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
('271789847', 'W12041494', 'W12041494', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0258, -116.977, NULL, NULL),
('271789847', 'W12041496', 'W12041496', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Micah', '', 'Wilson', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760779904', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0258, -116.977, NULL, NULL),
('271789847', 'W12041497', 'W12041497', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Micah', '', 'Wilson', 'NP-C', 'Family Practice', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760779904', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('390816848', 'W12041498', 'W12041498', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center South', 'Krishanthi', 'D', 'Seneviratne', 'MD', 'Family Practice', '', '', NULL, 'O', '415 Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8153567494', '8153567541', '415 Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8153567494', '8153567541', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1972814267', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.2322, -88.3052, NULL, NULL),
('203845479', 'W12041503', 'W12041503', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', 'Gary', 'S', 'Shapiro', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8479985680', '8479986365', '521 Greenbay Rd Ste 100', 'Wilmette', 'Cook', 'IL', '60091', '8479985680', '8479986365', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1881649689', 0, 'N', 0, '2014-02-04', NULL, NULL, 42.0744, -87.7073, NULL, NULL),
('271789847', 'W12041502', 'W12041502', 'IDONTSTD', 'Saint Alphonsus Medical Group Podiatry Ontario', 'Andrew', 'P', 'Black', 'DPM', 'Podiatry', '', '', NULL, 'O', '840 SW 4th Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418811310', '5418811238', '840 SW 4th Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418811310', '5418811238', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548408669', 0, 'N', 0, '2014-06-10', NULL, NULL, 44.0247, -116.974, NULL, NULL),
('271789847', 'W12041506', 'W12041506', 'IDBOISTD', 'Saint Alphonsus Medical Center Ontario', 'Trent', 'E', 'Corpron', 'DPM', 'Podiatry', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-11-27', '2014-02-02', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center  ', '', '', 'HCFA|UB|', '1871760603', 0, 'N', 0, '2014-06-10', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('364130066', 'W12041507', 'W12041507', 'ILCHIGSTD', 'Evanston Affiliated Podiatry', 'Robert', 'I', 'Cohen', 'DPM', 'Podiatry', '', '', NULL, 'O', '800 Austin St 201', 'Evanston', 'Cook', 'IL', '60202', '8478643338', '8478643338', '800 Austin St 201', 'Evanston', 'Cook', 'IL', '60202', '8478643338', '8478643338', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649239740', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('830337204', 'W12041511', 'W12041511', 'WYT1', 'Robert A Vigneri', 'Robert', 'A', 'Vigneri', 'MD', 'Pediatrics', '', '', NULL, 'O', '940 E 3rd St Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3075770465', '3075770469', '940 E 3rd St Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3075770465', '3075770469', 'CasperPed1', '', '', '0.00', '0.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|', '1083704803', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'W12041512', 'W12041512', 'UT01', 'Concentra Urgent Care M-F 7:30am-5:30pm', '', '', 'Concentra Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1735 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019734434', NULL, '1735 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019734434', '          ', '', '', '', '0.00', '0.00', '110.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639352768', 0, 'N', 0, '2013-12-06', NULL, NULL, 40.7327, -111.939, NULL, NULL),
('205805198', 'W12041513', 'W12041513', 'UT01', 'Concentra Urgent Care M-F 8am-5pm', '', '', 'Concentra Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '385 W 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015624382', NULL, '385 W 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015624382', '          ', '', '', '', '0.00', '0.00', '110.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265615397', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'W12041514', 'W12041514', 'UT01', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2827', 'Addison', 'Dallas', 'TX', '75001', '8774278801', NULL, 'PO Box 2827', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '          ', '', '', '', '0.00', '0.00', '110.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003090879', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('262102138', 'W12041524', 'W12041524', 'UT01', 'Heiden and Davidson Orthopedics', 'Eric', '', 'Heiden', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '2200 Park Ave Bldg D Ste100', 'Park City', 'Summit', 'UT', '84060', '4356158822', NULL, '2200 Park Ave Bldg D Ste100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '          ', 'WISEB2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386896652', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.6643, -111.513, NULL, NULL),
