033521', 'ILCHIGSTD', 'UroPartners', 'Jonas', '', 'Benson', 'MD', 'Urology', '', '', NULL, 'O', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841450525', 0, 'Y', 0, '2013-08-29', NULL, NULL, 41.8588, -88.0984, NULL, NULL),
('870281028', 'W12033525', 'W12033525', 'UT01', 'Central Utah Clinic PC', 'Michael', 'S', 'Dee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5957 S Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755683', '8014759499', '5957 S Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755683', '8014759499', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710106653', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.1544, -111.937, NULL, NULL),
('621801973', 'W12033528', 'W12033528', 'UT01', '', 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12033526', 'W12033526', 'UT01', '', 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', '8018203731', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', '8018203731', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2013-07-23', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('621801973', 'W12033527', 'W12033527', 'UT01', '', 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('542087434', 'W12033529', 'W12033529', 'UT01', 'Moab Family Medicine PC', 'Eve', 'M', 'Maher', 'PA', 'Family Practice', '', '', NULL, 'O', '476 Williams Way Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', '476 Williams Way Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558407288', 0, 'N', 0, '2013-07-09', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('542087434', 'W12033530', 'W12033530', 'UT01', 'Moab Family Medicine PC', 'Eve', 'M', 'Maher', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4352597121', '4352593112', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4352597121', '4352593112', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558407288', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('760124696', 'W12033531', 'W12033531', 'TXHOUSTD', 'Surya Battu MD', 'Surya', 'K', 'Battu', 'MD', 'Pediatrics', '', '', NULL, 'O', '17510 W Grand Pkwy S Ste 340', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813427111', '2813429111', '17510 W Grand Pkwy S Ste 340', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813427111', '2813429111', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114081379', 0, 'N', 0, '2013-06-07', NULL, NULL, 29.5639, -95.688, NULL, NULL),
('942854057', 'W12033544', 'W12033544', 'UTIHCPHY', 'Southern Utah Neurosciences Institute', 'Derek', 'L', 'Frieden', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1528059201', 0, 'Y', 0, '2014-02-05', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12033546', 'W12033546', 'UTIHCPHY', 'Utah Valley Ear Nose and Throat North Valley', 'Adam', 'C', 'Gardner', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '872 N 2000 W Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014928900', '8014928910', '872 N 2000 W Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014928900', '8014928910', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598013625', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.3706, -111.769, NULL, NULL),
('942854057', 'W12033547', 'W12033547', 'UTIHCPHY', 'Logan Hospitalists', 'Douglas', 'M', 'Maready', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357165588', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357165588', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689876252', 0, 'N', 0, '2013-05-23', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12033548', 'W12033548', 'UTIHCPHY', 'Sevier Valley Clinic', 'J', 'Kent', 'McGregor', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-01', '2014-03-30', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1407053010', 0, 'N', 0, '2014-05-12', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('942854057', 'W12033549', 'W12033549', 'UTIHCPHY', 'Southern Utah Neurosciences Institute', 'Jon', 'B', 'Obray', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-01', '2013-12-31', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1205814803', 0, 'Y', 0, '2014-06-27', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12033552', 'W12033552', 'UTIHCPHY', 'Southwest Cardiology St. George', 'Steven', 'J', 'Temple', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-02-19', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841238987', 0, 'Y', 0, '2013-05-23', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12033553', 'W12033553', 'UTIHCPHY', 'North Temple Clinic', 'Brent', 'E', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '54 N 800 W', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8014088654', '8013590928', '54 N 800 W', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8014088654', '8013590928', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124136221', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.7706, -111.914, NULL, NULL),
('942854057', 'W12033554', 'W12033554', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'David', 'Michael', 'Adams', 'MD', 'Urology', '', '', NULL, 'O', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1669695920', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('942854057', 'W12033558', 'W12033558', 'UTIHCPHY', 'Dixie Sleep Disorders Center', 'William', 'B', 'Christensen', 'APRN', 'Family Practice', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1043450760', 0, 'Y', 0, '2013-05-23', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12033559', 'W12033559', 'UTIHCPHY', 'Holladay Pediatrics', 'Jodi', '', 'Groot', 'APRN', 'Obstetrics and Gynecology', 'Mental Health', '', NULL, 'O', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942488002', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.6372, -111.834, NULL, NULL),
('942854057', 'W12033563', 'W12033563', 'UTIHCPHY', 'Bountiful KidsCare', 'Michael', 'D', 'Johnson', 'MD', 'Urgent Care', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-22', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1962607911', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12033564', 'W12033564', 'UTIHCPHY', 'Heber Valley Clinic', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-25', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12033565', 'W12033565', 'UTIHCPHY', 'Southern Utah Neurosciences Institute', 'Rusty', 'A', 'Moore', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-02-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205813474', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12033567', 'W12033567', 'UTIHCPHY', 'River Road InstaCare', 'Brett', 'T', 'Muse', 'MD', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144254350', 0, 'Y', 0, '2013-07-12', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12033568', 'W12033568', 'UTIHCPHY', 'Heber Valley Clinic', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-25', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12033570', 'W12033570', 'UTIHCPHY', 'Int Heart Rhythm', 'Tiina', 'M', 'Thorley', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '5169 S Cottonwood Dr Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood Dr Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336481274', 0, 'Y', 0, '2013-05-23', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12033571', 'W12033571', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'Bryant', 'M', 'Whiting', 'MD', 'Urology', '', '', NULL, 'O', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1760687388', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('760613455', 'W12033573', 'W12033573', 'TXHOUSTD', '', 'Barry', 'E', 'Troyan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 110', 'Houston', 'Harris', 'TX', '77043', '7139327011', '7137229649', '1140 Business Ctr Dr Ste 110', 'Houston', 'Harris', 'TX', '77043', '7139327011', '7137229649', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952610875', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('751453852', 'W12033574', 'W12033574', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W I-635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', '400 W I-635 Ste 320', 'Irving', 'Dallas', 'TX', '75063', '9728691242', '9728692921', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9124, -96.9516, NULL, NULL),
