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
('752943993', 'W12046235', 'W12046235', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Usha', 'N', 'Peri', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033100375', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046244', 'W12046244', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Syed', 'M', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144434010', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046245', 'W12046245', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Syed', 'M', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144434010', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046237', 'W12046237', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Usha', 'N', 'Peri', 'MD', 'Nephrology', '', '', NULL, 'O', '8 Medical Pkwy Plaza 2, Ste 201', 'Dallas', 'Dallas', 'TX', '75234', '9727594600', '9724369273', '8 Medical Pkwy Plaza 2, Ste 201', 'Dallas', 'Dallas', 'TX', '75234', '9727594600', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033100375', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046236', 'W12046236', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Usha', 'N', 'Peri', 'MD', 'Nephrology', '', '', NULL, 'O', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033100375', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046225', 'W12046225', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'George', 'A', 'Rojas', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9403201708', '9404839734', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9403201708', '9404839734', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427039403', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046228', 'W12046228', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mario', 'A', 'Ruiz', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9403201708', '9404839734', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9403201708', '9404839734', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841281177', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046233', 'W12046233', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Matthew', 'T', 'Smith', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457303323', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046226', 'W12046226', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'George', 'A', 'Rojas', 'DO', 'Nephrology', '', '', NULL, 'O', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427039403', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046230', 'W12046230', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mario', 'A', 'Ruiz', 'MD', 'Nephrology', '', '', NULL, 'O', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841281177', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046232', 'W12046232', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Matthew', 'T', 'Smith', 'MD', 'Nephrology', '', '', NULL, 'O', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457303323', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046229', 'W12046229', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mario', 'A', 'Ruiz', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9403201708', '9404839734', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9403201708', '9404839734', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841281177', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046221', 'W12046221', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Zhi', '', 'Mao', 'MD', 'Nephrology', '', '', NULL, 'O', '4240 International Pkwy Ste 154', 'Carrollton', 'Denton', 'TX', '75007', '4695740464', '4695740471', '4240 International Pkwy Ste 154', 'Carrollton', 'Denton', 'TX', '75007', '4695740464', '4695740471', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609087600', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046222', 'W12046222', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Zhi', '', 'Mao', 'MD', 'Nephrology', '', '', NULL, 'O', '4401 Coit Rd Ste 301', 'Frisco', 'Denton', 'TX', '75034', '4695740464', '4695740471', '4401 Coit Rd Ste 301', 'Frisco', 'Denton', 'TX', '75034', '4695740464', '4695740471', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609087600', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046224', 'W12046224', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'George', 'A', 'Rojas', 'DO', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9403201708', '9404839734', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9403201708', '9404839734', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427039403', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046220', 'W12046220', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Zhi', '', 'Mao', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609087600', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046216', 'W12046216', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Kannaeganti', '', 'Prasad', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114922630', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046217', 'W12046217', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Kannaeganti', '', 'Prasad', 'MD', 'Nephrology', '', '', NULL, 'O', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114922630', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('760540476', 'W12046213', 'W12046213', 'TXHOUSTD', 'Oakbend Medical Group', 'Sherry', '', 'Cameron-Berry', 'NP', 'Emergency Medicine', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235175472', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('760540476', 'W12046212', 'W12046212', 'TXHOUSTD', 'Oakbend Medical Group', 'Sherry', '', 'Cameron-Berry', 'NP', 'Emergency Medicine', '', '', NULL, 'O', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235175472', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046207', 'W12046207', 'TXHOUSTD', 'Critical Care Pediatrics of Houston', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'O', '500 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', '500 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12046203', 'W12046203', 'TXDALSTD', 'Questcare Medical Clinics', 'Bradley', '', 'Musser', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 678048', 'Dallas', 'Dallas', 'TX', '75267', '8172951121', '8172958170', 'PO Box 678048', 'Dallas', 'Dallas', 'TX', '75267', '8172951121', '8172958170', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497700603', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046206', 'W12046206', 'TXHOUSTD', 'Pediatric Heart Specialists of Houston', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'O', '450 Medical Ctr Blvd Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', '450 Medical Ctr Blvd Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046211', 'W12046211', 'TXHOUSTD', 'Houston Pediatric Specialty Group PLLC', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8664016413', 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8664016413', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046209', 'W12046209', 'TXHOUSTD', 'Pediatric Heart Specialists of Houston', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'O', '22999 US Hwy 59 N Ste 264', 'Kingwood', 'Harris', 'TX', '77339', '2815544300', '2815544355', '22999 US Hwy 59 N Ste 264', 'Kingwood', 'Harris', 'TX', '77339', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046210', 'W12046210', 'TXHOUSTD', 'Pediatric Heart Specialists of Houston', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'O', '705 S Fry Rd Ste 230', 'Katy', 'Harris', 'TX', '77450', '2815544300', '2815544355', '705 S Fry Rd Ste 230', 'Katy', 'Harris', 'TX', '77450', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12046208', 'W12046208', 'TXHOUSTD', 'Pediatric Heart Specialists of Houston', 'Heather', 'E', 'Nichols', 'MD', 'Family Practice', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 210', 'Conroe', 'Montgomery', 'TX', '77304', '2815544300', '2815544355', '500 Medical Ctr Blvd Ste 210', 'Conroe', 'Montgomery', 'TX', '77304', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, 'Kingwood Medical Center', '', '', '', 'HCFA|UB|', '1144246950', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12046202', 'W12046202', 'TXDALSTD', 'Questcare Medical Clinics', 'Bradley', '', 'Musser', 'MD', 'Family Practice', '', '', NULL, 'M', '6101 Windcom Ct Ste 200', 'Plano', 'Collin', 'TX', '75093', '2147051155', '0000000000', '6101 Windcom Ct Ste 200', 'Plano', 'Collin', 'TX', '75093', '2147051155', '0000000000', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497700603', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12046201', 'W12046201', 'TXDALSTD', 'Questcare Medical Clinics', 'Bradley', '', 'Musser', 'MD', 'Family Practice', '', '', NULL, 'O', '1571 SW Wilshire Blvd Ste 500', 'Burleson', 'Johnson', 'TX', '76028', '8172951121', '8172958170', '1571 SW Wilshire Blvd Ste 500', 'Burleson', 'Johnson', 'TX', '76028', '8172951121', '8172958170', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497700603', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12046200', 'W12046200', 'WYT2', 'Memorial Hospital Orthopedic and Sports Medicine', 'Jeffrey', 'S', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1790952406', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12046199', 'W12046199', 'WY01', 'Memorial Hospital Orthopedic and Sports Medicine', 'Jeffrey', 'S', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1790952406', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('830237418', 'W12046198', 'W12046198', 'WYT1', 'Memorial Hospital Orthopedic and Sports Medicine', 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073626615', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073626615', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1477564656', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830237418', 'W12046197', 'W12046197', 'WY01', 'Memorial Hospital Orthopedic and Sports Medicine', 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073626615', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073626615', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1477564656', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048122', 'W12048122', 'UTIHC04', 'Primary Childrens Medical Center', 'Michelle', 'D', 'Brough', 'OT', 'Occupational Therapy', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508283094', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('870373083', 'PGUTAH357', 'PGUTAH357', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Bruce', 'R', 'Kenwood', 'DO', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1144279019', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('262434224', 'CL0307056', 'CL0307056', 'SmartCare', 'Zeballos Healthcare Interventional Spine and Pain', NULL, NULL, 'Zeballos Healthcare Interventional Spine and Pain', NULL, 'Clinic', 'Dermatology', '', NULL, 'B', 'PO Box 8406 ', 'Belfast', 'Waldo', 'GA', '04915', '6174021009', '6174021099', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307056', 0, 'N', 0, NULL, NULL, NULL, 33.0646, -96.7984, NULL, NULL),
('364288034', 'CL0305538', 'CL0305538', 'SmartCare', 'Young Family Health Center', NULL, NULL, 'Young Family Health Center', NULL, 'Clinic', 'Pediatrics', '', NULL, 'O', '1431 N Western Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305538', 0, 'N', 0, NULL, NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('850232628', 'CL0306455', 'CL0306455', 'SmartCare', 'Womens Specialists of NM', NULL, NULL, 'Womens Specialists of NM', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306455', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'CL0306468', 'CL0306468', 'SmartCare', 'Womens Specialists of NM', NULL, NULL, 'Womens Specialists of NM', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '4640 Jefferson Ln NW ', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306468', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'CL0306469', 'CL0306469', 'SmartCare', 'Womens Specialists of NM', NULL, NULL, 'Womens Specialists of NM', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306469', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('752924037', 'CL0308876', 'CL0308876', 'SmartCare', 'Womens Integrated Healthcare PA', NULL, NULL, 'Womens Integrated Healthcare PA', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '816 Keller Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8174162229', '8174163667', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308876', 0, 'N', 0, NULL, NULL, NULL, 32.9342, -97.2358, NULL, NULL),
('752924037', 'CL0308875', 'CL0308875', 'SmartCare', 'Womens Integrated Healthcare PA', NULL, NULL, 'Womens Integrated Healthcare PA', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1625 Lancaster Dr ', 'Grapevine', 'Tarrant', 'TX', '76051', '8174162229', '8174163667', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308875', 0, 'N', 0, NULL, NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('752924037', 'CL0308874', 'CL0308874', 'SmartCare', 'Womens Integrated Healthcare PA', NULL, NULL, 'Womens Integrated Healthcare PA', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '816 Keller Pkwy', 'Keller', 'Dallas', 'TX', '75248', '8174162229', '8174163667', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308874', 0, 'N', 0, NULL, NULL, NULL, 32.9783, -96.7585, NULL, NULL),
('760231597', 'CL0311421', 'CL0311421', 'SmartCare', 'Womens Healthcare Associates', NULL, NULL, 'Womens Healthcare Associates', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1315 St Joseph Pkwy Ste 1818', 'Houston', 'Harris', 'TX', '77002', '7136548128', '7136547426', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311421', 0, 'N', 0, NULL, NULL, NULL, 29.7486, -95.3675, NULL, NULL),
('202904746', 'CL0308865', 'CL0308865', 'SmartCare', 'Womens Health Specialists of North Texas', NULL, NULL, 'Womens Health Specialists of North Texas', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308865', 0, 'N', 0, NULL, NULL, NULL, 32.5687, -97.1156, NULL, NULL),
