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
('611593123', 'W11020854', 'W11020854', 'UT01', 'BMT Division Department of University of Utah', 'Abigail', 'G', 'Staible', 'PA', 'Internal Medicine', 'Physician Assistant', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-02-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124206131', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020855', 'W11020855', 'UT01', 'University Health Care', 'Abigail', 'G', 'Staible', 'PA', 'Internal Medicine', 'Physician Assistant', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-02-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124206131', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020856', 'W11020856', 'UT01', 'BMT Division Department of University of Utah', 'Robin', 'A', 'Mountford', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', 'Hematolgy and Oncology', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-22', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720264237', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020857', 'W11020857', 'UT01', 'University Health Care', 'Robin', 'A', 'Mountford', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', 'Hematolgy and Oncology', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-22', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720264237', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11020858', 'W11020858', 'UT01', 'Pediatric Hematology-Oncology-Dept of University of Utah', 'Soumen', '', 'Khatua', 'MD', 'Pediatric Hematology and Oncolocy', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851389126', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11020859', 'W11020859', 'UT01', 'University Health Care', 'Soumen', '', 'Khatua', 'MD', 'Pediatric Hematology and Oncolocy', 'Pediatrics', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851389126', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020860', 'W11020860', 'UT01', 'University of Utah Orthopedic Consultants', 'Jason', 'J', 'Wilcox', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437260007', 0, 'N', 0, '2009-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020861', 'W11020861', 'UT01', 'University Health Care', 'Jason', 'J', 'Wilcox', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437260007', 0, 'N', 0, '2009-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020862', 'W11020862', 'UT01', 'University of Utah Orthopedic Consultants', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-10-01', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020863', 'W11020863', 'UT01', 'University Health Care', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2012-08-22', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W11020864', 'W11020864', 'UT01', 'U-U Endocrinology Division', 'Timothy', 'E', 'Graham', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134162258', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W11020865', 'W11020865', 'UT01', 'University Health Care', 'Timothy', 'E', 'Graham', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817763', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817763', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134162258', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020866', 'W11020866', 'UT01', 'BMT Division Department of University of Utah', 'Sherjeel', NULL, 'Sana', 'MBBS', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194847228', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020867', 'W11020867', 'UT01', 'University Health Care', 'Sherjeel', NULL, 'Sana', 'MBBS', 'Internal Medicine', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194847228', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11020869', 'W11020869', 'UT01', 'University Health Care', 'Christopher', 'J', 'McGann', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Radiologist', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477640423', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11020870', 'W11020870', 'UT01', 'University Health Care', 'Christopher', 'J', 'McGann', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Radiologist', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477640423', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020871', 'W11020871', 'UT01', 'BMT Division Department of University of Utah', 'Judy', 'L', 'Brown', 'FNP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', 'Physician Assistant', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760432710', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020872', 'W11020872', 'UT01', 'University Health Care', 'Judy', 'L', 'Brown', 'FNP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', 'Physician Assistant', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760432710', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020873', 'W11020873', 'UT01', 'BMT Division Department of University of Utah', 'Vicki', 'A', 'McKinney', 'PA-C', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891746202', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020874', 'W11020874', 'UT01', 'University Health Care', 'Vicki', 'A', 'McKinney', 'PA-C', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891746202', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020875', 'W11020875', 'UT01', 'University of Utah Orthopedic Consultants', 'Richard', 'B', 'Mackey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-10-01', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992923874', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11020876', 'W11020876', 'UT01', 'University Health Care', 'Richard', 'B', 'Mackey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-07-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992923874', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020877', 'W11020877', 'UT01', 'BMT Division Department of University of Utah', 'Charlotte', 'E', 'Schafer', 'APRN', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-06-05', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841459666', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020878', 'W11020878', 'UT01', 'University Health Care', 'Charlotte', 'E', 'Schafer', 'APRN', 'Internal Medicine', NULL, NULL, NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-06-05', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841459666', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020879', 'W11020879', 'UT01', 'BMT Division Department of University of Utah', 'Michael', 'W', 'Boyer', 'MD', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598763112', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020880', 'W11020880', 'UT01', 'University Health Care', 