('455018395', 'W12033576', 'W12033576', 'TXHOUSTD', 'Bay Area Advanced OBGYN PPLC', 'Maria', 'T', 'Rivero', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '450 Medical Ctr Blvd Ste 410', 'Webster', 'Harris', 'TX', '77598', '8323311125', '2817241077', '450 Medical Ctr Blvd Ste 410', 'Webster', 'Harris', 'TX', '77598', '8323311125', '2817241077', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1770524233', 0, 'N', 0, '2013-05-29', NULL, NULL, 29.5413, -95.126, NULL, NULL),
('760580939', 'W12033578', 'W12033578', 'TXHOUSTD', 'Hunaid Dollar MD', 'Hunaid', '', 'Dollar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 230', 'Tomball', 'Harris', 'TX', '77070', '2812528600', '2812528686', '18220 Tomball Pkwy Ste 230', 'Tomball', 'Harris', 'TX', '77070', '2812528600', '2812528686', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1487760229', 0, 'N', 0, '2013-05-29', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('760580939', 'W12033577', 'W12033577', 'TXHOUSTD', 'Hunaid Dollar MD', 'Hunaid', '', 'Dollar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18550 N 6th St', 'Magnolia', 'Montgomery', 'TX', '77354', '2812528600', '2812528686', '18550 N 6th St', 'Magnolia', 'Montgomery', 'TX', '77354', '2812528600', '2812528686', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1487760229', 0, 'N', 0, '2013-05-29', NULL, NULL, 30.2117, -95.7505, NULL, NULL),
('562408258', 'W12033581', 'W12033581', 'TXHOUSTD', '', 'Alfredo', '', 'Huerta', 'MD', 'Family Practice', '', '', NULL, 'O', '7825 Hwy 6 N Ste 107', 'Houston', 'Harris', 'TX', '77095', '2815500059', '2815500348', '7825 Hwy 6 N Ste 107', 'Houston', 'Harris', 'TX', '77095', '2815500059', '2815500348', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356398754', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.892, -95.6408, NULL, NULL),
('455018395', 'W12033582', 'W12033582', 'TXHOUSTD', 'Bay Area Advanced OBGYN PPLC', 'Erwin', 'M', 'Korman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '450 Medical Ctr Blvd Ste 410', 'Webster', 'Harris', 'TX', '77598', '8323311125', '2817241077', '450 Medical Ctr Blvd Ste 410', 'Webster', 'Harris', 'TX', '77598', '8323311125', '2817241077', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1225090426', 0, 'N', 0, '2013-05-29', NULL, NULL, 29.5413, -95.126, NULL, NULL),
('850275777', 'W12033585', 'W12033585', 'NM01', 'Southwest Medical Associates', 'Nicole', 'M', 'Dishong', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205272481', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12033586', 'W12033586', 'NM01', 'Southwest Medical Associates', 'Nicole', 'M', 'Dishong', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205272481', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('621801973', 'W12033587', 'W12033587', 'UT01', 'Davis Hospital and Medical Center', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '0000000000', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2013-05-23', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('621801973', 'W12033588', 'W12033588', 'UT01', 'Pioneer Valley Hospital', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy 5th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy 5th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('621801973', 'W12033589', 'W12033589', 'UT01', 'Salt Lake Regional Medical Center', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12033590', 'W12033590', 'UT01', 'Physician Group of Utah Inc', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', 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, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870656237', 'W12033579', 'W12033579', 'UT01', 'Southern Utah Physical Therapy and Rehabilitation', 'Casey', '', 'Kirkham', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1335 N Northfield Rd Ste 300', 'Cedar City', 'Iron', 'UT', '84721', '4358651902', '4355865176', '1335 N Northfield Rd Ste 300', 'Cedar City', 'Iron', 'UT', '84721', '4358651902', '4355865176', 'WestRehab', 'SouthernPT', '', '0.00', '0.00', '73.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376800466', 0, 'N', 0, '2013-07-09', NULL, NULL, 37.7013, -113.068, NULL, NULL),
('870656237', 'W12033580', 'W12033580', 'UT01', 'Southern Utah Physical Therapy and Rehabilitation', 'Casey', '', 'Kirkham', 'PT', 'Physical Therapy', '', '', NULL, 'O', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', 'WestRehab', 'SouthernPT', '', '0.00', '0.00', '73.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376800466', 0, 'N', 0, '2013-07-09', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('203059260', 'W12033591', 'W12033591', 'TXSATSTD', 'South East Baptist Hospital', 'Thilina ', '', 'Marasinghe', 'MD', 'Hospitalist', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', NULL, '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1821160938', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('203059260', 'W12033593', 'W12033593', 'TXSATSTD', 'South East Baptist Hospital', 'Freddy', '', 'Angulo', 'MD', 'Hospitalist', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', NULL, '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1255472205', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('203059260', 'W12033594', 'W12033594', 'TXSATSTD', 'North Central Baptist Hospital', 'Dicky ', '', 'Huey', 'MD', 'Hospitalist', '', '', NULL, 'O', '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', NULL, '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255388609', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.6213, -98.4912, NULL, NULL),
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('742719352', 'W12033641', 'W12033641', 'TXSATSTD', 'Urology of San Antonio', 'Andrew', 'A', 'Tobon', 'MD', 'Urology', '', '', NULL, 'O', '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', NULL, '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174503106', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0543, -98.7392, NULL, NULL),
('742719352', 'W12033642', 'W12033642', 'TXSATSTD', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'O', '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', NULL, '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0543, -98.7392, NULL, NULL),