('462253072', 'CL0307055', 'CL0307055', 'SmartCare', 'Womens Health Associates of Richardson', NULL, NULL, 'Womens Health Associates of Richardson', NULL, 'Clinic', 'Dermatology', '', NULL, 'B', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '9727925727', '9727925727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307055', 0, 'N', 0, NULL, NULL, NULL, 32.8624, -96.8066, NULL, NULL),
('202904746', 'CL0308864', 'CL0308864', 'SmartCare', 'Womens Health Specialists of North Texas', NULL, NULL, 'Womens Health Specialists of North Texas', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308864', 0, 'N', 0, NULL, NULL, NULL, 32.3968, -96.865, NULL, NULL),
('742591869', 'CL0312430', 'CL0312430', 'SmartCare', 'Women Partners in OB-GYN', NULL, NULL, 'Women Partners in OB-GYN', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '502 Madison Oak Dr Ste 440', 'San Antonio', 'Bexar', 'TX', '78258', '2109461300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00312430', 0, 'N', 0, NULL, NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('760424136', 'CL0311411', 'CL0311411', 'SmartCare', 'Women MD', NULL, NULL, 'Women MD', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '450 Medical Ctr Blvd Ste 400', 'Webster', 'Harris', 'TX', '77598', '2813380085', '2813359532', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311411', 0, 'N', 0, NULL, NULL, NULL, 29.5413, -95.126, NULL, NULL),
('742591869', 'CL0312429', 'CL0312429', 'SmartCare', 'Women Partners in OB-GYN', NULL, NULL, 'Women Partners in OB-GYN', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '5000 Baptist Health Dr Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2109461300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00312429', 0, 'N', 0, NULL, NULL, NULL, 29.599, -98.2749, NULL, NULL),
('363399794', 'CL0305522', 'CL0305522', 'SmartCare', 'WomanCare PC', NULL, NULL, 'WomanCare PC', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '814 E Woodfield Rd ', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305522', 0, 'N', 0, NULL, NULL, NULL, 42.0429, -88.0596, NULL, NULL),
('363399794', 'CL0305529', 'CL0305529', 'SmartCare', 'WomanCare PC', NULL, NULL, 'WomanCare PC', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305529', 0, 'N', 0, NULL, NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('363399794', 'CL0305521', 'CL0305521', 'SmartCare', 'WomanCare PC', NULL, NULL, 'WomanCare PC', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '355 W Northwest Hwy ', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305521', 0, 'N', 0, NULL, NULL, NULL, 42.123, -88.0508, NULL, NULL),
('363399794', 'CL0305528', 'CL0305528', 'SmartCare', 'WomanCare PC', NULL, NULL, 'WomanCare PC', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305528', 0, 'N', 0, NULL, NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'CL0305527', 'CL0305527', 'SmartCare', 'WomanCare PC', NULL, NULL, 'WomanCare PC', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305527', 0, 'N', 0, NULL, NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('752632114', 'CL0308849', 'CL0308849', 'SmartCare', 'Wise County Medical & Surgical Association', NULL, NULL, 'Wise County Medical & Surgical Association', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1001 Eagle Dr ', 'Decatur', 'Wise', 'TX', '76234', '9406277443', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308849', 0, 'N', 0, NULL, NULL, NULL, 33.2186, -97.5972, NULL, NULL),
('742825864', 'CL0306433', 'CL0306433', 'SmartCare', 'Western Dermatology Consultants', NULL, NULL, 'Western Dermatology Consultants', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '10151 Montgomery NE Ste A Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058555503', '5058555533', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306433', 0, 'N', 0, NULL, NULL, NULL, 35.1307, -106.527, NULL, NULL),
('870767026', 'CL0302590', 'CL0302590', 'SmartCare', 'West Valley Medical Group', NULL, NULL, 'West Valley Medical Group', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1906 Fairview Ave Ste 200 & 230', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00302590', 0, 'N', 0, NULL, NULL, NULL, 43.6588, -116.677, NULL, NULL),
('362120183', 'CL0305477', 'CL0305477', 'SmartCare', 'Villa Medical Arts', NULL, NULL, 'Villa Medical Arts', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '10 E Central Blvd ', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305477', 0, 'N', 0, NULL, NULL, NULL, 41.8839, -87.9787, NULL, NULL),
('364122551', 'CL0305492', 'CL0305492', 'SmartCare', 'West Suburban Eye Associates', NULL, NULL, 'West Suburban Eye Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305492', 0, 'N', 0, NULL, NULL, NULL, 41.8919, -87.775, 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
('364122551', 'CL0305493', 'CL0305493', 'SmartCare', 'West Suburban Eye Associates', NULL, NULL, 'West Suburban Eye Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305493', 0, 'N', 0, NULL, NULL, NULL, 41.8885, -87.8103, NULL, NULL),
('201780406', 'CL0305447', 'CL0305447', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305447', 0, 'N', 0, NULL, NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'CL0305441', 'CL0305441', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305441', 0, 'N', 0, NULL, NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('201780406', 'CL0305434', 'CL0305434', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305434', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'CL0305459', 'CL0305459', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '836 W Wellington Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7732811011', '7732811029', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305459', 0, 'N', 0, NULL, NULL, NULL, 41.9364, -87.6508, NULL, NULL),
('201780406', 'CL0305436', 'CL0305436', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305436', 0, 'N', 0, NULL, NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'CL0305465', 'CL0305465', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305465', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'CL0305463', 'CL0305463', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305463', 0, 'N', 0, NULL, NULL, NULL, 42.3596, -87.9019, NULL, NULL),
('201780406', 'CL0305435', 'CL0305435', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305435', 0, 'N', 0, NULL, NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'CL0305448', 'CL0305448', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305448', 0, 'N', 0, NULL, NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'CL0305466', 'CL0305466', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '160 E Illinois St ', 'Chicago', 'Cook', 'IL', '60611', '3124772390', '3124772391', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305466', 0, 'N', 0, NULL, NULL, NULL, 41.891, -87.6234, NULL, NULL),
('201780406', 'CL0305464', 'CL0305464', 'SmartCare', 'UroPartners', NULL, NULL, 'UroPartners', NULL, 'Clinic', 'Urology', '', NULL, 'O', '151 W Golf Rd ', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00305464', 0, 'N', 0, NULL, NULL, NULL, 42.2696, -87.9527, NULL, NULL),
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('621801973', 'PGUTAH201', 'PGUTAH201', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Francine', 'N', 'Jacobs', 'MD', 'Pediatrics', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643492', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643492', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639224959', 0, 'y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH200', 'PGUTAH200', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Francine', 'N', 'Jacobs', 'MD', 'Pediatrics', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 205', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643492', NULL, '4052 W Pioneer Pkwy Ste 205', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643492', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639224959', 0, 'n', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12034104', 'W12034104', 'UT01', 'Salt Lake Regional Medical Center', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, NULL, '', '', '', '', 'HCFA|UB|DEN|', '1144494113', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH049', 'PGUTAH049', 'UT01', 'Salt Lake Regional Medical Center', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144494113', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12034102', 'W12034102', 'UT01', 'Davis Hospital & Medical Center', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1144494113', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH050', 'PGUTAH050', 'UT01', 'Davis Hospital & Medical Center', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144494113', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12034103', 'W12034103', 'UT01', 'Pioneer Valley Hospital', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, NULL, '', '', '', '', 'HCFA|UB|DEN|', '1144494113', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH051', 'PGUTAH051', 'UT01', 'Pioneer Valley Hospital', 'Kelli', '', 'Hyland', '', 'Psychiatry', NULL, NULL, NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144494113', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH334', 'PGUTAH334', 'UT01', 'Rocky Mountain Womens Health Center', 'William', 'G', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1881787885', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH335', 'PGUTAH335', 'UT01', 'Rocky Mountain Womens Health Center', 'William', 'G', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1881787885', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH178', 'PGUTAH178', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH177', 'PGUTAH177', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH176', 'PGUTAH176', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH002', 'PGUTAH002', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Virginia', 'J', 'Homewood', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003072216', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH001', 'PGUTAH001', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Virginia', 'J', 'Homewood', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003072216', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH249', 'PGUTAH249', 'UT01', 'Salt Lake Regional Medical Associates', 'Patrice', 'F', 'Hirning', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770580078', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH250', 'PGUTAH250', 'UT01', 'Salt Lake Regional Medical Associates', 'Patrice', 'F', 'Hirning', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770580078', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH337', 'PGUTAH337', 'UT01', 'Rocky Mountain Womens Health Center', 'Maria', 'D', 'Hernandez', 'MD', 'Urogynecology', 'Gynecology', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891960738', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH336', 'PGUTAH336', 'UT01', 'Rocky Mountain Womens Health Center', 'Maria', 'D', 'Hernandez', 'MD', 'Urogynecology', 'Gynecology', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891960738', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH331', 'PGUTAH331', 'UT01', 'Rocky Mountain Womens Health Center', 'Stacie', 'B', 'Carter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710180591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH332', 'PGUTAH332', 'UT01', 'Rocky Mountain Womens Health Center', 'Stacie', 'B', 'Carter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3110 W 300 N Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017760880', '8017737399', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710180591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH333', 'PGUTAH333', 'UT01', 'Rocky Mountain Womens Health Center', 'Stacie', 'B', 'Carter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017737399', '8017738625', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710180591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH449', 'PGUTAH449', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH006', 'PGUTAH006', 'UT01', 'Salt Lake Reg Hosp - Gero Psych', 'David', 'B', 'Brown', 'PA-C', 'Mental Health', 'Physician Assistant', NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003990573', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH007', 'PGUTAH007', 'UT01', 'Salt Lake Reg Hosp -  Gero Psych', 'David', 'B', 'Brown', 'PA-C', 'Mental Health', 'Physician Assistant', NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003990573', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH226', 'PGUTAH226', 'UT01', 'Jordan Valley Neurology', 'Thomas ', 'M', 'Buchanan', 'MD', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710162227', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH227', 'PGUTAH227', 'UT01', 'Jordan Valley Neurology Associates', 'Thomas ', 'M', 'Buchanan', 'MD', 'Neurology', '', '', NULL, 'O', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710162227', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH228', 'PGUTAH228', 'UT01', 'Neurology Associates', 'Thomas ', 'M', 'Buchanan', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 30384', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710162227', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH289', 'PGUTAH289', 'UT01', 'Davis Comp Health Psych Services', 'David', 'W', 'Carrington', '', 'Mental Health', 'Psychiatry', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077377', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942323654', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH290', 'PGUTAH290', 'UT01', 'Davis Comp Health Psych Services', 'David', 'W', 'Carrington', '', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942323654', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH229', 'PGUTAH229', 'UT01', 'Legacy Point Womens Center', 'Stacie', 'B', 'Carter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3110 W 300 N Ste B', 'West Point', 'Davis', 'UT', '84015', '8016145270', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710180591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH131', 'PGUTAH131', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'Reid', 'C', 'Harrison', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643101', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356373500', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH132', 'PGUTAH132', 'UT01', 'Pioneer Valley Hospital Physicians', 'Reid', 'C', 'Harrison', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356373500', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH175', 'PGUTAH175', 'UT01', 'Physician Group of Utah', 'Amanda', '', 'Hall', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8014088123', '8014088124', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568773935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH174', 'PGUTAH174', 'UT01', 'Physician Group of Utah', 'Amanda', '', 'Hall', 'PA-C', 'Family Practice', '', '', NULL, 'O', '324 E 10th Ave Ste 172', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088123', '8014088124', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568773935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH061', 'PGUTAH061', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174617310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH060', 'PGUTAH060', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174617310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12043203', 'W12043203', 'IDBOISTD', 'Saint Alphonsus Medical Group Podiatry Iowa', 'Trent', 'E', 'Corpron', 'DPM', 'Podiatry', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-02-03', '2014-05-04', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center  ', '', '', 'HCFA|UB|', '1871760603', 0, 'N', 0, '2014-06-10', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('260553931', 'W12043204', 'W12043204', 'IDBOISTD', 'Saint Alphonsus Medical Group Podiatry Caldwell', 'Trent', 'E', 'Corpron', 'DPM', 'Podiatry', '', '', NULL, 'O', '1906 Fairview Ave Ste 430', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1906 Fairview Ave Ste 430', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-02-03', '2014-05-04', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center  ', '', '', 'HCFA|UB|', '1871760603', 0, 'N', 0, '2014-06-10', NULL, NULL, 43.6588, -116.677, 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