'Michael', 'W', 'Boyer', 'MD', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598763112', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11020881', 'W11020881', 'UT01', 'Pediatric Neonatology-Dept of University of Utah', 'Robert', 'J', 'DiGeronimo', 'MD', 'Pediatrics', 'Neonatal-Prenatal Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497788426', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11020882', 'W11020882', 'UT01', 'University Health Care', 'Robert', 'J', 'DiGeronimo', 'MD', 'Pediatrics', 'Neonatal-Prenatal Medicine', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497788426', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020883', 'W11020883', 'UT01', 'BMT Division Department of University of Utah', 'Hilary', 'F', 'Isenhour', 'APRN', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', 'Nurse Practitioner', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972553014', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020884', 'W11020884', 'UT01', 'University Health Care', 'Hilary', 'F', 'Isenhour', 'APRN', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', 'Nurse Practitioner', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972553014', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020885', 'W11020885', 'UT01', 'BMT Division Department of University of Utah', 'Renee', 'A', 'Vadeboncoeur', 'APRN', 'Pediatric Hematology and Oncolocy', 'Nurse Practitioner', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659320240', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020886', 'W11020886', 'UT01', 'University Health Care', 'Renee', 'A', 'Vadeboncoeur', 'APRN', 'Pediatric Hematology and Oncolocy', 'Nurse Practitioner', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659320240', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
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('742246239', 'W11020915', 'W11020915', 'TX01', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '215 E Quincy Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2104263994', NULL, '215 E Quincy Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2104263994', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-10-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.4358, -98.493, NULL, NULL),
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('621801973', 'W11020917', 'W11020917', 'UT01', 'Davis Comp Health', 'Bradley', 'A', 'Urie', 'MD', 'Pain Management', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-15', '2011-07-31', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1588688360', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020918', 'W11020918', 'UT01', 'Davis Comp Health', 'Bradley', 'A', 'Urie', 'MD', 'Pain Management', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-10-15', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1588688360', 0, 'y', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'W11020919', 'W11020919', 'UT01', 'Pediatric Anesthesiologists', 'Charles', 'E', 'Liu', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883272', '8017335872', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', NULL, NULL, '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2009-10-21', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548380744', 0, 'Y', 0, '2009-10-22', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11020920', 'W11020920', 'UTMH1', 'The Childrens Center', 'Devon', 'T', 'Rose', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825534', NULL, '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825534', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-10-25', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821281221', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11020921', 'W11020921', 'UTMH1', NULL, 'Diane', 'G', 'Maciel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013584140', NULL, 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013584140', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578786364', 0, 'y', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11020922', 'W11020922', 'UTMH1', NULL, 'Diane', 'G', 'Maciel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013584140', NULL, '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013584140', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578786364', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W11020923', 'W11020923', 'UT01', 'USU Speech Language Hearing Center', 'Vicki', 'L', 'Simonsmeier', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971374', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971374', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-25', '2013-10-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639319775', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020924', 'W11020924', 'UTPEHP', 'Park City Specialty Clinic', 'Jeanette', 'M', 'Falk', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-08-24', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588673974', 0, 'N', 0, '2009-10-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020925', 'W11020925', 'UTPEHP', 'Park City Specialty Clinic', 'Vanessa', 'M', 'Hart', 'MD', 'General Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1366439127', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020926', 'W11020926', 'UTPEHP', 'Southwest Spine & Pain Center', 'Michael', 'R', 'Major', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', NULL, '652 S Medical Center Dr Ste 110', 'St George', 'Iron', 'UT', '84790', '4352513700', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831193879', 0, 'N', 0, '2010-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11020928', 'W11020928', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1275559080', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W11020927', 'W11020927', 'ID01', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', 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, '2009-12-21', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1275559080', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6481, -116.335, NULL, NULL),