('272824844', 'W12033644', 'W12033644', 'TXSATSTD', 'The Skin Center of San Antonio', 'Virnalisis', 'M', 'Gonzalez', 'MD', 'Dermatology', '', '', NULL, 'O', '21 Spurs Ln Ste 110', 'San Antonio', 'Bexar', 'TX', '78240', '2102684941', '0000000000', '21 Spurs Ln Ste 110', 'San Antonio', 'Bexar', 'TX', '78240', '2102684941', '0000000000', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1194735290', 0, 'N', 0, '2013-12-12', NULL, NULL, 29.5267, -98.5922, NULL, NULL),
('742083988', 'W12033646', 'W12033646', 'TXSATSTD', 'Renal Associates', 'Robert', 'Allen', 'Holub', 'MD', 'Nephrology', '', '', NULL, 'O', '1603 Hwy 97 E', 'Jourdanton', 'Atascosa', 'TX', '78026', '8009275436', NULL, '1603 Hwy 97 E', 'Jourdanton', 'Atascosa', 'TX', '78026', '8009275436', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083667893', 0, 'N', 0, '2013-05-24', NULL, NULL, 28.9262, -98.5338, NULL, NULL),
('364492913', 'W12033648', 'W12033648', 'ILCHIGSTD', 'Chicago Womens Health', 'Eden', '', 'Takhsh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '711 W North Ave', 'Chicago', 'Cook', 'IL', '60610', '3127267272', '0000000000', '711 W North Ave', 'Chicago', 'Cook', 'IL', '60610', '3127267272', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1881677730', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('363018460', 'W12033649', 'W12033649', 'ILCHIGSTD', 'Alia Siddiqi MD', 'Alia', 'N', 'Siddiqi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5310 N Sheridan Rd A', 'Chicago', 'Cook', 'IL', '60640', '7735611574', '7737696201', '5310 N Sheridan Rd A', 'Chicago', 'Cook', 'IL', '60640', '7735611574', '7737696201', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1225148000', 0, 'N', 0, '2013-07-10', NULL, NULL, 41.9786, -87.6551, NULL, NULL),
('760555526', 'W12033650', 'W12033650', 'TXHOUSTD', 'Kidney Associates', 'Emil', '', 'Abdulhayoglu', 'MD', 'Nephrology', '', '', NULL, 'O', '1213 Hermann Dr Ste 530', 'Houston', 'Harris', 'TX', '77004', '7133419685', '0000000000', '1213 Hermann Dr Ste 530', 'Houston', 'Harris', 'TX', '77004', '7133419685', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801860671', 0, 'N', 0, '2013-05-28', NULL, NULL, 29.7231, -95.3892, NULL, NULL),
('760609536', 'W12033651', 'W12033651', 'TXHOUSTD', 'Texas Alliance Medical Group', 'Michael', 'E', 'Byrne', 'MD', 'Family Practice', '', '', NULL, 'O', '10961 NW Fwy', 'Houston', 'Harris', 'TX', '77092', '7136863700', '0000000000', '10961 NW Fwy', 'Houston', 'Harris', 'TX', '77092', '7136863700', '0000000000', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912023649', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.8171, -95.4667, NULL, NULL),
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('760609536', 'W12033656', 'W12033656', 'TXHOUSTD', 'Texas Alliance Medical Group', 'Cynthia', '', 'Ketterer', 'MD', 'General Practice', '', '', NULL, 'O', '10961 NW Fwy', 'Houston', 'Harris', 'TX', '77092', '7136863700', '0000000000', '10961 NW Fwy', 'Houston', 'Harris', 'TX', '77092', '7136863700', '0000000000', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356520712', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.8171, -95.4667, NULL, NULL),
('760609536', 'W12033657', 'W12033657', 'TXHOUSTD', 'Texas Alliance Medical Group', 'Cynthia', '', 'Ketterer', 'MD', 'General Practice', '', '', NULL, 'O', '13259 E Fwy', 'Houston', 'Harris', 'TX', '77015', '7133301530', '7133301535', '13259 E Fwy', 'Houston', 'Harris', 'TX', '77015', '7133301530', '7133301535', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356520712', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7712, -95.1897, NULL, NULL),
('760609536', 'W12033658', 'W12033658', 'TXHOUSTD', 'Texas Alliance Medical Group', 'Cynthia', '', 'Ketterer', 'MD', 'General Practice', '', '', NULL, 'O', '6535 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '7139818184', '7139818118', '6535 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '7139818184', '7139818118', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356520712', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7176, -95.4976, NULL, NULL),
('760609536', 'W12033659', 'W12033659', 'TXHOUSTD', 'Texas Alliance Medical Group', 'Cynthia', '', 'Ketterer', 'MD', 'General Practice', '', '', NULL, 'O', '6969 Gulf Fwy Ste 370', 'Houston', 'Harris', 'TX', '77087', '7136430600', '7136414229', '6969 Gulf Fwy Ste 370', 'Houston', 'Harris', 'TX', '77087', '7136430600', '7136414229', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356520712', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7027, -95.2959, NULL, NULL),
('752825783', 'W12033665', 'W12033665', 'TXDALSTD', 'Metroplex Foot and Ankle ', 'Robert', 'T', 'Angelier', 'DPM', 'Podiatry', '', '', NULL, 'O', '3600 Gaston Ave Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', NULL, '3600 Gaston Ave Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', '2013-08-15', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720017205', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('134298938', 'W12033661', 'W12033661', 'TXHOUSTD', 'Warren Ellsworth MD', 'Warren', '', 'Ellsworth', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '18400 Katy Fwy Ste 500', 'Houston', 'Harris', 'TX', '77094', '8325228400', '0000000000', '18400 Katy Fwy Ste 500', 'Houston', 'Harris', 'TX', '77094', '8325228400', '0000000000', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-05-28', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336470343', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('203236957', 'W12033662', 'W12033662', 'TXHOUSTD', 'Jason Miller DPM', 'Jason ', '', 'Miller', 'DPM', 'Podiatry', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 150', 'Kingwood', 'Harris', 'TX', '77339', '2813482166', '0000000000', '350 Kingwood Medical Dr Ste 150', 'Kingwood', 'Harris', 'TX', '77339', '2813482166', '0000000000', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164411021', 0, 'N', 0, '2013-07-08', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('261891316', 'W12033664', 'W12033664', 'TXHOUSTD', 'Pediatric Surgery Associates of Clear Lake', 'Stephen', '', 'Kimmel', 'MD', 'General Surgery', 'Pediatrics', '', NULL, 'O', '450 Medical Center Blvd Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815541690', '8662380423', '450 Medical Center Blvd Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815541690', '8662380423', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1700892148', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5413, -95.126, NULL, NULL),
('270918982', 'W12033666', 'W12033666', 'TXDALSTD', 'Stoll Neurodiagnostics', 'Scott', 'Thomas', 'Stoll', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '5717 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8172943195', NULL, '5717 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8172943195', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1912231408', 0, 'N', 0, '2014-05-05', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('203774683', 'W12033667', 'W12033667', 'TXDALSTD', 'Muhammad Memon MD', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8174775500', NULL, '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8174775500', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1780691923', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.58, -97.307, NULL, NULL),