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('820200895', 'W12043205', 'W12043205', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN EHP', 'Amy', 'E', 'English-Burt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083676237', '2083676232', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083676237', '2083676232', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1568407765', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W12044014', 'W12044014', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Mary', '', 'Jeffress', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326003377', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('820312175', 'W12043207', 'W12043207', 'ID01', 'Idaho Emergency Physicians PA', 'Mark', 'C', 'Thomas', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1134142623', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12043208', 'W12043208', 'ID01', 'Idaho Emergency Physicians PA', 'Mark', 'C', 'Thomas', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1134142623', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12043209', 'W12043209', 'ID01', 'Idaho Emergency Physicians PA', 'Mark', 'C', 'Thomas', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083221730', '2083221731', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1134142623', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820312175', 'W12043211', 'W12043211', 'ID01', 'Idaho Emergency Physicians PA', 'Elisha', '', 'Jimenez', 'PA', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2013-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487920674', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12043213', 'W12043213', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', 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, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12043214', 'W12043214', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Urgent Care', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', 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, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12043215', 'W12043215', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Urgent Care', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', 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, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6534, -116.695, NULL, NULL),
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('820200895', 'W12043217', 'W12043217', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12043218', 'W12043218', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12043219', 'W12043219', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Urgent Care', 'Kathryn', 'H', 'Fuhriman', 'PA', 'Urgent Care', '', '', 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, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992147201', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12043221', 'W12043221', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Michael', 'F', 'Reidy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609950500', 0, 'Y', 0, '2014-01-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12043222', 'W12043222', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep', 'Michael', 'F', 'Reidy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609950500', 0, 'Y', 0, '2014-01-13', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12043224', 'W12043224', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'Sergei', 'V', 'Kashirny', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1548452683', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'W12043226', 'W12043226', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Jeffery', 'L', 'Johnson', 'PA', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609887801', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12043228', 'W12043228', 'IDBOISTD', 'Saint Alphonsus Medical Group Gynecology/Oncology', 'Polina', '', 'Kokoulina', 'PA', 'Gynecologic Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083675227', '2083675225', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083675227', '2083675225', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1013342468', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12043230', 'W12043230', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Talia', 'M', 'Sierra', 'PA', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1629228978', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12043231', 'W12043231', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Diane', 'K', 'Turner', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467498196', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.7, -116.35, NULL, NULL),
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('262072378', 'W12043288', 'W12043288', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Stephen', 'M', 'Rees', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8013741801', '8012168357', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-08', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1689750838', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.045, -111.713, NULL, NULL),
('529379607', 'W12043287', 'W12043287', 'UTMH1', 'Darlene Horton CMHC, ASUDC', 'Darlene', '', 'Horton', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1800 W Royal Hunte Dr Ste 4', 'Cedar City', 'Iron', 'UT', '84720', '4358676471', '4355864363', '1800 W Royal Hunte Dr Ste 4', 'Cedar City', 'Iron', 'UT', '84720', '4358676471', '4355864363', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609065044', 0, 'N', 0, '2014-02-02', NULL, NULL, 37.6579, -113.086, NULL, NULL),
('264814166', 'W12043291', 'W12043291', 'Test', '', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', '', '', '', '0.00', '0.00', '75.00', 8, '2014-01-15', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12043407', 'W12043407', 'UT01', 'Jordan Valley Surgical Specialists', 'Kris', '', 'Mitchell', '', 'General Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205040664', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043298', 'W12043298', 'WYBILLINGS', 'Billings Clinic - Rehab', 'Annalee', 'L', 'Anderson', 'ST', 'Speech Therapy', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083047088', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043299', 'W12043299', 'WYBILLINGS', 'Billings Clinic', 'Annalee', 'L', 'Anderson', 'ST', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083047088', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W12043302', 'W12043302', 'WYBILLINGS', 'Billings Clinic', 'Rick', 'L', 'Pullen', 'DO', 'Psychiatry', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588738660', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043303', 'W12043303', 'WYBILLINGS', 'Billings Clinic', 'Rick', 'L', 'Pullen', 'DO', 'Psychiatry', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588738660', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043304', 'W12043304', 'WYBILLINGS', 'Billings Clinic - Psychiatry', 'Rick', 'L', 'Pullen', 'DO', 'Psychiatry', '', '', NULL, 'O', '2950 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062525430', '2950 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062525430', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588738660', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043306', 'W12043306', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Bridget', 'C', 'Eckley', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912288283', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043307', 'W12043307', 'WYBILLINGS', 'Billings Clinic', 'Bridget', 'C', 'Eckley', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912288283', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043308', 'W12043308', 'WYBILLINGS', 'Billings Clinic', 'Bridget', 'C', 'Eckley', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912288283', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043309', 'W12043309', 'WYBILLINGS', 'Billings Clinic', 'Julia', 'A', 'Mitzel', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053340232', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12038855', 'W12038855', 'WYBILLINGS', 'Billings Clinic OB/GYN', 'Julia', 'A', 'Mitzel', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '', '', '', '0.00', '17.00', '0.00', 3, '2013-06-06', '2014-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1053340232', 0, 'N', 0, '2014-02-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043310', 'W12043310', 'WYBILLINGS', 'Billings Clinic', 'Julia', 'A', 'Mitzel', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053340232', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12043311', 'W12043311', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Julia', 'A', 'Mitzel', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053340232', 0, 'N', 0, '2014-02-20', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047456', 'W12047456', 'WYT1', 'Big Country Rehab', 'Jessica', '', 'McWilliams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1609107259', 0, 'N', 1, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12043313', 'W12043313', 'UTIHC04', 'PCMC Rehab Bountiful', 'Stacy', 'M', 'Gillette', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457378424', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12043315', 'W12043315', 'UTIHC04', 'PCMC Rehab Ogden', 'Ann', 'M', 'Hoffman', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3903 Harrison Blvd ', 'Ogden', 'Weber', 'UT', '84403', '8013876603', NULL, '3903 Harrison Blvd ', 'Ogden', 'Weber', 'UT', '84403', '8013876603', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790762011', 0, 'N', 0, '2014-01-15', NULL, NULL, 41.1922, -111.949, NULL, NULL),
('942854057', 'W12043316', 'W12043316', 'UTIHC04', 'Primary Childrens Medical Center', 'Adrienne', 'B', 'Jackson', 'AUD', 'Audiology', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902087687', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12043317', 'W12043317', 'UTIHC04', 'Sanpete Valley Hospital', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12043318', 'W12043318', 'UTIHC04', 'Delta Community Medical Center', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12043319', 'W12043319', 'UTIHC04', 'Fillmore Community Medical Center', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4358645591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('830335677', 'W12047452', 'W12047452', 'WY01', 'Big Country Rehab', 'Jessica', '', 'McWilliams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1609107259', 0, 'N', 1, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12043320', 'W12043320', 'UTIHC04', 'Sevier Valley Medical Center', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12043321', 'W12043321', 'UTIHC04', 'Heber Valley Medical Center', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Brigham City', 'Box Elder', 'UT', '84302', '4356542500', NULL, '1485 S Hwy 40', 'Brigham City', 'Box Elder', 'UT', '84302', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('841625538', 'W12043324', 'W12043324', 'UT01', 'Beyond Limits Phyiscal Therapy', 'Isaak', 'L', 'Duncan', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1164851267', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.5079, -112.027, NULL, NULL),
('841625538', 'W12043323', 'W12043323', 'UT01', 'Beyond Limits Phyiscal Therapy', 'Isaak', 'L', 'Duncan', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3726 E Campus Dr Ste H', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017897333', '8017897444', '3726 E Campus Dr Ste H', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017897333', '8017897444', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1164851267', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.3802, -111.972, NULL, NULL),
('455125865', 'W12043326', 'W12043326', 'UT01', 'Utah Physical Therapy, Inc.', 'Justin', 'Denis', 'Longhurst', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4640 S 3500 W Ste 3', 'Ogden', 'Weber', 'UT', '84401', '8016890200', '8016890201', '4640 S 3500 W Ste 3', 'Ogden', 'Weber', 'UT', '84401', '8016890200', '8016890201', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255763439', 0, 'N', 0, '2014-01-15', NULL, NULL, 41.1794, -112.064, NULL, NULL),