('820471268', 'W12041523', 'W12041523', 'ID01', 'Sage Health Care', 'Christopher', 'D', 'Streeter', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1811968217', 0, 'N', 0, '2013-12-23', NULL, NULL, 43.6087, -116.266, NULL, NULL),
('262102138', 'W12041525', 'W12041525', 'UT01', 'Heiden and Davidson Orthopedics', 'Eric', '', 'Heiden', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017038397', NULL, '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017038397', '          ', 'WISEB2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386896652', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.6633, -111.838, NULL, NULL),
('262102138', 'W12041526', 'W12041526', 'UT01', 'Heiden Davidson Orthopedics', 'Karen', 'D', 'Heiden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2200 Park Ave Bldg D Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '4356158823', '2200 Park Ave Bldg D Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '4356158823', 'WISEB2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346230760', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.6643, -111.513, NULL, NULL),
('262102138', 'W12041527', 'W12041527', 'UT01', 'Heiden Davidson Orthopedics', 'Karen', 'D', 'Heiden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4888 S Highlind Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356158822', '4356158823', '4888 S Highlind Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356158822', '4356158823', 'WISEB2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346230760', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.6633, -111.838, NULL, NULL),
('202533400', 'W12041528', 'W12041528', 'UT01', '', 'Chad', 'M', 'Gonzales', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1669447801', 0, 'N', 0, '2014-03-20', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('841617523', 'W12041529', 'W12041529', 'NM01', 'Northside Family Medicine', 'Carmela', 'C', 'Mondragon', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942285473', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('272768083', 'W12041530', 'W12041530', 'UT01', '', 'Caroline', 'R', 'Tadros', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107770', 0, 'N', 0, '2013-12-02', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('421582800', 'W12041531', 'W12041531', 'UT01', '', 'Steven', 'A', 'Porter', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1740255819', 0, 'N', 0, '2014-07-24', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('760393310', 'W12041532', 'W12041532', 'TXHOUSTD', 'J Mark McBath', 'J. Mark', '', 'McBath', 'MD', 'General Surgery', '', '', NULL, 'O', '7900 Fannin Ste 2400', 'Houston', 'Harris', 'TX', '77054', '7133839909', '7133839939', '7900 Fannin Ste 2400', 'Houston', 'Harris', 'TX', '77054', '7133839909', '7133839939', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'The Womans Hospital Of Texas', NULL, '', '', 'HCFA|UB|', '1568423747', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('452947108', 'W12041533', 'W12041533', 'UTMH1', 'Aspire Counseling Services', 'Blaine', 'R', 'Hickman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881822716', 0, 'N', 0, '2013-12-23', NULL, NULL, 41.0937, -111.974, NULL, NULL),
('760438819', 'W12041535', 'W12041535', 'TXHOUSTD', '', 'Clement', '', 'Chow', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16902 SW Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812422719', '2814913299', '16902 SW Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812422719', '2814913299', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013025998', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5906, -95.6366, NULL, NULL),
('760438819', 'W12041536', 'W12041536', 'TXHOUSTD', '', 'Clement', '', 'Chow', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 19729', 'Houston', 'Harris', 'TX', '77224', '2812422719', '2814913299', 'PO Box 19729', 'Houston', 'Harris', 'TX', '77224', '2812422719', '2814913299', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013025998', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('752924733', 'W12041537', 'W12041537', 'TXDALSTD', 'Irving Coppell Womens Health Center', 'Patrick', 'M', 'Weix', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7429 Las Colinas Blvd Ste 101', 'Irving', 'Dallas', 'TX', '75063', '9728690202', '9724329903', '7429 Las Colinas Blvd Ste 101', 'Irving', 'Dallas', 'TX', '75063', '9728690202', '9724329903', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1033103072', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.9092, -96.954, NULL, NULL),