('197328116', 'W12033668', 'W12033668', 'TXDALSTD', 'Northpoint Cancer Center', 'Edward', 'H', 'Gilbert', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '6957 W Plano Pkwy Ste 1300', 'Plano', 'Collin', 'TX', '75093', '9728201400', NULL, '6957 W Plano Pkwy Ste 1300', 'Plano', 'Collin', 'TX', '75093', '9728201400', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-28', '2013-12-04', 0, 0, 0, '', 'Baylor Medical Center at Garland', '', '', 'HCFA|UB|', '1700849163', 0, 'N', 0, '2014-04-16', NULL, NULL, 33.0332, -96.85, NULL, NULL),
('363312906', 'W12033669', 'W12033669', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christopher', '', 'Lynch', 'DC', 'Chiropractic', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '0000000000', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '0000000000', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-28', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124354139', 0, 'N', 0, '2013-07-22', NULL, NULL, 42.1223, -87.9959, NULL, NULL),
('363312906', 'W12033670', 'W12033670', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christopher', '', 'Lynch', 'DC', 'Chiropractic', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '0000000000', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '0000000000', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-28', '2013-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124354139', 0, 'N', 0, '2013-07-22', NULL, NULL, 42.1726, -87.926, NULL, NULL),
('742625722', 'W12033671', 'W12033671', 'TXSATSTD', 'Alamo ENT Associates', 'William', 'C', 'Smith', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '19026 Stone Oak Pkwy Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2105450404', NULL, '19026 Stone Oak Pkwy Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2105450404', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-28', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336140680', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.6192, -98.4942, NULL, NULL),
('202186142', 'W12033673', 'W12033673', 'TXDALSTD', '', 'Pradip', '', 'Kanani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722854141', '9722707320', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1831107416', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8013, -96.6102, NULL, NULL),
('202186142', 'W12033672', 'W12033672', 'TXDALSTD', '', 'Pradip', '', 'Kanani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '410 Pinson', 'Forney', 'Kaufman', 'TX', '75126', '9725649380', '9725649287', '410 Pinson', 'Forney', 'Kaufman', 'TX', '75126', '9725649380', '9725649287', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1831107416', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('421733646', 'W12033674', 'W12033674', 'TXHOUSTD', '', 'Naila', '', 'Ramiz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Perkwood Dr Ste 7G', 'Houston', 'Harris', 'TX', '77090', '2819575770', '2818806684', '800 Perkwood Dr Ste 7G', 'Houston', 'Harris', 'TX', '77090', '2819575770', '2818806684', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845577', 0, 'N', 0, '2013-05-29', NULL, NULL, 30.0222, -95.4426, NULL, NULL),
('421733646', 'W12033675', 'W12033675', 'TXHOUSTD', '', 'Naila', '', 'Ramiz', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 11381', 'Spring', 'Harris', 'TX', '77391', '2819575770', '2818806684', 'PO Box 11381', 'Spring', 'Harris', 'TX', '77391', '2819575770', '2818806684', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845577', 0, 'N', 0, '2013-05-29', NULL, NULL, 0, 0, NULL, NULL),
('461108641', 'W12033676', 'W12033676', 'ID01', 'Firstline Medical', 'Hugh', 'G', 'Sterling', 'MD', 'Family Practice', '', '', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1538198098', 0, 'N', 0, '2013-09-27', NULL, NULL, 43.5899, -116.256, NULL, NULL),
('461108641', 'W12033677', 'W12033677', 'ID01', 'Firstline Medical', 'Hugh', 'G', 'Sterling', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083237588', '2085153468', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083237588', '2085153468', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1538198098', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('760618309', 'W12033679', 'W12033679', 'TXHOUSTD', '', 'Asaf', '', 'Qadeer', 'MD', 'Family Practice', '', '', NULL, 'O', '7333 N Fwy Ste 111', 'Houston', 'Harris', 'TX', '77076', '7136926191', '7136926922', '7333 N Fwy Ste 111', 'Houston', 'Harris', 'TX', '77076', '7136926191', '7136926922', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124069984', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.8667, -95.4066, NULL, NULL),
('870527264', 'W12033680', 'W12033680', 'UT01', 'Alta View Sports Medicine Center', 'Laurie', 'M', 'Lualemaga', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1093088445', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('870419324', 'W12033681', 'W12033681', 'UT01', 'Nephi Medical Clinic ', 'Leslie', 'K', 'Rasch', 'APRN', '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, '2013-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Dixie Regional Medical Center', NULL, NULL, 'HCFA|UB', '1962784504', 0, 'N', 0, '2013-07-23', NULL, NULL, 39.6276, -111.634, NULL, NULL),
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('562406285', 'W12033896', 'W12033896', 'TXHOUSTD', 'Family Care Plus', 'Nancy', '', 'Naghavi', 'DO', 'Family Practice', '', '', NULL, 'O', '3815 N Fry Rd Ste 100', 'Katy', 'Harris', 'TX', '77449', '2818295452', '2816469511', '3815 N Fry Rd Ste 100', 'Katy', 'Harris', 'TX', '77449', '2818295452', '2816469511', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1811978901', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.829, -95.72, NULL, NULL),
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('752768444', 'W12033688', 'W12033688', 'TXDALSTD', 'First Family Healthcare Association PA', 'Walter', '', 'Hinshaw', 'DO', 'Family Practice', '', '', NULL, 'O', '2201 Forest Ln', 'Garland', 'Dallas', 'TX', '75042', '9722766822', '9724874060', '2201 Forest Ln', 'Garland', 'Dallas', 'TX', '75042', '9722766822', '9724874060', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1063622322', 0, 'N', 0, '2013-06-03', NULL, NULL, 32.909, -96.6592, NULL, NULL),
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('870758137', 'W12033690', 'W12033690', 'TXHOUSTD', 'Fort Bend Rhematology Associates', '', '', 'Fort Bend Rhematology Associates', '', 'Rheumatology', '', '', NULL, 'O', '1327 Lake Pointe Pkwy Ste 515', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819801742', '2819801754', '1327 Lake Pointe Pkwy Ste 515', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819801742', '2819801754', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1770516551', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.6061, -95.6214, NULL, NULL),
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('911947573', 'W12033722', 'W12033722', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', '', 'Rahimi', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093927188', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
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('364088232', 'W12033729', 'W12033729', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shelly', 'A', 'Benson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065151', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065151', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346515715', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.7618, -88.3621, NULL, NULL),