('455125865', 'W12043327', 'W12043327', 'UT01', 'Utah Physical Therapy, Inc.', 'Justin', 'Denis', 'Longhurst', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 66', 'Hooper', 'Weber', 'UT', '84315', '8016890200', '8016890201', 'PO Box 66', 'Hooper', 'Weber', 'UT', '84315', '8016890200', '8016890201', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255763439', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('208984522', 'W12043329', 'W12043329', 'UT01', 'Precision Rehabiltiation Blanding', 'Shontol', '', 'Burkhalter', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356783769', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356783769', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013349935', 0, 'N', 0, '2014-02-10', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('208984522', 'W12043330', 'W12043330', 'UT01', 'Precision Rehabiltiation Blanding', 'Shontol', '', 'Burkhalter', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 745', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356783769', 'PO Box 745', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356783769', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013349935', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12043333', 'W12043333', 'IDREC', 'St Lukes Pediatrics Surgery of Idaho', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '100 E Idaho St Ste 315', 'Boise', 'Ada', 'ID', '83712', '2083817020', '0000000000', '100 E Idaho St Ste 315', 'Boise', 'Ada', 'ID', '83712', '2083817020', '0000000000', '', '', '', '0.00', '0.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12043335', 'W12043335', 'IDREC', 'St Lukes Pediatric Surgery of Idaho (Recognized PPO but not contracted pre-auth required)', 'Christina', 'G', 'Biller', 'MD', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083817020', '          ', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083817020', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689830820', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12043361', 'W12043361', 'TXHOUSTD', 'Lone Star Family Health Center', 'Daniel', 'M', 'Porter', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1356555866', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL);
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('262498431', 'W12043383', 'W12043383', 'TXSATSTD', 'Cedar Hills Family Practice ', 'Lydia', '', 'Avila', 'MD', 'Family Practice', '', '', NULL, 'O', '3166 SE Military Dr Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2102984711', '2102984717', '3166 SE Military Dr Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2102984711', '2102984717', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, '', '', 'HCFA|', '1982825964', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
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('208475454', 'W12043392', 'W12043392', 'ID02', 'Black Canyon Family Medicine', 'Brett', 'T', 'Mumford', 'DO', 'Family Practice', '', '', NULL, 'B', '1475 Tyrell Ln', 'Boise', 'Ada', 'ID', '83706', '2083656311', '2083651003', '1475 Tyrell Ln', 'Boise', 'Ada', 'ID', '83706', '2083656311', '2083651003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164463113', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12043682', 'W12043682', 'IDBOISTD', 'Primary Health Medical Group', 'Patrick', 'D', 'Stowell', 'MD', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720022239', 0, 'N', 0, '2014-02-11', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12028454', 'W12028454', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '1603 E 12th Ave Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 E 12th Ave Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'W12043426', 'W12043426', 'TXSATSTD', 'Consultants in Womens Health', 'Barbara', '', 'McLaren', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', '2104956578', '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', '2104956578', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437231479', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('010852954', 'W12043394', 'W12043394', 'UT01', 'Southeastern Utah Eye Clinic ', 'Mason', 'G', 'Livingston', 'OD', 'Optometry', '', '', NULL, 'O', '54 E 100 N', 'Price', 'Carbon', 'UT', '84501', '4356372414', '4356378205', '54 E 100 N', 'Price', 'Carbon', 'UT', '84501', '4356372414', '4356378205', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962841221', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'W12043425', 'W12043425', 'TXSATSTD', 'Consultants in Womens Health', 'Barbara', '', 'McLaren', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3327 Research Plaza Ste 206', 'San Antonio', 'Bexar', 'TX', '78235', '2106535501', '2106505993', '3327 Research Plaza Ste 206', 'San Antonio', 'Bexar', 'TX', '78235', '2106535501', '2106505993', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437231479', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.3447, -98.4359, NULL, NULL),
('264333033', 'W12043427', 'W12043427', 'TXSATSTD', 'Consultants in Womens Health', 'Barbara', '', 'McLaren', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1437231479', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
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('841401924', 'W12045695', 'W12045695', 'UT01', 'Alpine Medical Group', 'Phyllis', 'K', 'Mandel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', '8013504361', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', '8013504361', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-20', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1174748404', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12043441', 'W12043441', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Herson', 'CNP', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013968148', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('461327827', 'W12043437', 'W12043437', 'UTMH1', 'Resilience Counseling Services', 'Carl', 'J', 'Sorenson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '580 N Main St Ste 250-A', 'Moab', 'Grand', 'UT', '84532', '4356120788', NULL, '580 N Main St Ste 250-A', 'Moab', 'Grand', 'UT', '84532', '4356120788', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033349659', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'W12044769', 'W12044769', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Hong', '', 'Vo', 'MD', 'Anesthesiology', '', '', NULL, 'O', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', '2401 Ravine Way Ste 200', 'Glenview', 'Cook', 'IL', '60025', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2014-01-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447419940', 0, 'N', 0, '2014-02-21', NULL, NULL, 42.1019, -87.8102, NULL, NULL),
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('760540476', 'W12044785', 'W12044785', 'TXHOUSTD', 'Oakbend Medical Group', 'Debbie', '', 'Banks', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334930', '2816334933', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334930', '2816334933', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932537925', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('753083159', 'W12044786', 'W12044786', 'TXDALSTD', '', 'Rizwan', 'H', 'Bukhari', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '3865 Childress Ave Ste A', 'Mesquite', 'Dallas', 'TX', '75150', '2148262114', '2148219325', '3865 Childress Ave Ste A', 'Mesquite', 'Dallas', 'TX', '75150', '2148262114', '2148219325', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225076227', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('363819982', 'W12044717', 'W12044717', 'ILCHIGSTD', 'Accelerated Rehabilitation Centers', '', '', 'Accelerated Rehabilitation Centers', '', 'Physical Therapy', '', '', NULL, 'O', '1348 Patriot Blvd', 'Glenview', 'Cook', 'IL', '60026', '8479983433', '8479984063', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '0.00', '95.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA| ', '1205875713', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('770621510', 'W12044720', 'W12044720', 'TXSATSTD', '', 'Mika', 'K', 'Cole', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '8001 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2109304555', '2109300893', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-28', NULL, 0, 0, NULL, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1285688168', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('518966578', 'W12044781', 'W12044781', 'ID01', '', 'Kelly', 'W', 'Wedeven', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '750 Warm Springs Ave Ste D', 'Boise', 'Ada', 'ID', '83712', '2088412318', '          ', '750 Warm Springs Ave Ste D', 'Boise', 'Ada', 'ID', '83712', '2088412318', '          ', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1912923871', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('820497538', 'W12044722', 'W12044722', 'ID01', 'All Seasons Mental Health ', 'Tanya', '', 'White', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', '2083211082', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', '2083211082', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811229552', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('810622020', 'W12044719', 'W12044719', 'WYT1', 'Yellowstone Imaging', '', '', 'Yellowstone Imaging', '', 'Imaging Center', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781898', '3075781894', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781898', '3075781894', '', '', '', '0.00', '15.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1558437913', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('202422775', 'W12044787', 'W12044787', 'UT01', 'Wasatch Endocrinology and Diabetes Specialists', 'Robert', 'E', 'Burr', 'MD', 'Endocrinology', 'Diabetes', '', NULL, 'O', '1233 E Second St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '0000000000', '1233 E Second St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-20', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770533788', 0, 'N', 0, '2014-02-24', NULL, NULL, 42.8487, -106.309, NULL, NULL),
('262978009', 'W12044790', 'W12044790', 'TXDALSTD', 'Baylor Emergency Medical Center at Murphy', '', '', 'Baylor Emergency Medical Center at Murphy', '', 'Hospital', '', '', NULL, 'B', 'PO Box 48029', 'Houston', 'Harris', 'TX', '77210', '2142946150', NULL, 'PO Box 48029', 'Houston', 'Harris', 'TX', '77210', '2142946150', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-02-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619308319', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
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('363330928', 'W12044793', 'W12044793', 'ILCHIGSTD', 'Presence Healthcare Services', 'Suhair', '', 'Abdel-Jalil', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142499', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1932216819', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12044792', 'W12044792', 'ILCHIGSTD', 'Presence Healthcare Services', 'Suhair', '', 'Abdel-Jalil', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '800 Austin Ave Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', '800 Austin Ave Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1932216819', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('463266853', 'W12044794', 'W12044794', 'UT01', 'Freedom Healthcare', 'Jeffery', 'S', 'Nelson', 'DO', 'Family Practice', '', '', NULL, 'O', '2015 Sidewinder Dr', 'Park City', 'Summit', 'UT', '84060', '8019878800', '8018787507', '2015 Sidewinder Dr', 'Park City', 'Summit', 'UT', '84060', '8019878800', '8018787507', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619961315', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
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('463266853', 'W12044796', 'W12044796', 'UT01', 'Freedom Healthcare', 'Jeffery', 'S', 'Nelson', 'DO', 'Family Practice', '', '', NULL, 'O', '653 N Landmark Ste E', 'Park City', 'Summit', 'UT', '84098', '8019878800', '8018787507', '653 N Landmark Ste E', 'Park City', 'Summit', 'UT', '84098', '8019878800', '8018787507', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619961315', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
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('366763171', 'W12044799', 'W12044799', 'ID01', '', 'Heidi', 'M', 'Lasser', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1865 N Lakes Pl', 'Meridian', 'Ada', 'ID', '83646', '2088552295', NULL, '1865 N Lakes Pl', 'Meridian', 'Ada', 'ID', '83646', '2088552295', '          ', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2014-02-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982884110', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6214, -116.383, NULL, NULL),
('202630141', 'W12044800', 'W12044800', 'IDBOISTD', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W12044802', 'W12044802', 'IDBOISTD', 'Primary Health Medical Group', 'Katie', '', 'Weller', 'CFNP', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275584534', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044803', 'W12044803', 'IDBOISTD', 'Primary Health Medical Group', 'James', '', 'Yerger', 'MD', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265477962', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('202630141', 'W12044804', 'W12044804', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044805', 'W12044805', 'IDBOISTD', 'Primary Health Medical Group', 'Becky', NULL, 'Wells', 'PA', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780617811', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044806', 'W12044806', 'IDBOISTD', 'Primary Health Medical Group', 'James', '', 'Weiss', 'MD', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1598701757', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044807', 'W12044807', 'IDBOISTD', 'Primary Health Medical Group', 'Nathan', 'J', 'Ward', 'DO', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487967089', 0, 'Y', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W12044819', 'W12044819', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044820', 'W12044820', 'IDBOISTD', 'Primary Health Medical Group', 'Michael ', '', 'Graff', 'MD', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689603219', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044821', 'W12044821', 'IDBOISTD', 'Primary Health Medical Group', 'Jeremy', '', 'Frix', 'PA', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164450862', 0, 'Y', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12044822', 'W12044822', 'IDBOISTD', 'Primary Health Medical Group', 'Scott', '', 'Frisby', 'PA', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1982857702', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