('820200895', 'W11020929', 'W11020929', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1275559080', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020930', 'W11020930', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1275559080', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11020931', 'W11020931', 'ID01', 'Saint Alphonsus Medical Group Elm Familly Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1275559080', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020932', 'W11020932', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Sherri', 'L', 'Brown', 'MD', 'Family Practice', 'Internal Medicine/Nursing Home Only', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', '', 'HCFA|', '1235172644', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020933', 'W11020933', 'ID01', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Anne', 'P', 'Burgess', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1194767178', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820200895', 'W11020934', 'W11020934', 'ID01', 'Saint Alphonsus Medical Group Iowa', 'Jonathan', 'L', 'Chu', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-11-15', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1972547685', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W11020935', 'W11020935', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Scott', 'A', 'Culpepper', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952321606', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11020936', 'W11020936', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'Seana', 'K', 'Daly', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1558301929', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11020937', 'W11020937', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Charles', 'M', 'Davis', 'DO', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1104877364', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W11020938', 'W11020938', 'ID01', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Angeline "Angie"', 'G', 'Devitt', 'MD', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659324358', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820200895', 'W11020939', 'W11020939', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Matthew', 'K', 'Eastman', 'DO', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952344962', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020940', 'W11020940', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Matthew', 'K', 'Eastman', 'DO', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2054597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2054597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952344962', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020941', 'W11020941', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Fred', 'W', 'Fender', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1558300491', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020942', 'W11020942', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'James', 'W', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1730275876', 0, 'N', 0, '2014-03-24', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020943', 'W11020943', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Michelle', '', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1437231354', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020944', 'W11020944', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Sheila', 'M', 'Giffen', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1013957802', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6119, -116.268, 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
('820200895', 'W11020945', 'W11020945', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Marcel', 'A', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801837141', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020946', 'W11020946', 'ID01', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Steven', 'M', 'Greenberg', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407817364', 0, 'N', 0, '2014-04-21', NULL, NULL, 43.5916, -116.204, NULL, NULL),
('820200895', 'W11020947', 'W11020947', 'ID01', 'CARE Maternal/Child Health Program - Do Not Publish', 'Steven', 'M', 'Greenberg', 'MD', 'Family Practice', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407817364', 0, 'Y', 0, '2014-04-21', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'W11020948', 'W11020948', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020949', 'W11020949', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Douglas', 'M', 'Hill', 'MD', 'Family Practice', 'Occupational Medicine', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-03-18', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1699719674', 0, 'N', 0, '2012-05-09', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11020950', 'W11020950', 'ID01', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Randall', 'H', 'Hutchings', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1609818228', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W11020951', 'W11020951', 'ID01', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Lisa', 'M', 'Kern', 'MD', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1588618219', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820200895', 'W11020952', 'W11020952', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Daniel', 'S', 'Knorpp', 'DO', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1538214184', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11020953', 'W11020953', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Stacy', 'J', 'Lamers', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1003867094', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11020954', 'W11020954', 'ID01', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Gregory', 'S', 'Lewer', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|', '1669414975', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820200895', 'W11020955', 'W11020955', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Paul', 'A', 'McConnel', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-06-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', '', 'HCFA|', '1407876071', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6539, -116.695, NULL, NULL),
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('820200895', 'W11020958', 'W11020958', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.6188, -116.431, NULL, NULL),
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('820200895', 'W11020966', 'W11020966', 'ID01', 'Saint Alphonsus Medical Group Iowa', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1316965239', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.554, -116.638, NULL, NULL),
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('820200895', 'W11020971', 'W11020971', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1316965239', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6188, -116.431, NULL, NULL),