('364088232', 'W12033726', 'W12033726', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shelly', 'A', 'Benson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346515715', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('371520288', 'W12033730', 'W12033730', 'TXHOUSTD', 'Methodist Pathology Associates', 'Aleksandar', '', 'Babic', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1548236961', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('371520288', 'W12033731', 'W12033731', 'TXHOUSTD', 'Methodist Pathology Associates', 'David', '', 'Bernard', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1538117007', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
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('371520288', 'W12033747', 'W12033747', 'TXHOUSTD', 'Methodist Pathology Associates', 'Wayne', '', 'Chandler', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1770673634', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, 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
('270852226', 'W12033749', 'W12033749', 'UT01', 'Silverton Group', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-21', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'Y', 0, '2014-07-10', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('203059260', 'W12033750', 'W12033750', 'TXSATSTD', 'North Central Baptist Hospital', 'Uma ', '', 'Nair', 'MD', 'Hospitalist', '', '', NULL, 'O', '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', NULL, '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962475962', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.6213, -98.4912, NULL, NULL),
('371520288', 'W12033751', 'W12033751', 'TXHOUSTD', 'Methodist Pathology Associates', 'Lillian', '', 'Gaber', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1942465448', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('363330928', 'W12033752', 'W12033752', 'ILCHIGSTD', 'St Mary and Elizabeth Medical Ctr Hospitalist Group', 'Carolyn', 'B', 'Stroncek', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962636241', 0, 'N', 0, '2013-06-25', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363330928', 'W12033753', 'W12033753', 'ILCHIGSTD', 'St Mary and Elizabeth Medical Ctr Hospitalist Group', 'Carolyn', 'B', 'Stroncek', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962636241', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12033754', 'W12033754', 'TXSATSTD', 'North East Baptist Hospital', 'Adi ', '', 'Klein', 'MD', 'Hospitalist', '', '', NULL, 'O', '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1912929423', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('203059260', 'W12033755', 'W12033755', 'TXSATSTD', 'Baptist Medical Center', 'Haritha', '', 'Mikkilineni', 'MD', 'Hospitalist', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891947438', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.4329, -98.4928, NULL, NULL),
('371520288', 'W12033758', 'W12033758', 'TXHOUSTD', 'Methodist Pathology Associates', 'Philip', '', 'Cagle', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1598713059', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('203059260', 'W12033759', 'W12033759', 'TXSATSTD', 'South East Baptist Hospital', 'Edward', '', 'Sternaman', 'MD', 'Hospitalist', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', NULL, '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1801994462', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('203059260', 'W12033760', 'W12033760', 'TXSATSTD', 'South East Baptist Hospital', 'Robert', '', 'Ching', 'MD', 'Hospitalist', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1770565707', 0, 'Y', 0, '2014-06-03', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('371520288', 'W12033761', 'W12033761', 'TXHOUSTD', 'Methodist Pathology Associates', 'Ashok', '', 'Balsaver', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1770541054', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('371520288', 'W12033762', 'W12033762', 'TXHOUSTD', 'Methodist Pathology Associates', 'Kevin', '', 'Burns', 'MD', 'Pathology', '', '', NULL, 'O', '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', NULL, '6565 Fannin St MS205', 'Houston', 'Harris', 'TX', '77030', '7133946450', '', '', '', 'TMHPHOPATH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1750527917', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('203059260', 'W12033763', 'W12033763', 'TXSATSTD', 'North East Baptist Hospital', 'Minh', '', 'Do', 'MD', 'Hospitalist', '', '', NULL, 'O', '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1740387695', 0, 'Y', 0, '2013-07-11', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('203059260', 'W12033764', 'W12033764', 'TXSATSTD', 'Baptist Medical Center', 'Richa', '', 'Mahajan', 'MD', 'Hospitalist', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730396656', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.4329, -98.4928, NULL, NULL),
('364088232', 'W12033766', 'W12033766', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mansi', 'C', 'Sheth', 'OD', 'Family Practice', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1669600870', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'W12033767', 'W12033767', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mansi', 'C', 'Sheth', 'OD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1669600870', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
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('203059260', 'W12033769', 'W12033769', 'TXSATSTD', 'North East Baptist Hospital', 'William', '', 'Mallott', 'MD', 'Hospitalist', '', '', NULL, 'O', '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679670624', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
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('942854057', 'W12033874', 'W12033874', 'UTIHCPHY', 'Salt Lake Clinic', 'Laurie', 'Lynne', 'Hilyer', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326093758', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12033876', 'W12033876', 'UTIHCPHY', 'Salt Lake Clinic', 'John', 'R', 'Hunt', 'MD', 'Internal Medicine', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693289', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12033877', 'W12033877', 'UTIHCPHY', 'Salt Lake Clinic', 'Sierra', 'E', 'Pardey', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982885471', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12033878', 'W12033878', 'UTIHCPHY', 'Salt Lake Clinic', 'Kim', 'N', 'Rigby', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568408086', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12033882', 'W12033882', 'UTIHCPHY', 'Heber Valley Clinic', 'Landon', 'K', 'Preece', 'MD', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063701654', 0, 'Y', 0, '2013-05-30', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12033883', 'W12033883', 'UTIHCPHY', 'LDS Campus Sleep Program', 'Lori', '', 'Neeleman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992000145', 0, 'Y', 0, '2013-05-30', NULL, NULL, 40.7785, -111.881, 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', 'W12033885', 'W12033885', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Clint', 'R', 'Nelson', 'MD', 'Pediatric Neurology', 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, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629221981', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12033886', 'W12033886', 'UTIHCPHY', 'Bountiful KidsCare', 'Scott', 'G', 'Newbold', 'DO', 'Pediatrics', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033393806', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('274586141', 'W12033887', 'W12033887', 'Test', '', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', '', '', 'BAYHEALTHR', '0.00', '0.