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('464746305', 'W12044834', 'W12044834', 'UTMH1', '', 'Georgia', 'A', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '1348 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014676136', '8014676157', '1348 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014676136', '8014676157', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2014-02-06', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689627416', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.7405, -111.86, NULL, NULL),
('870609622', 'W12044835', 'W12044835', 'UT01', 'Snow Canyon Clinic', 'Vernon', 'H', 'Kirk', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750343372', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870609622', 'W12044836', 'W12044836', 'UT01', 'Snow Canyon Clinic', 'William', 'F', 'Esplin', 'DO', 'Family Practice', '', '', NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093923393', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870609622', 'W12044837', 'W12044837', 'UT01', 'Snow Canyon Clinic', 'Carl', 'P', 'Hallenborg', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508978651', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870609622', 'W12044838', 'W12044838', 'UT01', 'Snow Canyon Clinic', 'Dana', 'B', 'Hardin', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356341320', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356341320', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053381558', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870609622', 'W12044839', 'W12044839', 'UT01', 'Snow Canyon Clinic', 'John', 'G', 'Schmidt', 'MD', 'Neurology', NULL, NULL, NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295786507', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870609622', 'W12044840', 'W12044840', 'UT01', 'Snow Canyon Clinic', 'Laura', 'J', 'Schlagel', 'MD', 'Neurology', '', '', NULL, 'B', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', '640 E 700 S Ste 205', 'St George', 'Washington', 'UT', '84770', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306803226', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('461715412', 'W12044841', 'W12044841', 'UT01', 'Rebirth OB/GYN', 'Rixt', 'A', 'Luikenaar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 E 4500 S Ste 265', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012723909', '8012723902', '2180 E 4500 S Ste 265', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012723909', '8012723902', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1285688101', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('460752191', 'W12044842', 'W12044842', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'Todd', '', 'Morrison', '', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1201 S Main St Ste 1', 'Logan', 'Cache', 'UT', '84321', '4352324279', '8886685207', '1201 S Main St Ste 1', 'Logan', 'Cache', 'UT', '84321', '4352324279', '8886685207', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134567282', 0, 'N', 0, '2014-04-29', NULL, NULL, 41.7102, -111.835, NULL, NULL),
('460752191', 'W12044843', 'W12044843', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'Todd', '', 'Morrison', '', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4352324279', '8886685207', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4352324279', '8886685207', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134567282', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('460752191', 'W12044844', 'W12044844', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'David', '', 'Skalka', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4352324279', '8886685207', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '4352324279', '8886685207', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851692735', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('460752191', 'W12044845', 'W12044845', 'UT01', 'Mountain View Urgent Care & Family Medicine ', 'David', '', 'Skalka', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1201 S Main St Ste 2', 'Logan', 'Cache', 'UT', '84321', '4352324279', '8886685207', '1201 S Main St Ste 2', 'Logan', 'Cache', 'UT', '84321', '4352324279', '8886685207', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851692735', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.7102, -111.835, NULL, NULL),
('830300467', 'W12044849', 'W12044849', 'WY01', 'Powell Valley Healthcare', 'Bergen', '', 'Vardell', 'WHCNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', NULL, '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942359757', 0, 'N', 0, '2014-02-25', NULL, NULL, 44.7567, -108.769, NULL, NULL),
('830300467', 'W12044847', 'W12044847', 'WY01', 'Powell Valley Healthcare', 'Bergen', '', 'Vardell', 'WHCNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '450 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3077547257', NULL, '450 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942359757', 0, 'N', 0, '2014-02-25', NULL, NULL, 44.7554, -108.77, NULL, NULL),
('830300467', 'W12044848', 'W12044848', 'WYT1', 'Powell Valley Healthcare', 'Bergen', '', 'Vardell', 'WHCNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '450 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3077547257', NULL, '450 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942359757', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('830300467', 'W12044850', 'W12044850', 'WYT1', 'Powell Valley Healthcare', 'Bergen', '', 'Vardell', 'WHCNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', NULL, '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077542267', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942359757', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12044852', 'W12044852', 'UT01', 'Wasatch Pediatrics', 'Lulu', '', 'Waterhouse', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1558687236', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12044853', 'W12044853', 'UT01', 'Wasatch Pediatrics', 'LuLu', '', 'Waterhouse', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1558687236', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12044855', 'W12044855', 'ID02', 'Family Medicine Health Center', 'Allyson', 'R', 'Bateman', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306157466', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12044856', 'W12044856', 'ID02', 'Family Medicine Health Center', 'Allyson', 'R', 'Bateman', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306157466', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12044857', 'W12044857', 'UT01', 'Pioneer Valley Hospital', 'Isaac', '', 'Alfaro', 'APRN', 'Mental Health', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-20', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093817884', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('621801973', 'W12044858', 'W12044858', 'UT01', 'Davis Hospital & Medical Center', 'Isaac', '', 'Alfaro', 'APRN', 'Mental Health', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '0000000000', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-20', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093817884', 0, 'N', 0, '2014-02-25', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('621801973', 'W12044859', 'W12044859', 'UT01', 'Salt Lake Regional Medical Center', 'Isaac', '', 'Alfaro', 'APRN', 'Mental Health', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-20', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093817884', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12044860', 'W12044860', 'UT01', 'Physician Group of Utah', 'Isaac', '', 'Alfaro', 'APRN', 'Mental Health', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8014088123', '8014088124', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8014088123', '8014088124', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-20', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093817884', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044861', 'W12044861', 'WY01', 'Memorial Hospital of Sweetwater County', '', '', 'Memorial Hospital of Sweetwater County', 'GROUP', 'Hospital', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', NULL, '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007562', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044862', 'W12044862', 'WYT2', 'Memorial Hospital of Sweetwater County', '', '', 'Memorial Hospital of Sweetwater County', 'GROUP', 'Hospital', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', NULL, '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007562', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12044863', 'W12044863', 'NM01', 'New Mexico Heart Institute', 'Joanna', 'A', 'Brightwater', 'CNP', 'Geriatrics', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1689947038', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('900935499', 'W12044866', 'W12044866', 'UT01', 'Lumina Vision', 'Benjamin', 'H', 'Leishman', 'OD', 'Optometry', '', '', NULL, 'O', '1025 E 11400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84094', '3852023937', '3852328083', '1025 E 11400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84094', '3852023937', '3852328083', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942438015', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.5443, -111.862, NULL, NULL),
('836000295', 'W12044873', 'W12044873', 'WY01', 'Memorial Hospital of Sweetwater County', 'Neal', 'V', 'Asper', 'DO', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710115753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044878', 'W12044878', 'WY01', 'Memorial Hospital of Sweetwater County', 'Steven', 'A', 'Croft', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497957153', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044876', 'W12044876', 'WY01', 'Memorial Hospital of Sweetwater County', 'Steven', 'A', 'Croft', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497957153', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044883', 'W12044883', 'WY01', 'Memorial Hospital of Sweetwater County', 'David', 'L', 'Mischel', 'NP', 'Psychiatry', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1811329006', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044882', 'W12044882', 'WY01', 'Memorial Hospital of Sweetwater County', 'David', 'L', 'Mischel', 'NP', 'Psychiatry', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1811329006', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044891', 'W12044891', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Jad', '', 'Wakim', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3073822234', '3073626737', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3073822234', '3073626737', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1205099959', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044890', 'W12044890', 'WY01', 'Memorial Hospital of Sweetwater County', 'Jad', '', 'Wakim', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3073822234', '3073626737', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3073822234', '3073626737', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1205099959', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044896', 'W12044896', 'WYT2', 'Memorial Hospital of Sweetwater County', 'James', '', 'Douglas', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528518', '3073528180', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528518', '3073528180', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1851476659', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044895', 'W12044895', 'WY01', 'Memorial Hospital of Sweetwater County', 'James', '', 'Douglas', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528518', '3073528180', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528518', '3073528180', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1851476659', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044877', 'W12044877', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Steven', 'A', 'Croft', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497957153', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044900', 'W12044900', 'WYT2', 'Memorial Hospital of Sweetwater County', 'James', 'T', 'Nelson', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710116231', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044901', 'W12044901', 'WY01', 'Memorial Hospital of Sweetwater County', 'James', 'T', 'Nelson', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710116231', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044905', 'W12044905', 'WY01', 'Memorial Hospital of Sweetwater County', 'Jeffrey', 'S', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1790952406', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044904', 'W12044904', 'WY01', 'Memorial Hospital of Sweetwater County', 'Jeffrey', 'S', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 102', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '1204 Hilltop Dr Ste 102', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528545', '3073528583', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1790952406', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044908', 'W12044908', 'WY01', 'Memorial Hospital of Sweetwater County', 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1477564465', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044910', 'W12044910', 'WY01', 'Memorial Hospital of Sweetwater County', 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073826615', '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073826615', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1477564465', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044911', 'W12044911', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073826615', '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '3073826615', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1477564465', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044915', 'W12044915', 'WY01', 'Memorial Hospital of Sweetwater County', 'Laura', 'J', 'Heitz', 'FNP', 'Family Practice', '', '', NULL, 'O', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', '3073825099', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', '3073825099', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013090554', 0, 'N', 1, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044920', 'W12044920', 'WYT2', 'Memorial Hospital Obstetrics & Womens Health', 'Peter', 'G', 'Allyn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801991013', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044919', 'W12044919', 'WY01', 'Memorial Hospital Obstetrics & Womens Health', 'Peter', 'G', 'Allyn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801991013', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