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('820200895', 'W11020974', 'W11020974', 'ID01', 'Saint Alphonsus Medical Group Internal Medicine ', 'Leck', NULL, 'Read', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6140 W Curtisian  Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG2', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316965239', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W11020977', 'W11020977', 'ID01', 'Saint Alphonsus Medical Group Federal Way', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1316965239', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.5916, -116.204, NULL, NULL),
('820200895', 'W11020978', 'W11020978', 'ID01', 'Saint Alphonsus Medical Group Overland', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1316965239', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.5899, -116.31, NULL, NULL),
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('820200895', 'W11020985', 'W11020985', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Scott', 'N', 'Schwendiman', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1538110234', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W11020986', 'W11020986', 'ID01', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Scott', 'A', 'Shappard', 'DO', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649275587', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820200895', 'W11020987', 'W11020987', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
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('820200895', 'W11021029', 'W11021029', 'ID01', 'Saint Alphonsus Medical Group MHP Family  do not list on websites', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2014-02-26', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11021030', 'W11021030', 'ID01', 'Saint Alphonsus Medical Group EHP Family Medicine  do not list on websites', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2013-09-18', NULL, NULL, 43.6892, -116.351, 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
('820200895', 'W11021031', 'W11021031', 'ID01', 'CARE Maternal/Child Health Program - Do Not Publish', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2013-09-18', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'W11021032', 'W11021032', 'ID01', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W11021033', 'W11021033', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083674224', '2083678555', '3025 W Cherry Lane Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083674224', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-09-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11021034', 'W11021034', 'ID01', 'CARE Maternal/Child Health Program - Do Not Publish', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'W11021035', 'W11021035', 'ID01', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'N', 0, '2014-03-21', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'W11021036', 'W11021036', 'ID01', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'W11021037', 'W11021037', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11021038', 'W11021038', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11021039', 'W11021039', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11021040', 'W11021040', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W11021041', 'W11021041', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'W11021042', 'W11021042', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021043', 'W11021043', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6228, -116.21, NULL, NULL),
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('820200895', 'W11021047', 'W11021047', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Bobbi', 'A', 'Bullock', 'NP-C', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2013-02-04', 0, 0, 0, '', '', '', '', 'HCFA|', '1669620506', 0, 'Y', 0, '2013-10-14', NULL, NULL, 43.6188, -116.431, NULL, NULL),
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('820200895', 'W11021049', 'W11021049', 'ID01', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Bobbi', 'A', 'Bullock', 'NP-C', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1669620506', 0, 'Y', 0, '2013-10-14', NULL, NULL, 43.6151, -116.256, NULL, NULL),
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('820200895', 'W11021118', 'W11021118', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6534, -116.695, 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
('820200895', 'W11021119', 'W11021119', 'ID01', 'Saint Alphonsus Medical Group Diabetic Education', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11021120', 'W11021120', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W11021121', 'W11021121', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W11021122', 'W11021122', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021123', 'W11021123', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W11021124', 'W11021124', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', NULL, '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021125', 'W11021125', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W11021126', 'W11021126', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W11021127', 'W11021127', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W11021128', 'W11021128', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W11021129', 'W11021129', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W11021130', 'W11021130', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021131', 'W11021131', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W11021132', 'W11021132', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', NULL, '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021133', 'W11021133', 'ID01', 'Saint Alphonsus Medical Group Iowa', 'Laura', 'M', 'Thompson', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084677397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084677397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, '', '', '', '', 'HCFA|', '1548205966', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W11021134', 'W11021134', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W11021135', 'W11021135', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W11021136', 'W11021136', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W11021137', 'W11021137', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W11021138', 'W11021138', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W11021139', 'W11021139', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021140', 'W11021140', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W11021141', 'W11021141', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Linda', 'A', 'Whitener', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', NULL, '2809 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084594759', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1104853738', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021142', 'W11021142', 'ID01', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11021143', 'W11021143', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11021144', 'W11021144', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W11021145', 'W11021145', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'W11021146', 'W11021146', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'W11021147', 'W11021147', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11021148', 'W11021148', 'ID01', 'Saint Alphonsus Express Care, Inc.', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6228, -116.21, NULL, NULL),