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12033888', 'W12033888', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78251', '2108046000', NULL, '3903 Wiseman Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78251', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('743003947', 'W12033889', 'W12033889', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Bjorn', 'C', 'Balldin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931400', '0000000000', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931400', '0000000000', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366654667', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
('743003947', 'W12033890', 'W12033890', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Bjorn', 'C', 'Balldin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', '0000000000', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', '0000000000', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366654667', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('743003947', 'W12033892', 'W12033892', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Mayo', 'J', 'Galindo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', NULL, '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', '2013-12-30', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1649212648', 0, 'N', 0, '2014-01-28', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('743003947', 'W12033893', 'W12033893', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'David', 'M', 'Gonzalez', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', NULL, '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326080219', 0, 'N', 0, '2013-10-15', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('743003947', 'W12033894', 'W12033894', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Sergio', '', 'Viroslav', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2102819595', NULL, '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2102819595', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-31', NULL, 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1760424790', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('260233069', 'W12033895', 'W12033895', 'TXHOUSTD', 'Mansoora Sheikh MD', 'Mansoora', '', 'Sheikh', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6207 Alameda Point Ln', 'Houston', 'Harris', 'TX', '77041', '2819707797', '2819707710', '6207 Alameda Point Ln', 'Houston', 'Harris', 'TX', '77041', '2819707797', '2819707710', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1841389020', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('900906244', 'W12033897', 'W12033897', 'UT01', 'Deseret Health Rehab at Crosslands', '', '', 'Deseret Health Rehab at Crosslands', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', '', '', '7', '0.00', '100.00', '0.00', 3, '2013-06-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790029056', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.5515, -111.875, NULL, NULL),
('352332742', 'W12033898', 'W12033898', 'ID01', 'Healthy Habits Wellness Clinic', 'Susan', 'L', 'Lords', 'NP', 'Family Practice', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1629334651', 0, 'Y', 0, '2013-11-04', NULL, NULL, 43.6048, -116.381, NULL, NULL),
('461138696', 'W12033899', 'W12033899', 'TXHOUSTD', 'Woodlands Gynecology and Aesthetics, PLLC', 'John', 'J', 'Peet', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17350 St Lukes Way Ste 390', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362731600', '9362731635', '17350 St Lukes Way Ste 390', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362731600', '9362731635', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1477641322', 0, 'N', 0, '2013-06-06', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('461138696', 'W12033900', 'W12033900', 'TXHOUSTD', 'Woodlands Gynecology and Aesthetics', 'John', 'J', 'Peet', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1721', 'Conroe', 'Montgomery', 'TX', '77305', '9362731600', '9362731635', 'PO Box 1721', 'Conroe', 'Montgomery', 'TX', '77305', '9362731600', '9362731635', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1477641322', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('800865745', 'W12033901', 'W12033901', 'UT01', 'Deseret Health and Rehab at Federal Heights', '', '', 'Deseret Health and Rehab at Federal Heights', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8013283926', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8013283926', '', '', '7', '0.00', '100.00', '0.00', 3, '2013-06-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1063756328', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.7685, -111.865, NULL, NULL),
('264565853', 'W12033902', 'W12033902', 'UTMH1', 'Life Stone Group LLC', 'Anastasia', 'E', 'Pollock', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '21 E 100 N Ste 100', 'American Fork', 'Utah', 'UT', '84003', '8019807222', '8019841720', '21 E 100 N Ste 100', 'American Fork', 'Utah', 'UT', '84003', '8019807222', '8019841720', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417263138', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12033903', 'W12033903', 'UT01', 'St Marks Senior Health Center', 'Mina', '', 'Gohari', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1083824940', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12033904', 'W12033904', 'UT01', 'St Marks Senior Health Center', 'Mina', '', 'Gohari', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1083824940', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('264565853', 'W12033905', 'W12033905', 'UTMH1', 'Life Stone Group LLC', 'Jimmie', '', 'Long', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '21 E 100 N Ste 100', 'American Fork', 'Utah', 'UT', '84003', '8019807222', '8019841720', '21 E 100 N Ste 100', 'American Fork', 'Utah', 'UT', '84003', '8019807222', '8019841720', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023297868', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('742698089', 'W12033906', 'W12033906', 'TXSATSTD', 'Alamo City Medical Group', '', '', 'Alamo City Medical Group', '', 'Family Practice', '', '', NULL, 'O', '518 N Main St', 'Boerne', 'Kendall', 'TX', '78006', '8302495400', '9727256996', '518 N Main St', 'Boerne', 'Kendall', 'TX', '78006', '8302495400', '9727256996', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-24', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010111', 0, 'N', 0, '2014-06-09', NULL, NULL, 29.7976, -98.7342, NULL, NULL),