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('836000295', 'W12044955', 'W12044955', 'WY01', 'Memorial Hospital of Sweetwater County', 'Amy', '', 'Dolce', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1588791826', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044956', 'W12044956', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Amy', '', 'Dolce', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1588791826', 0, 'N', 0, '2014-03-20', 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
('836000295', 'W12044957', 'W12044957', 'WYT2', 'Memorial Hospital Family Practice', 'Amy', '', 'Dolce', 'PA', 'Internal Medicine', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1588791826', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044958', 'W12044958', 'WY01', 'Memorial Hospital Family Practice', 'Amy', '', 'Dolce', 'PA', 'Internal Medicine', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1588791826', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044960', 'W12044960', 'WY01', 'Memorial Hospital Pulmonology', 'Pritam', '', 'Neupane', 'MD', 'Pulmonary', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822234', '3073626737', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822234', '3073626737', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801939772', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044961', 'W12044961', 'WYT2', 'Memorial Hospital Pulmonology', 'Pritam', '', 'Neupane', 'MD', 'Pulmonary', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822234', '3073626737', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822234', '3073626737', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801939772', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044962', 'W12044962', 'WY01', 'Memorial Hospital of Sweetwater County', 'Pritam', '', 'Neupane', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801939772', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044963', 'W12044963', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Pritam', '', 'Neupane', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801939772', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12044964', 'W12044964', 'UT01', 'MountainStar Urgent Care at Jordan Family Health', '', '', 'HCA Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010141', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('463979717', 'W12044966', 'W12044966', 'UT01', 'MountainStar Urgent Care at Layton Family Medicine', '', '', 'HCA Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010141', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('463979717', 'W12044967', 'W12044967', 'UT01', 'Layton Family Medicine LLC', '', '', 'HCA Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010141', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12044968', 'W12044968', 'UT01', 'MountainStar Urgent Care at Layton Family Medicine', '', '', 'HCA Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010141', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12044969', 'W12044969', 'UT01', 'Layton Family Medicine LLC', '', '', 'HCA Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010141', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('463979717', 'W12044970', 'W12044970', 'UT01', 'MountainStar Urgent Care at Layton Family Medicine', 'Robert', '', 'Gertge', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356402374', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12044972', 'W12044972', 'UT01', 'Layton Family Practice', 'Randall', '', 'Archibald', 'PA', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396752119', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('161767581', 'W12044976', 'W12044976', 'UT01', 'Layton Family Medicine LLC', 'Randall', '', 'Archibald', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396752119', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('463979717', 'W12044977', 'W12044977', 'UT01', 'Layton Family Medicine LLC', 'Randall', '', 'Archibald', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396752119', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('463979717', 'W12044980', 'W12044980', 'UT01', 'MountainStar Urgent Care at Layton Family Medicine', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('463979717', 'W12044982', 'W12044982', 'UT01', 'Layton Family Medicine LLC', 'Casey', 'L', 'Stelter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017717700', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073607222', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('363097297', 'W12044984', 'W12044984', 'ILCHIGSTD', 'Northwestern Medical Faculty Foundation', 'Kush', '', 'Desai', 'MD', 'Interventional Radiology', '', '', NULL, 'O', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1194906560', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('363097297', 'W12044987', 'W12044987', 'ILCHIGSTD', 'Northwestern Medical Faculty Foundation', 'Ryan', '', 'Hickey', 'MD', 'Interventional Radiology', '', '', NULL, 'O', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1972669265', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('363097297', 'W12044988', 'W12044988', 'ILCHIGSTD', 'Northwestern Medical Faculty Foundation', 'Ryan', '', 'Hickey', 'MD', 'Interventional Radiology', '', '', NULL, 'B', '38205 Eagle Way', 'Chicago', 'Cook', 'IL', '60678', '3126951901', '3129265645', '38205 Eagle Way', 'Chicago', 'Cook', 'IL', '60678', '3126951901', '3129265645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1972669265', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('363097297', 'W12044990', 'W12044990', 'ILCHIGSTD', 'Northwestern Medical Faculty Foundation', 'George', '', 'Hohlastos', 'MD', 'Interventional Radiology', '', '', NULL, 'O', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', '1200 S York Rd Ste 3100', 'Elmhurst', 'Dupage', 'IL', '60126', '3129265645', '3129265645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780830539', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('363097297', 'W12044991', 'W12044991', 'ILCHIGSTD', 'Northwestern Medical Faculty Foundation', 'George', '', 'Hohlastos', 'MD', 'Interventional Radiology', '', '', NULL, 'B', '38205 Eagle Way', 'Chicago', 'Cook', 'IL', '60678', '3126951901', '3129265645', '38205 Eagle Way', 'Chicago', 'Cook', 'IL', '60678', '3126951901', '3129265645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780830539', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('360176561', 'W12044993', 'W12044993', 'ILCHIGSTD', 'Midwest Orthopedics at Rush LLC', 'David', '', 'Garras', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', '2014-02-19', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1386847283', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('360176561', 'W12044994', 'W12044994', 'ILCHIGSTD', 'Midwest Orthopedics at Rush LLC', 'David', '', 'Garras', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '3129421517', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', '2014-02-19', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1386847283', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('360176561', 'W12044995', 'W12044995', 'ILCHIGSTD', 'Midwest Orthopedics at Rush LLC', 'David', '', 'Garras', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', '2014-02-19', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1386847283', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12044998', 'W12044998', 'ILCHIGSTD', 'Hinsdale Orthopedic Associates SC', 'Steven', '', 'Chudik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1010 Executive Ct Ste 250', 'Westmont', 'Dupage', 'IL', '60559', '6309202350', '6309202381', '1010 Executive Ct Ste 250', 'Westmont', 'Dupage', 'IL', '60559', '6309202350', '6309202381', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1215029210', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12044997', 'W12044997', 'ILCHIGSTD', 'Elmhurst PHO', 'Steven', '', 'Chudik', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303234358', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303234358', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1215029210', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045002', 'W12045002', 'ILCHIGSTD', 'Elmhurst PHO', 'Nathan', '', 'Fanter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303712719', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303712719', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1194980607', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045001', 'W12045001', 'ILCHIGSTD', 'Hinsdale Orthopedic Associates SC', 'Nathan', '', 'Fanter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '6302792401', '6302792519', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '6302792401', '6302792519', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1194980607', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045000', 'W12045000', 'ILCHIGSTD', 'Hinsdale Orthopedic Associates SC', 'Nathan', '', 'Fanter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1194980607', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045004', 'W12045004', 'ILCHIGSTD', 'Hinsdale Orthopedic Associates SC', 'Victor', '', 'Romano', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '7088484662', '7088487113', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '7088484662', '7088487113', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1033149901', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045005', 'W12045005', 'ILCHIGSTD', 'Hinsdale Orthopedic Associates SC', 'Victor', '', 'Romano', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1033149901', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12045006', 'W12045006', 'ILCHIGSTD', 'Elmhurst PHO', 'Victor', '', 'Romano', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303712719', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303712719', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1033149901', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045008', 'W12045008', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ann', '', 'Hackfort', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308012589', '6308013232', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308012589', '6308013232', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1538470398', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045010', 'W12045010', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ann', '', 'Hackfort', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1538470398', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045009', 'W12045009', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ann', '', 'Hackfort', 'DO', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1538470398', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045012', 'W12045012', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jessica', '', 'Dube', 'NP', 'Psychiatry', '', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841527538', 0, 'Y', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045013', 'W12045013', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jessica', '', 'Dube', 'NP', 'Psychiatry', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841527538', 0, 'Y', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12045015', 'W12045015', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Joseph', 'W', 'Petrie', 'PA', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851721401', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12045016', 'W12045016', 'IDBOISTD', 'Saint Alphonsus Medical Group New Plymouth', 'Joseph', 'W', 'Petrie', 'PA', 'Family Practice', '', '', NULL, 'O', '213 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2086741444', '2086741440', '213 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2086741444', '2086741440', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851721401', 0, 'Y', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045017', 'W12045017', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Baker', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '2083678550', '2083678555', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045018', 'W12045018', 'ID01', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Thomas', '', 'Rambow', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1055 N Curtis Rd 6th Fl', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', '1055 N Curtis Rd 6th Fl', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1679534184', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045020', 'W12045020', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12045031', 'W12045031', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'William', 'Z', 'Allen', 'PA-C', '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, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045032', 'W12045032', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045033', 'W12045033', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'William', 'Z', 'Allen', 'PA-C', '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, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045034', 'W12045034', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'William', 'Z', 'Allen', 'PA-C', '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, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045035', 'W12045035', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045036', 'W12045036', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', 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, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045037', 'W12045037', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045038', 'W12045038', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045039', 'W12045039', 'IDBOISTD', 'Saint Alphonsus Medical Group Curtisian Internal Medicine (Moreau Bldg) ', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045040', 'W12045040', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald  ', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045042', 'W12045042', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820435241', 'W12045043', 'W12045043', 'ID02', 'Idaho Physical Medicine and Rehabilitation', 'Richard', 'A', 'DuBose', 'MD', 'Pain Management', '', '', NULL, 'O', '600 N Robbins Rd Ste 300', 'Boise', 'Ada', 'ID', '83702', '2084894016', '2084894015', '600 N Robbins Rd Ste 300', 'Boise', 'Ada', 'ID', '83702', '2084894016', '2084894015', 'IDACN', '', '', '0.00', '30.