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('820200895', 'W11021254', 'W11021254', 'ID01', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720020217', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
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('870395551', 'W11021257', 'W11021257', 'UT01', '', 'Brandon', 'D', 'Bradford', 'DC', 'Chiropractic', '', '', NULL, 'O', '45 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356237400', '8017561588', '45 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356237400', '8017561588', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-10-11', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790942365', 0, 'N', 0, '2014-05-16', 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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('870564069', 'W11021386', 'W11021386', 'UT01', 'U Dept of Family & Preventative Medicine', 'Timothy', 'W', 'Farrell', 'MD', 'Family Practice', 'Geriatric Medicine', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306959747', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11021387', 'W11021387', 'UT01', 'University Health Care', 'Timothy', 'W', 'Farrell', 'MD', 'Family Practice', 'Geriatric Medicine', '', NULL, 'O', '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306959747', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL);
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('743134291', 'W11021389', 'W11021389', 'UT01', 'University Health Care', 'Vandana', 'S', 'Raman', 'MD', 'Pediatric Endocrinology', 'Pediatrics', 'Endocrinology', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015817761', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015817761', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-10-01', '2012-07-31', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730378456', 0, 'N', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('263510730', 'W11021390', 'W11021390', 'UTMH1', 'Autism Assessment and Treatment Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', NULL, '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-11-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'n', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11021391', 'W11021391', 'UTMH1', 'Valley Mental Health  Inc', 'April', NULL, 'Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-11-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275721763', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11021394', 'W11021394', 'UT01', 'Legacy Point Family Medicine Center', 'Amberly', 'L', 'Lucas', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8016145270', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8016145270', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-11-30', '2010-07-08', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760719389', 0, 'N', 0, '2009-11-09', NULL, NULL, 0, 0, NULL, NULL),
('200302299', 'W11021395', 'W11021395', 'UT01', 'Mountain View Orthopaedics & Sports Medicine', 'Bruce', 'E', 'Thomas', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1477 N 2000 W Ste B', 'Clinton', 'Davis', 'UT', '84015', '8014755683', NULL, '1477 N 2000 W Ste B', 'Clinton', 'Davis', 'UT', '84015', '8014755683', '', 'WUOGORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255422192', 0, 'N', 0, '2012-10-03', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('200302299', 'W11021396', 'W11021396', 'UT01', 'Mountain View Orthopaedics & Sports Medicine', 'David', 'B', 'Glover', 'DPM', 'Podiatry', '', '', NULL, 'O', '1477 N 2000 W Ste B', 'Clinton', 'Davis', 'UT', '84015', '8014755683', NULL, '1477 N 2000 W Ste B', 'Clinton', 'Davis', 'UT', '84015', '8014755683', '          ', 'WUOGORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-01', '2012-04-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1740371681', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('205128411', 'W11021397', 'W11021397', 'UT01', 'South Summit Pediatrics', 'Richard', 'A', 'Greenberg', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '267 E Traversepoint Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015538300', '          ', '267 E Traversepoint Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015538300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-06', '2014-03-16', 0, 0, 0, 'Primary Childrens Medical Center', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1154402949', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.4853, -111.883, NULL, NULL),
('870470731', 'W11021398', 'W11021398', 'UT01', 'Ungricht Eye Associates', 'Jared', 'W', 'Parker', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5770 S 250 E Ste 410', 'Salt lake City', 'Salt Lake', 'UT', '84107', '8013144420', NULL, '5770 S 250 E Ste 410', 'Salt lake City', 'Salt Lake', 'UT', '84107', '8013144420', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-11-06', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124146253', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870609595', 'W11021399', 'W11021399', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W11021400', 'W11021400', 'UT01', 'Utah County Medical Associates', 'Virginia', 'D', 'Burnett', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194931352', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11021401', 'W11021401', 'TX01', 'The San Antonio Orthopaedic Group', 'Michael', 'C', 'Abiog', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-11-06', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174506430', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11021402', 'W11021402', 'TX01', 'The San Antonio Orthopaedic Group', 'Michael', 'C', 'Abiog', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045470', '          ', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045470', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-11-06', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174506430', 0, 'Y', 0, '2014-07-18', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