('760557838', 'W12041538', 'W12041538', 'TXHOUSTD', 'Care for Women', '', '', 'Care for Women', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285615286', 0, 'Y', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041539', 'W12041539', 'TXHOUSTD', 'Care for Women', 'Kris', 'Ellen', 'Barnsfather', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407951940', 0, 'N', 0, '2013-12-03', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041541', 'W12041541', 'TXHOUSTD', 'Care for Women', 'Jennifer', 'M', 'Browning', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003898354', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041545', 'W12041545', 'TXHOUSTD', 'Care for Women', 'Stehpanie', '', 'Champion', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518130459', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041543', 'W12041543', 'TXHOUSTD', 'Care for Women', 'Randall', '', 'Feuer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043291362', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041548', 'W12041548', 'TXHOUSTD', 'Care for Women', 'Joseph', 'Lee', 'Petty', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649461211', 0, 'N', 0, '2013-12-03', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041547', 'W12041547', 'TXHOUSTD', 'Care for Women', 'Kavita', '', 'Mahajan-Merritt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457517419', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041550', 'W12041550', 'TXHOUSTD', 'Care for Women', 'Richard', 'J', 'Spinnato', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306828082', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041552', 'W12041552', 'TXHOUSTD', 'Care for Women', 'Brenda', '', 'Uribe-Torres', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376525048', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041554', 'W12041554', 'TXHOUSTD', 'Care for Women', 'Sharon', 'K', 'Zavala', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609878842', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('760557838', 'W12041556', 'W12041556', 'TXHOUSTD', 'Care for Women', 'Sujatha', '', 'Mohan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', '350 Kingwood Medical Dr Ste 350', 'Kingwood', 'Harris', 'TX', '77339', '2813597000', '2813592897', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891936860', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.0549, -95.2215, NULL, NULL),
('741893048', 'W12041557', 'W12041557', 'TXHOUSTD', 'Robert Arkus', 'Robert', '', 'Arkus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7500 Beechnut St Ste 210', 'Houston', 'Harris', 'TX', '77074', '7139950404', '7139950465', '7500 Beechnut St Ste 210', 'Houston', 'Harris', 'TX', '77074', '7139950404', '7139950465', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-06', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1871574889', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.6912, -95.5182, NULL, NULL),
('383765633', 'W12041558', 'W12041558', 'TXHOUSTD', 'Katy Internists', 'Adil', '', 'Asaduddin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18400 Katy Fwy Ste 590', 'Houston', 'Harris', 'TX', '77094', '2815781200', '2815781255', '18400 Katy Fwy Ste 590', 'Houston', 'Harris', 'TX', '77094', '2815781200', '2815781255', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-06', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1538199708', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('830216112', 'W12041559', 'W12041559', 'WY01', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 43.0263, -108.445, NULL, NULL),
('830216112', 'W12041561', 'W12041561', 'WY01', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830216112', 'W12041564', 'W12041564', 'WY01', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 44.4489, -69.0236, NULL, NULL),
('830216112', 'W12041560', 'W12041560', 'WYT1', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12041562', 'W12041562', 'WYT1', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12041563', 'W12041563', 'WYT1', 'Lander Medical Clinic', 'Eric', 'M', 'Ridgway', 'MD', 'Family Practice', '', '', NULL, 'O', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1811073364', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('870776259', 'W12041565', 'W12041565', 'TXHOUSTD', 'Shahzeb Raza Naqvi', 'Shahzeb', 'R', 'Naqvi', 'MD', 'Nephrology', '', '', NULL, 'O', '1120 Medical Plaza Ste 310', 'Spring', 'Montgomery', 'TX', '77380', '8328138074', '8328138076', '1120 Medical Plaza Ste 310', 'Spring', 'Montgomery', 'TX', '77380', '8328138074', '8328138076', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287448', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.1728, -95.455, NULL, NULL),
('870776259', 'W12041566', 'W12041566', 'TXHOUSTD', 'Shahzeb Raza Naqvi', 'Shahzeb', 'R', 'Naqvi', 'MD', 'Nephrology', '', '', NULL, 'O', '116 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '8328138074', '8328138076', '116 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '8328138074', '8328138076', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287448', 0, 'N', 0, '2013-12-06', NULL, NULL, 30.7099, -95.5613, NULL, NULL),
('454925135', 'W12041573', 'W12041573', 'UT01', 'Southridge Foot and Ankle Clinic', 'Ryan', 'S', 'Ellsworth', 'DPM', 'Podiatry', '', '', NULL, 'O', '1377 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012730100', '8012730001', '1377 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012730100', '8012730001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104130574', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6871, -111.852, NULL, NULL),
('454925135', 'W12041572', 'W12041572', 'UT01', 'Southridge Foot and Ankle Clinic', 'Ryan', 'S', 'Ellsworth', 'DPM', 'Podiatry', '', '', NULL, 'O', '4019 W 12600 S Ste 120', 'Herriman', 'Salt Lake', 'UT', '84096', '8012536886', '8012536888', '4019 W 12600 S Ste 120', 'Herriman', 'Salt Lake', 'UT', '84096', '8012536886', '8012536888', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104130574', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5222, -111.988, NULL, NULL),