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821156365', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('463815168', 'W12045044', 'W12045044', 'ID02', 'Justin Rowe, OD', 'Paul', 'V', 'Hakes', 'OD', 'Optometry', '', '', NULL, 'O', '204 Lenora St', 'Mccall', 'Valley', 'ID', '83638', '2086344161', '2086341716', '204 Lenora St', 'Mccall', 'Valley', 'ID', '83638', '2086344161', '2086341716', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063491835', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045045', 'W12045045', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12045047', 'W12045047', 'NM01', 'New Mexico Heart Institute', '', '', 'New Mexico Heart Institute', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346242575', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044872', 'W12044872', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Neal', 'V', 'Asper', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710115753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044953', 'W12044953', 'WY01', 'Memorial Hospital of Sweetwater County', 'Steven', 'W', 'Babcock', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572101', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044952', 'W12044952', 'WYT2', 'Memorial Hospital Family Practice', 'Steven', 'W', 'Babcock', 'DO', 'Family Practice', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572101', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044954', 'W12044954', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Steven', 'W', 'Babcock', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572101', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12044864', 'W12044864', 'NM01', 'New Mexico Heart Institute', 'Joanna', 'A', 'Brightwater', 'CNP', 'Geriatrics', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1689947038', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044936', 'W12044936', 'WY01', 'Memorial Hospital of Sweetwater County', 'Elina', '', 'Chernyak', 'DO', 'Mental Health', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1710110820', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044937', 'W12044937', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Elina', '', 'Chernyak', 'DO', 'Mental Health', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1710110820', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044879', 'W12044879', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Steven', 'A', 'Croft', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497957153', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044893', 'W12044893', 'WY01', 'Memorial Hospital of Sweetwater County', 'James', '', 'Douglas', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1851476659', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044894', 'W12044894', 'WYT2', 'Memorial Hospital of Sweetwater County', 'James', '', 'Douglas', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1851476659', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
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('836000295', 'W12044922', 'W12044922', 'WYT2', 'Memorial Hospital Obstetrics & Womens Health', 'Samer', '', 'Kattan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528471', '', '', '', '0.00', '5.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1750502753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL);
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('836000295', 'W12044881', 'W12044881', 'WYT2', 'Memorial Hospital of Sweetwater County', 'David', 'L', 'Mischel', 'NP', 'Psychiatry', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1811329006', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12044884', 'W12044884', 'WYT2', 'Memorial Hospital of Sweetwater County', 'David', 'L', 'Mischel', 'NP', 'Psychiatry', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1811329006', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
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('836000295', 'W12044941', 'W12044941', 'WYT2', 'Memorial Hospital Internal Medicine', 'Leah', '', 'Muthuri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073829101', '3073528148', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073829101', '3073528148', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1003059684', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
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('741724391', 'W12044530', 'W12044530', 'TXSATSTD', 'CommuniCare Health Centers', 'Sergio', 'R', 'Rodriguez', 'NP', 'Family Practice', '', '', NULL, 'O', '1102 Barclay St', 'San Antonio', 'Bexar', 'TX', '78207', '2102337000', '2104341704', '1102 Barclay St', 'San Antonio', 'Bexar', 'TX', '78207', '2102337000', '2104341704', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881908077', 0, 'Y', 0, '2014-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('741724391', 'W12044534', 'W12044534', 'TXSATSTD', 'CommuniCare Health Centers', 'Miranda', '', 'Williams', 'NP', 'Family Practice', '', '', NULL, 'O', '1102 Barclay St', 'San Antonio', 'Bexar', 'TX', '78207', '2102337000', '2104341704', '1102 Barclay St', 'San Antonio', 'Bexar', 'TX', '78207', '2102337000', '2104341704', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750710323', 0, 'Y', 0, '2014-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('820435241', 'W12045129', 'W12045129', 'ID02', 'Idaho Physical Medicine and Rehabilitation', 'Robert', '', 'Pollmann', 'PA-C', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '600 N Robbins Rd Ste 300', 'Boise', 'Ada', 'ID', '83702', '2084894016', '2084894015', '600 N Robbins Rd Ste 300', 'Boise', 'Ada', 'ID', '83702', '2084894016', '2084894015', 'IDACN', '', '', '0.00', '30.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528045283', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('911609410', 'W12045130', 'W12045130', 'ID02', 'Physicians Primary Care Center', 'Kent', 'M', 'Sandquist', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '335 SW 13th St', 'Ontario', 'Malheur', 'OR', '97914', '5418898410', '5418898093', '335 SW 13th St', 'Ontario', 'Malheur', 'OR', '97914', '5418898410', '5418898093', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1407918501', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH192', 'PGUTAH192', 'UT01', 'Physican Group of Utah Inc', 'Nancy', 'E', 'Gundersen', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504602', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504602', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609080720', 0, 'y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH136', 'PGUTAH136', 'UT01', 'Jordan Valley Wound Care Specialists', 'Horace', 'P', 'Guerra', 'MD', 'Family Practice', '', '', NULL, 'O', '3590 W 9000 S Ste 105', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016012322', '8016012679', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376643296', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH135', 'PGUTAH135', 'UT01', 'Hyperbaric & Wound Care Center', 'Horace', 'P', 'Guerra', 'MD', 'Family Practice', '', '', NULL, 'O', '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', '8018077904', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376643296', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH083', 'PGUTAH083', 'UT01', 'Salt Lake Senior Clinic', 'Gary', '', 'Griffin', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245307735', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH091', 'PGUTAH091', 'UT01', 'Associates in Orthopaedic Surgery', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH092', 'PGUTAH092', 'UT01', 'Jordan Valley Neurology', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH093', 'PGUTAH093', 'UT01', 'Physician Group of Utah Inc', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH094', 'PGUTAH094', 'UT01', 'Physician Group of Utah', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH082', 'PGUTAH082', 'UT01', 'Salt Lake Senior Clinic', 'Gary', '', 'Griffin', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245307735', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH044', 'PGUTAH044', 'UT01', 'Physician Group of Utah', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH042', 'PGUTAH042', 'UT01', 'Jordan Valley Neurology', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH043', 'PGUTAH043', 'UT01', 'Physician Group of Utah, Inc', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'M', '406 W S Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH287', 'PGUTAH287', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'Gloria', 'R', 'Gonzales', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019675866', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942235916', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH288', 'PGUTAH288', 'UT01', 'Pioneer Valley Hospital Physicians', 'Gloria', 'R', 'Gonzales', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942235916', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH241', 'PGUTAH241', 'UT01', 'Endocrinology of Utah', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643697', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH242', 'PGUTAH242', 'UT01', 'Lakeside Comprehensive Health', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643697', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH041', 'PGUTAH041', 'UT01', 'Jordan Valley Internal Medicine', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH348', 'PGUTAH348', 'UT01', 'Heart And Lung Institute', 'Kathryn', 'S', 'Gowers', 'PA-C', 'Cardiology', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1053736017', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH347', 'PGUTAH347', 'UT01', 'Heart And Lung Institute', 'Kathryn', 'S', 'Gowers', 'PA-C', 'Cardiology', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1053736017', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH346', 'PGUTAH346', 'UT01', 'Heart And Lung Institute', 'Kathryn', 'S', 'Gowers', 'PA-C', 'Cardiology', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1053736017', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH161', 'PGUTAH161', 'UT01', 'Herriman Medical Clinic ', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH160', 'PGUTAH160', 'UT01', 'Herriman Medical Clinic ', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'O', '5746 W 13400 S Ste 200', 'Herriman', 'Salt Lake', 'UT', '84096', '8019877500', '8019877539', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH244', 'PGUTAH244', 'UT01', 'Salt Lake Senior Center', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH243', 'PGUTAH243', 'UT01', 'Endocrinology of Utah', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'O', '5980 S Fashion Place Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8019643697', '8019643698', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH134', 'PGUTAH134', 'UT01', 'Jordan Valley Internal Medicine', 'Kenneth', 'W', 'Goldberg', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356465793', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH133', 'PGUTAH133', 'UT01', 'Jordan Valley Internal Medicine', 'Kenneth', 'W', 'Goldberg', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356465793', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH239', 'PGUTAH239', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'Roy', 'J', 'Gandolfi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '9019643101', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740211101', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH151', 'PGUTAH151', 'UT01', 'Jordan Valley Internal Medicine', 'Joseph', 'C', 'Fyans', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447431317', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH070', 'PGUTAH070', 'UT01', 'Salt lake Regional Medical Center ', 'Phillip', '', 'Gale', '', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205953445', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH071', 'PGUTAH071', 'UT01', 'Salt lake Regional Medical Center ', 'Phillip', '', 'Gale', '', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205953445', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH240', 'PGUTAH240', 'UT01', 'Pioneer Valley Hospital Physicians', 'Roy', 'J', 'Gandolfi', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740211101', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH252', 'PGUTAH252', 'UT01', 'Just Kids Pediatric and Adolescent Clinic', 'John', 'Bryant', 'Freer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821193947', 0, 'N', 0, '2014-04-29', 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