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('742083988', 'W11021404', 'W11021404', 'TX01', 'Renal Associates', 'Shweta', '', 'Bansal', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-11-06', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215083894', 0, 'Y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'W11021405', 'W11021405', 'TX01', 'Renal Associates', 'Shweta', '', 'Bansal', 'MD', 'Nephrology', '', '', NULL, 'O', '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', NULL, '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-11-06', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215083894', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.4358, -98.493, NULL, NULL),
('742083988', 'W11021406', 'W11021406', 'TX01', 'Renal Associates', 'Carlos', 'H', 'Zem', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-11-06', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1437237914', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'W11021407', 'W11021407', 'TX01', 'Renal Associates', 'Carlos', 'H', 'Zem', 'MD', 'Nephrology', '', '', NULL, 'O', '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', NULL, '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-11-06', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1437237914', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.4358, -98.493, NULL, NULL),
('621762573', 'W11021408', 'W11021408', 'UT01', 'Carbon - Emery OB/GYN', 'Terrance', 'P', 'Nielsen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356372092', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356372092', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-06', '2010-05-01', 0, 0, 0, 'salinas valley memorial', '', '', '', 'HCFA|UB|', '1861588865', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W11021409', 'W11021409', 'UT01', 'Carbon - Emery OB/GYN', 'Terrance', 'P', 'Nielsen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '280 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356372092', NULL, '280 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356372092', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-06', '2013-10-02', 0, 0, 0, 'salinas valley memorial', '', '', '', 'HCFA|UB|', '1861588865', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11021410', 'W11021410', 'TX01', 'The San Antonio Orthopaedic Group', 'Ephraim', 'K', 'Brenman', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-11-06', '2014-07-16', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104836832', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11021411', 'W11021411', 'TX01', 'The San Antonio Orthopaedic Group', 'Ephraim', 'K', 'Brenman', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2108045927', '          ', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2108045927', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-11-06', '2014-07-16', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104836832', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.5129, -98.5916, NULL, NULL),
('743003947', 'W11021412', 'W11021412', 'TX01', 'The San Antonio Orthopaedic Group', 'Ephraim', 'K', 'Brenman', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', '          ', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-11-06', '2014-07-16', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104836832', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
('507601670', 'W11021413', 'W11021413', 'ID02', NULL, 'D', 'P', 'Reedy', 'MD', 'Neurosurgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 307', 'Boise', 'Ada', 'ID', '83706', '2083677500', NULL, '999 N Curtis Rd Ste 307', 'Boise', 'Ada', 'ID', '83706', '2083677500', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-12-01', '2009-01-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588665434', 0, 'n', 0, '2012-06-07', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('810231784', 'W11021414', 'W11021414', 'WYBILLINGS', 'Billings Clinic - Radiology', 'Ronald', '', 'Egan', 'MD', 'Radiologist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295820025', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11021452', 'W11021452', 'UT01', 'Performance West Physical Therapy', 'Amanda', '', 'Thompson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8015720696', '1551 S Renaissance Towne Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8015720696', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588650196', 0, 'N', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11021457', 'W11021457', 'UT01', 'Hand & Ortho Murray', 'Marcia', '', 'Stapley', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '5151 S  900 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', '5151 S  900 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992952527', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021458', 'W11021458', 'UT01', 'Registered Physical Therapy Riverton', 'Jared', 'M', 'Suker', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '12391 S 4000 W Ste W210', 'Riverton', 'Salt Lake', 'UT', '84065', '8014460990', '8014460909', '12391 S 4000 W Ste W210', 'Riverton', 'Salt Lake', 'UT', '84065', '8014460990', '8014460909', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649416728', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021459', 'W11021459', 'UT01', 'ProRehab Vernal', 'David', '', 'Hume', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4356131500', '4356131501', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184686404', 0, 'N', 0, '2011-04-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021460', 'W11021460', 'UT01', 'Toole & Associates', 'Preston', 'B', 'Hall', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '142 S 50 E Ste 101', 'Coalville', 'Summit', 'UT', '84017', '4353369355', '4353369356', '142 S 50 E Ste 101', 'Coalville', 'Summit', 'UT', '84017', '4353369355', '4353369356', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386747707', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021461', 'W11021461', 'UT01', 'Toole & Associates', 'Douglas', 'B', 'Toole', 'PT', 'Physical Therapy', '', '', NULL, 'O', '142 S 50 E Ste 101', 'Coalville', 'Summit', 'UT', '84017', '4353369355', '4353369356', '142 S 50 E Ste 101', 'Coalville', 'Summit', 'UT', '84017', '4353369355', '4353369356', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962617290', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021462', 'W11021462', 'UT01', 'Physical Therapy & Sports Payson', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871750059', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021463', 'W11021463', 'UT01', 'Mountain Land Sandy', 'David', 'D', 