('651249880', 'W12041575', 'W12041575', 'TXDALSTD', 'Children Medicaid Clinic', 'Dionna', 'M', 'Dalzell', 'NP', 'Family Practice', '', '', NULL, 'O', '11751 Alta Vista Rd Ste 103', 'Keller', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', '11751 Alta Vista Rd Ste 103', 'Keller', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114984663', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.945, -97.2814, NULL, NULL),
('470905770', 'W12041577', 'W12041577', 'TXDALSTD', 'Westside Podiatry', 'Alan', 'I', 'Ettinger', 'DPM', 'Podiatry', '', '', NULL, 'O', '1001 Twelfth Ave Ste 104', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177381931', '8177386990', '1001 Twelfth Ave Ste 104', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177381931', '8177386990', 'TIOPA', 'TXHCPC13', '', '45.00', '0.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295762771', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('470905770', 'W12041578', 'W12041578', 'TXDALSTD', 'Westside Podiatry', 'Alan', 'I', 'Ettinger', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 171015', 'Arlington', 'Tarrant', 'TX', '76003', '8174682546', '8177848795', 'PO Box 171015', 'Arlington', 'Tarrant', 'TX', '76003', '8174682546', '8177848795', 'TIOPA', 'TXHCPC13', '', '45.00', '0.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295762771', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('454642223', 'W12041580', 'W12041580', 'TXDALSTD', 'Harris Foot and Ankle Institute', 'Tommie', 'T', 'Harris', 'DPM', 'Podiatry', '', '', NULL, 'O', '751 Hebron Pkwy Ste 240', 'Lewisville', 'Denton', 'TX', '75057', '2145130481', '2145130482', '751 Hebron Pkwy Ste 240', 'Lewisville', 'Denton', 'TX', '75057', '2145130481', '2145130482', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750606802', 0, 'N', 0, '2013-12-03', NULL, NULL, 33.0111, -96.9671, NULL, NULL),
('651249880', 'W12041582', 'W12041582', 'TXDALSTD', 'Children Medicaid Clinic', 'Aisha', '', 'Khan', 'MD', 'Family Practice', '', '', NULL, 'O', '11751 Alta Vista Rd Ste 103', 'Keller', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', '11751 Alta Vista Rd Ste 103', 'Keller', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548450539', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.945, -97.2814, NULL, NULL),
('263050971', 'W12041584', 'W12041584', 'TXDALSTD', '', 'Gordon', 'G', 'McWatt', 'DO', 'Family Practice', '', '', NULL, 'O', '1307 8th Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179213000', '8179213001', '1307 8th Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179213000', '8179213001', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821035783', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.7306, -97.3437, NULL, NULL),
('454224395', 'W12041588', 'W12041588', 'TXDALSTD', 'Metroplex Internal Medicine Associates', 'Muhammad', '', 'Naeem', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5311A Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175030223', '8175032340', '5311A Colleyville Blvd', 'Colleyville', 'Tarrant', 'TX', '76034', '8175030223', '8175032340', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245284165', 0, 'N', 0, '2014-04-24', NULL, NULL, 32.8874, -97.1512, NULL, NULL),
('161676686', 'W12041587', 'W12041587', 'TXDALSTD', 'JPS Hospital Dept of Internal Medicine', 'Muhammad', '', 'Naeem', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528450', '8178528445', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528450', '8178528445', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245284165', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('161676686', 'W12041586', 'W12041586', 'TXDALSTD', 'JPS Hospital Dept of Internal Medicine', 'Muhammad', '', 'Naeem', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1500 S Main St Dptmt of Internal Medicine', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179271395', '8179273603', '1500 S Main St Dptmt of Internal Medicine', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179271395', '8179273603', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245284165', 0, 'N', 0, '2014-04-24', NULL, NULL, 32.7273, -97.3264, NULL, NULL),
('364526593', 'W12041590', 'W12041590', 'TXDALSTD', 'Arlington Urgent Care', 'Tuan', 'Dinh', 'Nguyen', 'DO', 'Family Practice', '', '', NULL, 'O', '3295 S Cooper St Ste 101', 'Arlington', 'Tarrant', 'TX', '76015', '8175579616', '8175579604', '3295 S Cooper St Ste 101', 'Arlington', 'Tarrant', 'TX', '76015', '8175579616', '8175579604', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427027762', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.6923, -97.1279, NULL, NULL),
('452447512', 'W12041592', 'W12041592', 'TXDALSTD', 'PM&R Solutions', 'Sankar', '', 'Pemmaraju', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '5348 Davis Blvd', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8002560268', '8774796776', '5348 Davis Blvd', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8002560268', '8774796776', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1487663282', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.8443, -97.2143, NULL, NULL),