('742698089', 'W12033907', 'W12033907', 'TXSATSTD', 'Alamo City Medical Group', '', '', 'Alamo City Medical Group', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 792', 'Boerne', 'Kendall', 'TX', '78006', '2105414501', '2103080244', 'PO Box 792', 'Boerne', 'Kendall', 'TX', '78006', '2105414501', '2103080244', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010111', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12033914', 'W12033914', 'UT01', 'Central Utah Clinic PC', 'Mark', 'T', 'Hunt', 'OD', 'Optometry', '', '', NULL, 'O', '1054 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356284507', '4356283748', '1054 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356284507', '4356283748', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457334740', 0, 'N', 0, '2014-01-07', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('870281028', 'W12033915', 'W12033915', 'UT01', 'Central Utah Clinic PC', 'Mark', 'T', 'Hunt', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457334740', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12033916', 'W12033916', 'UT01', 'Central Utah Clinic PC', 'Mark', 'T', 'Hunt', 'OD', 'Optometry', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457334740', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('752931933', 'W12033917', 'W12033917', 'TXDALSTD', 'Vinita Schroeder, MD PA', 'Vinita', 'B', 'Schroeder', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '4119 Lomo Alto Dr', 'Dallas', 'Dallas', 'TX', '75219', '2145590202', '2145590221', '4119 Lomo Alto Dr', 'Dallas', 'Dallas', 'TX', '75219', '2145590202', '2145590221', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750498713', 0, 'N', 0, '2013-06-06', NULL, NULL, 32.8208, -96.8152, NULL, NULL),
('455582889', 'W12033918', 'W12033918', 'TXDALSTD', 'Cubic Care', 'Thein An', '', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9724799960', '9724799996', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '9724799960', '9724799996', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-03', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1669663654', 0, 'N', 0, '2014-07-21', NULL, NULL, 32.9594, -96.6831, NULL, NULL),
('752783862', 'W12033919', 'W12033919', 'TXDALSTD', 'Dallas Best Care Family Clinic', 'Armando', '', 'DeFex', 'MD', 'Family Practice', '', '', NULL, 'O', '80 N Bishop Ave Ste 2', 'Dallas', 'Dallas', 'TX', '75208', '2149410801', '2149412161', '80 N Bishop Ave Ste 2', 'Dallas', 'Dallas', 'TX', '75208', '2149410801', '2149412161', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376504704', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.7451, -96.8283, NULL, NULL),
('450472287', 'W12033920', 'W12033920', 'TXHOUSTD', 'Asma Khan MD', 'Asma', '', 'Khan', 'MD', 'Family Practice', '', '', NULL, 'O', '11301 Fallbrook Dr Ste 202', 'Houston', 'Harris', 'TX', '77065', '8326783530', '8326783536', '11301 Fallbrook Dr Ste 202', 'Houston', 'Harris', 'TX', '77065', '8326783530', '8326783536', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1306009121', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.9256, -95.589, NULL, NULL),
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('450472287', 'W12033922', 'W12033922', 'TXHOUSTD', 'Said Uddin MD', 'Said', '', 'Uddin', 'md', 'Internal Medicine', '', '', NULL, 'O', '11301 Fallbrook Dr Ste 200', 'Houston', 'Harris', 'TX', '77065', '2818979966', '2818978806', '11301 Fallbrook Dr Ste 200', 'Houston', 'Harris', 'TX', '77065', '2818979966', '2818978806', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205938867', 0, 'N', 0, '2013-06-06', NULL, NULL, 29.9256, -95.589, NULL, NULL),
('450472287', 'W12033923', 'W12033923', 'TXHOUSTD', 'Said Uddin MD', 'Said', '', 'Uddin', 'md', 'Internal Medicine', '', '', NULL, 'O', '21216 NW Fwy Ste 230', 'Cypress', 'Harris', 'TX', '77429', '2818979966', '2818978806', '21216 NW Fwy Ste 230', 'Cypress', 'Harris', 'TX', '77429', '2818979966', '2818978806', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205938867', 0, 'N', 0, '2013-06-06', NULL, NULL, 29.9265, -95.635, NULL, NULL),
('942854057', 'W12033924', 'W12033924', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'Robert', 'D', 'Corry', 'MD', 'Family Practice', '', '', NULL, 'O', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-01', '2013-12-31', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1952324410', 0, 'Y', 0, '2014-05-12', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('942854057', 'W12033925', 'W12033925', 'UTIHCPHY', 'Holladay Pediatrics', 'Janice', 'B', 'Lamborn', 'APRN', 'Pediatrics', '', '', NULL, 'O', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033121918', 0, 'Y', 0, '2013-06-03', NULL, NULL, 40.6372, -111.834, NULL, NULL),
('942854057', 'W12033926', 'W12033926', 'UTIHCPHY', 'Sunset InstaCare', 'Brett', 'T', 'Muse', 'MD', 'Urgent Care', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144254350', 0, 'Y', 0, '2013-07-12', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12033927', 'W12033927', 'UTIHCPHY', 'Logan InstaCare', 'Steven', '', 'Nail', 'MD', 'Hyperbaric Medicine', '', '', 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, '2013-05-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114978137', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12033928', 'W12033928', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Denise', '', 'Pons', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609104553', 0, 'N', 0, '2013-06-03', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12033880', 'W12033880', 'UTIHCPHY', 'Heber Valley Clinic', 'Andrew', 'B', 'Sanders', 'MD', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538458138', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12033929', 'W12033929', 'UTIHCPHY', 'Logan InstaCare', 'Andrew', 'B', 'Sanders', '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, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538458138', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12033931', 'W12033931', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Elizabeth', 'S', 'Soukup', 'MD', 'Pediatric Surgery', NULL, NULL, NULL, 'O', '1134 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1134 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083720858', 0, 'Y', 0, '2013-06-03', NULL, NULL, 40.2484, -111.667, NULL, NULL),
('942854057', 'W12033932', 'W12033932', 'UTIHCPHY', 'Hurricane Valley Clinic', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'N', 0, '2013-06-03', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12033933', 'W12033933', 'UTIHCPHY', 'Valley View Wound Clinic', 'Eugene', 'R', 'Worth', 'MD', 'Hyperbaric Medicine', '', '', NULL, 'O', '1333 N Main St Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358685656', '4538685695', '1333 N Main St Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358685656', '4538685695', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-29', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801816061', 0, 'N', 0, '2013-06-03', NULL, NULL, 37.7009, -113.064, NULL, NULL),