'Butler', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '50 E 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015620066', '8015622124', '50 E 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015620066', '8015622124', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477752152', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021464', 'W11021464', 'UT01', 'Salt Lake Speech & Language', 'Mark', 'M', 'Cantor', 'MS, CCC,SLP', 'Physical Therapy', 'Speech Therapy', NULL, NULL, 'O', '1308 S 1700 E Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015811307', '8015811306', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144333139', 0, 'N', 0, '2009-04-15', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021465', 'W11021465', 'UT01', 'Salt Lake Speech & Language', 'Shelly', 'L', 'Hamula', 'SP', 'Speech Therapy', 'Physical Therapy', NULL, NULL, 'O', '1308 S 1700 E Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015811307', '8015811306', '1308 S 1700 E Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015811307', '8015811306', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073692547', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021466', 'W11021466', 'UT01', 'Orem Sports Medicine Center , LLC', 'Jeremy', 'F', 'Branch', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '252 N State St', 'Orem', 'Utah', 'UT', '84057', '8012260599', '8012663145', '252 N State St', 'Orem', 'Utah', 'UT', '84057', '8012260599', '8012663145', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619068376', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021467', 'W11021467', 'UT01', 'Pro Rehab Price', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021468', 'W11021468', 'UT01', 'Pro Rehab Castledale', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '150 E Main', 'Castledale', 'Emery', 'UT', '84513', '4353815100', '4353815099', '150 E Main', 'Castledale', 'Emery', 'UT', '84513', '4353815100', '4353815099', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021469', 'W11021469', 'UT01', 'Wasatch Physical Therapy Roy', 'Melissa', 'A', 'Ita aehau', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1957 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', '1957 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043319528', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021470', 'W11021470', 'UT01', 'Pro Rehab Price', 'Clayton', 'Lloyd', 'Taylor', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093995292', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021471', 'W11021471', 'UT01', 'MLR West Layton', 'Susan', '', 'Miller', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760586283', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021472', 'W11021472', 'UT01', 'Saratoga Physcial Therapy & Sports Medicine', 'Todd', 'W', 'Austin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '24 W Sergeant Ct Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660103', '8017660136', '24 W Sergeant Ct Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660103', '8017660136', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932214442', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021473', 'W11021473', 'UT01', 'Registered Physical Therapy West Jordan', 'Jason', 'C', 'West', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015720690', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015720690', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952389371', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021474', 'W11021474', 'UT01', 'Cheryl Farnsworth Physical Therapy', 'Cheryl', 'Ann', 'Farnsworth', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1151 E 3900 S Ste B-19', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B-19', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720089485', 0, 'N', 0, '2011-09-08', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021475', 'W11021475', 'UT01', 'Meier & Marsh Professional Therapy', 'Travis', 'N', 'Allen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1226 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358431311', '4358438946', '1226 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358431311', '4358438946', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164688347', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021476', 'W11021476', 'UT01', 'Mountain Top Physical Therapy', 'Preston', 'B', 'Hall', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '2080 Gold Dust Ln', 'Park City', 'Summit', 'UT', '84098', '4356479355', '4356470464', '2080 Gold Dust Ln', 'Park City', 'Summit', 'UT', '84098', '4356479355', '4356470464', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386747707', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021477', 'W11021477', 'UT01', 'Rehab Services of Craig', 'Kathryn', NULL, 'Roof', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'O', '473 Yampa Ave', 'Craig', 'Moffat', 'CO', '81625', '9708249359', '9708246777', NULL, NULL, 'Moffat', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013176056', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021478', 'W11021478', 'UT01', 'Sports Medicine Clinic', 'Chris', 'H', 'Dahlberg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '990 S Medical Dr Ste U4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', '990 S Medical Dr Ste U4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366553208', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021479', 'W11021479', 'UT01', 'Mountain Land Movement Specialist Salt Lake', 'Paisley', 'A', 'Hardman', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '508 E S Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015219222', '8015219333', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487811196', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11021480', 'W11021480', 'UT01', 'Mountain Land Kaysville', 'Rebekah', 'E', 'Lund', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1188 W Sportsplex Dr Ste B', 'Kaysville', 'Davis', 'UT', '84037', '8015471155', '8015471173', '1188 W Sportsplex Dr Ste B', 'Kaysville', 'Davis', 'UT', '84037', '8015471155', '8015471173', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699900654', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('522229954', 'W11021481', 'W11021481', 'UT01', 'Blackfoot Physical Therapy', 'Ryan', 'Bosworth', 'Hurst', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '285 W Francis', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850123', '2087821885', NULL, NULL, 'Bingham', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548429087', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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