('452447512', 'W12041593', 'W12041593', 'TXDALSTD', 'PM&R Solutions', 'Sankar', '', 'Pemmaraju', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 171444', 'Arlington', 'Tarrant', 'TX', '76003', '8172817776', '8172817760', 'PO Box 171444', 'Arlington', 'Tarrant', 'TX', '76003', '8172817776', '8172817760', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1487663282', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('455326325', 'W12041595', 'W12041595', 'TXDALSTD', '1st Class Urgent Care Center', 'Joseph', 'B', 'Taiwo', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '910 N Galloway Ave Ste 102', 'Mesquite', 'Dallas', 'TX', '75149', '9722882300', '9722882559', '910 N Galloway Ave Ste 102', 'Mesquite', 'Dallas', 'TX', '75149', '9722882300', '9722882559', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174796254', 0, 'N', 0, '2013-12-03', NULL, NULL, 32.7759, -96.5992, NULL, NULL),
('455326325', 'W12041596', 'W12041596', 'TXDALSTD', '1st Class Urgent Care Center', 'Joseph', 'B', 'Taiwo', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'B', 'PO Box 851591', 'Mesquite', 'Dallas', 'TX', '75185', '9722882300', '9722882559', 'PO Box 851591', 'Mesquite', 'Dallas', 'TX', '75185', '9722882300', '9722882559', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174796254', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12041597', 'W12041597', 'UT01', 'Hofmann Arthritis Institute', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('272752875', 'W12041598', 'W12041598', 'UT01', 'Hofmann Arthritis Institute', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('272752875', 'W12041599', 'W12041599', 'UT01', 'Hofmann Arthritis Institute', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('272752875', 'W12041600', 'W12041600', 'UT01', 'Hofmann Arthritis Institute', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('272752875', 'W12041601', 'W12041601', 'UT01', 'Hofmann Arthritis Institute', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('830207671', 'W12041603', 'W12041603', 'WY01', 'West Park Hospital District', 'Aaron', 'R', 'Brown', '', 'Emergency Medicine', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154653178', 0, 'N', 0, '2013-12-03', NULL, NULL, 44.526, -109.074, NULL, NULL),
('830207671', 'W12041604', 'W12041604', 'WYT1', 'West Park Hospital District', 'Aaron', 'R', 'Brown', '', 'Emergency Medicine', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154653178', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12041605', 'W12041605', 'ILCHIGSTD', 'Ressurrection Services', 'Lenus', '', 'Damasaru', 'MD', 'Family Practice', '', '', NULL, 'O', '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', '7737369416', '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', '7737369416', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467690040', 0, 'N', 0, '2013-12-03', NULL, NULL, 41.9382, -87.7957, NULL, NULL),
('363200170', 'W12041607', 'W12041607', 'ILCHIGSTD', 'Presence St Joseph Hospital Chicago', 'Poornima', '', 'Narayen', 'MD', 'Pediatrics', '', '', NULL, 'O', '2913 N Commonwealth', 'Chicago', 'Cook', 'IL', '60657', '8557647687', '6309142469', '2913 N Commonwealth', 'Chicago', 'Cook', 'IL', '60657', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1487787867', 0, 'N', 0, '2013-12-03', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('363200170', 'W12041606', 'W12041606', 'ILCHIGSTD', 'Presence Healthcare Services', 'Poornima', '', 'Narayen', 'MD', 'Pediatrics', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1487787867', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12041609', 'W12041609', 'UT01', 'Wasatch Pediatrics', 'Amanda', '', 'Orme', 'NP', '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, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497930853', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12041608', 'W12041608', 'UT01', 'Wasatch Pediatrics', 'Amanda', '', 'Orme', 'NP', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '8015010048', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '8015010048', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497930853', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'W12041610', 'W12041610', 'UT01', 'Wasatch Pediatrics', 'Amanda', '', 'Orme', 'NP', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497930853', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('202422775', 'W12041611', 'W12041611', 'UT01', 'Wasatch Endocrinology and Diabetes Specialists', 'Joyce', 'C', 'Ferrone', 'NP', 'Endocrinology', 'Diabetes', '', NULL, 'O', '1035 W Bellwood Ln Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8017460776', '8017460775', '1035 W Bellwood Ln Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8017460776', '8017460775', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811107261', 0, 'N', 0, '2013-12-03', NULL, NULL, 40.6537, -111.921, NULL, NULL),
('830207671', 'W12041612', 'W12041612', 'WY01', 'West Park Hospital ', 'Gregory', '', 'McCue', 'MD', 'Hospitalist', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679670251', 0, 'N', 0, '2013-12-23', NULL, NULL, 44.526, -109.074, NULL, NULL),