('942854057', 'W12033935', 'W12033935', 'UTIHCPHY', 'Heber Valley Clinic', 'Michael', 'G', 'McMahon', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477693281', 0, 'Y', 0, '2013-06-03', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12033392', 'W12033392', 'UTIHCPHY', 'Park City Clinic Bonanza', 'Michael', 'G', 'McMahon', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477693281', 0, 'Y', 0, '2013-06-03', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12033937', 'W12033937', 'UTIHCPHY', 'River Road InstaCare', 'Mary-Marie', 'A', 'Sullivan', 'MD', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770872319', 0, 'Y', 0, '2013-10-03', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12033938', 'W12033938', 'UTIHCPHY', 'Heber Valley Clinic', 'Mary-Marie', 'A', 'Sullivan', 'MD', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770872319', 0, 'Y', 0, '2013-10-03', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('262072378', 'W12033949', 'W12033949', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Robert', '', 'Aagard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1477661379', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033950', 'W12033950', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Robert', '', 'Aagard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1477661379', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033951', 'W12033951', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Robert', '', 'Aagard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1477661379', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033952', 'W12033952', 'UT01', 'Southern Utah Womens Health Center', 'Craig', 'D', 'Astle', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033119862', 0, 'N', 0, '2013-07-10', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('262072378', 'W12033954', 'W12033954', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Gregory', 'H', 'Bean', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629069695', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033955', 'W12033955', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Gregory', 'H', 'Bean', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629069695', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033956', 'W12033956', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Gregory', 'H', 'Bean', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629069695', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033957', 'W12033957', 'UT01', 'Southern Utah Womens Health Center', 'Brady', 'N', 'Benham', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952380685', 0, 'N', 0, '2013-07-10', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('262072378', 'W12033958', 'W12033958', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Donna', 'S', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1801820253', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12033959', 'W12033959', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Donna', 'S', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8013741801', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1801820253', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033960', 'W12033960', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Booth', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821114505', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12033961', 'W12033961', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Booth', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821114505', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033962', 'W12033962', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jeffrey', 'C', 'Broberg', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639150485', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12033963', 'W12033963', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jeffrey', 'C', 'Broberg', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639150485', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033964', 'W12033964', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Cook', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1679667315', 0, 'N', 0, '2014-03-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
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('262072378', 'W12033969', 'W12033969', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Peter', 'G', 'Drewes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275571804', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.3121, -111.713, NULL, NULL),
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('262072378', 'W12033975', 'W12033975', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Christy', '', 'Jorgensen', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1699927418', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
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('262072378', 'W12033978', 'W12033978', 'UT01', 'Valley Obstetrics & Gynecology PC', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033979', 'W12033979', 'UT01', 'Valley Obstetrics & Gynecology PC', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033980', 'W12033980', 'UT01', 'Valley Obstetrics & Gynecology PC', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033981', 'W12033981', 'UT01', 'Valley Obstetrics and Gynecology ', 'Heidi ', '', 'McSweeney', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063538775', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033982', 'W12033982', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033983', 'W12033983', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033984', 'W12033984', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033985', 'W12033985', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Cassandra', '', 'Morris', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1174701163', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033986', 'W12033986', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Cassandra', '', 'Morris', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1174701163', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033987', 'W12033987', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Cassandra', '', 'Morris', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1174701163', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033988', 'W12033988', 'UT01', '', 'Steven', 'G', 'Nance', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1376645887', 0, 'N', 0, '2014-04-04', NULL, NULL, 40.1611, -111.605, NULL, NULL),
('262072378', 'W12033989', 'W12033989', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Ryan', 'C', 'Ollerton', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528275898', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033990', 'W12033990', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Ryan', 'C', 'Ollerton', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528275898', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033991', 'W12033991', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Ryan', 'C', 'Ollerton', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528275898', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('262072378', 'W12033992', 'W12033992', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Kelli', '', 'Parker', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861615296', 0, 'Y', 0, '2013-07-10', NULL, NULL, 40.379, -111.765, NULL, NULL),
('262072378', 'W12033993', 'W12033993', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Kelli', '', 'Parker', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861615296', 0, 'Y', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033994', 'W12033994', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Kelli', '', 'Parker', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861615296', 0, 'Y', 0, '2013-06-03', NULL, NULL, 40.3848, -111.914, NULL, NULL);