('621801973', 'PGUTAH251', 'PGUTAH251', 'UT01', 'Just Kids Pediatric and Adolescent Clinic', 'John', 'Bryant', 'Freer', 'MD', 'Pediatrics', '', '', NULL, 'O', '3336 S 4155 W  Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821193947', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH148', 'PGUTAH148', 'UT01', 'Davis Medical Group', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH292', 'PGUTAH292', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH312', 'PGUTAH312', 'UT01', 'Rocky Mountain Womens Health Center ', 'Jennifer ', 'L', 'Evans', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174784367', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH313', 'PGUTAH313', 'UT01', 'Rocky Mountain Womens Health Center ', 'Jennifer ', 'L', 'Evans', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3110 W 300 N Ste B', 'Clearfield', 'Davis', 'UT', '84015', '8016145271', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174784367', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH314', 'PGUTAH314', 'UT01', 'Rocky Mountain Womens Health Center ', 'Jennifer ', 'L', 'Evans', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8016145271', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174784367', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH206', 'PGUTAH206', 'UT01', 'Gero - Psych', 'Sajid', '', 'Faizi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659386357', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH207', 'PGUTAH207', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Sajid', '', 'Faizi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659386357', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH208', 'PGUTAH208', 'UT01', 'Gero - Psych', 'Sajid', '', 'Faizi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659386357', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH291', 'PGUTAH291', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S 4155 W Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH147', 'PGUTAH147', 'UT01', 'Davis Medical Group', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273080', '8019273088', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH455', 'PGUTAH455', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH052', 'PGUTAH052', 'UT01', 'Physician Group of Utah ', 'Megan', 'J', 'Engelen', '', 'Internal Medicine', '', '', NULL, 'O', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154529246', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH053', 'PGUTAH053', 'UT01', 'Physician Group of Utah ', 'Megan', 'J', 'Engelen', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154529246', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH182', 'PGUTAH182', 'UT01', 'Rock Run Medical', 'Angela', NULL, 'Epstein', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588660864', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH183', 'PGUTAH183', 'UT01', 'Rock Run Medical', 'Angela', NULL, 'Epstein', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8017732838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588660864', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH453', 'PGUTAH453', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH454', 'PGUTAH454', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH324', 'PGUTAH324', 'UT01', 'Rocky Mountain Womens Health Center', 'Teresa', 'V', 'Durbin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609987791', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH450', 'PGUTAH450', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH451', 'PGUTAH451', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH452', 'PGUTAH452', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH323', 'PGUTAH323', 'UT01', 'Rocky Mountain Womens Health Center', 'Teresa', 'V', 'Durbin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609987791', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH238', 'PGUTAH238', 'UT01', 'Physicians Group of Utah', 'Cara', '', 'Drury', 'PA-C', 'General Surgery', 'Hospitalist', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730482209', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH190', 'PGUTAH190', 'UT01', 'Physician Group of Utah', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH191', 'PGUTAH191', 'UT01', 'Physician Group of Utah', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH420', 'PGUTAH420', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-05-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH421', 'PGUTAH421', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-05-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH424', 'PGUTAH424', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-05-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH423', 'PGUTAH423', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-05-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH422', 'PGUTAH422', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-05-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH189', 'PGUTAH189', 'UT01', 'Salt Lake Regional Medical Center', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH020', 'PGUTAH020', 'UT01', 'Salt Lake Senior Clinic', 'Kip', '', 'DeWeese', 'NP', 'Geriatrics', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063506889', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH019', 'PGUTAH019', 'UT01', 'Salt Lake Senior Clinic', 'Kip', '', 'DeWeese', 'NP', 'Geriatrics', '', '', NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '8013504753', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063506889', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH138', 'PGUTAH138', 'UT01', 'Center for Orthopedic and Rehabilitation Excellence', 'Jeffrey', 'S', 'Devaney', 'APRN', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376716399', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH137', 'PGUTAH137', 'UT01', 'Center for Orthopedic and Rehabilitation Excellence', 'Jeffrey', 'S', 'Devaney', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '3584W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376716399', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH320', 'PGUTAH320', 'UT01', 'Rocky Mountain Womens Health Center', 'Vivian', '', 'Dearden', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437260510', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH319', 'PGUTAH319', 'UT01', 'Rocky Mountain Womens Health Center', 'Vivian', '', 'Dearden', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437260510', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH141', 'PGUTAH141', 'UT01', 'Rock Run Medical', 'Micheal ', 'S', 'Dawson', '', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376853036', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH142', 'PGUTAH142', 'UT01', 'Rock Run Medical', 'Micheal ', 'S', 'Dawson', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376853036', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH105', 'PGUTAH105', 'UT01', 'Gero - Psych', 'Joel', 'S', 'Dario', '', 'Mental Health', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275547507', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH104', 'PGUTAH104', 'UT01', 'Gero - Psych', 'Joel', 'S', 'Dario', '', 'Mental Health', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275547507', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH013', 'PGUTAH013', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH234', 'PGUTAH234', 'UT01', 'Physician Group of Utah', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH012', 'PGUTAH012', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH199', 'PGUTAH199', 'UT01', 'Legacy Point Family Medicine', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '0.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH198', 'PGUTAH198', 'UT01', 'Legacy Point Family Medicine', 'Gretel', 'K', 'Crison', 'DPM', 'Podiatry', '', '', NULL, 'O', '3110 W 300 N Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8016145140', '8016145144', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '0.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629187547', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH327', 'PGUTAH327', 'UT01', 'Rocky Mountain Womens Health Center', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH231', 'PGUTAH231', 'UT01', 'Jordan Parkway Medical Clinic ', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH232', 'PGUTAH232', 'UT01', 'Oval Sports Medicine', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH233', 'PGUTAH233', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH326', 'PGUTAH326', 'UT01', 'Rocky Mountain Womens Health Center', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH442', 'PGUTAH442', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH443', 'PGUTAH443', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH300', 'PGUTAH300', 'UT01', 'Davis Internal Medicine', 'Andrew', 'E', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982721106', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH301', 'PGUTAH301', 'UT01', 'Davis Internal Medicine', 'Andrew', 'E', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982721106', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH213', 'PGUTAH213', 'UT01', 'Davis Internal Medicine', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH214', 'PGUTAH214', 'UT01', 'Davis Internal Medicine', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH325', 'PGUTAH325', 'UT01', 'Rocky Mountain Womens Health Center', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH441', 'PGUTAH441', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH440', 'PGUTAH440', 'UT01', 'Heart And Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH209', 'PGUTAH209', 'UT01', 'Copper Canyon Womens Center', 'May', '', 'Chambers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3336 S 4155 W 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019649894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669512026', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH210', 'PGUTAH210', 'UT01', 'Copper Canyon Womens Center', 'May', '', 'Chambers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019649894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669512026', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH393', 'PGUTAH393', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH392', 'PGUTAH392', 'UT01', 'Heart and Lung Institute of Utah', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'O', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH391', 'PGUTAH391', 'UT01', 'Heart And Lung Institute', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012622370', '8012661200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH211', 'PGUTAH211', 'UT01', 'Copper Canyon Womens Center', 'May', '', 'Chambers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', '8019649894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669512026', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH447', 'PGUTAH447', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH448', 'PGUTAH448', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH264', 'PGUTAH264', 'UT01', 'Salt Lake Regional Medical Associates', 'Kathryn', '', 'Casull', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831256635', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH263', 'PGUTAH263', 'UT01', 'Salt Lake Regional Medical Associates', 'Kathryn', '', 'Casull', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831256635', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH330', 'PGUTAH330', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH329', 'PGUTAH329', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH328', 'PGUTAH328', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273077', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH230', 'PGUTAH230', 'UT01', 'Legacy Point Womens Center', 'Stacie', 'B', 'Carter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8016145270', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710180591', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH282', 'PGUTAH282', 'UT01', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH283', 'PGUTAH283', 'UT01', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH284', 'PGUTAH284', 'WYT1', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH446', 'PGUTAH446', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH445', 'PGUTAH445', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH444', 'PGUTAH444', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, '', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH285', 'PGUTAH285', 'WYT1', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH374', 'PGUTAH374', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH375', 'PGUTAH375', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH376', 'PGUTAH376', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH377', 'PGUTAH377', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH281', 'PGUTAH281', 'UT01', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH373', 'PGUTAH373', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH163', 'PGUTAH163', 'UT01', 'Copper Canyon Womens Center', 'Shelley', 'S', 'Binkley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497787576', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH372', 'PGUTAH372', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH162', 'PGUTAH162', 'UT01', 'Copper Canyon Womens Center', 'Shelley', 'S', 'Binkley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497787576', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH248', 'PGUTAH248', 'UT01', 'Salt Lake Regional/Solitude Ski Clinic', 'Annika', '', 'Bickford', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760791966', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH118', 'PGUTAH118', 'UT01', 'Davis Internal Medicine', 'Heather', '', 'Berkel', 'FNP-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326372764', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH247', 'PGUTAH247', 'UT01', 'Salt Lake Regional/Solitude Ski Clinic', 'Annika', '', 'Bickford', 'PA-C', 'Family Practice', '', '', NULL, 'O', '12000 Big Cottonwood Canyon Rd', 'Solitutde', 'Salt Lake', 'UT', '84121', '8015365712', '8015365790', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760791966', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH116', 'PGUTAH116', 'UT01', 'Davis Internal Medicine', 'Heather', '', 'Berkel', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '1493 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326372764', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL);