('830207671', 'W12041613', 'W12041613', 'WYT1', 'West Park Hospital ', 'Gregory', '', 'McCue', 'MD', 'Hospitalist', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679670251', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12041614', 'W12041614', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('272752875', 'W12041615', 'W12041615', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('272752875', 'W12041616', 'W12041616', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('272752875', 'W12041617', 'W12041617', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('272752875', 'W12041618', 'W12041618', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('870284475', 'W12041620', 'W12041620', 'UT01', 'Granger Medical Clinic', 'Jack', '', 'Saunders', 'PA-C', 'Family Practice', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801175807', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870284475', 'W12041621', 'W12041621', 'UT01', 'Granger Medical Clinic', 'Jack', '', 'Saunders', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801175807', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870284475', 'W12041619', 'W12041619', 'UT01', 'Granger Medical Clinic', 'Jack', '', 'Saunders', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801175807', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12041622', 'W12041622', 'UT01', 'Granger Medical Clinic', 'Jack', '', 'Saunders', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801175807', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12041623', 'W12041623', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12041624', 'W12041624', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.6339, -111.806, 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
('272752875', 'W12041625', 'W12041625', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('272752875', 'W12041626', 'W12041626', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('272752875', 'W12041627', 'W12041627', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('272752875', 'W12041628', 'W12041628', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('272752875', 'W12041629', 'W12041629', 'UT01', 'Hofmann Arthritis Institute', 'Jordan', 'R', 'McQueen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1861776494', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('272752875', 'W12041630', 'W12041630', 'UT01', 'Hofmann Arthritis Institute', 'Jordan', 'R', 'McQueen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', '6360 S 3000 E ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1861776494', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('272752875', 'W12041631', 'W12041631', 'UT01', 'Hofmann Arthritis Institute', 'Jordan', 'R', 'McQueen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', '1580 W Antelope Dr Ste 200', 'Layton', 'Davis', 'UT', '84041', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1861776494', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('272752875', 'W12041632', 'W12041632', 'UT01', 'Hofmann Arthritis Institute', 'Jordan', 'R', 'McQueen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1861776494', 0, 'N', 0, '2014-05-27', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('272752875', 'W12041633', 'W12041633', 'UT01', 'Hofmann Arthritis Institute', 'Jordan', 'R', 'McQueen', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1861776494', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('770701557', 'W12041635', 'W12041635', 'UT01', 'South Jordan Family Medicine', 'Sean', 'A', 'Ponce', 'MD', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376577049', 0, 'N', 0, '2013-12-19', NULL, NULL, 40.5582, -111.939, NULL, NULL),
('850275777', 'W12041636', 'W12041636', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('850275777', 'W12041637', 'W12041637', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12041638', 'W12041638', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12041639', 'W12041639', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850275777', 'W12041640', 'W12041640', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', NULL, '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12041641', 'W12041641', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12041642', 'W12041642', 'NM01', 'Southwest Medical Associates', 'Christopher', 'R', 'Miera', 'MD', 'Family Practice', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293313', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041645', 'W12041645', 'UT01', 'Central Utah Clinic PC', 'M', 'S', 'Major', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018126730', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018126730', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1558394783', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041644', 'W12041644', 'UT01', 'Central Utah Clinic PC', 'M', 'S', 'Major', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5896 S Ridgeline Dr Ste B', 'Ogden', 'Weber', 'UT', '84405', '8018660170', '8018660169', '5896 S Ridgeline Dr Ste B', 'Ogden', 'Weber', 'UT', '84405', '8018660170', '8018660169', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1558394783', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.157, -111.951, NULL, NULL),
('870281028', 'W12041643', 'W12041643', 'UT01', 'Central Utah Clinic PC', 'M', 'S', 'Major', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1558394783', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12041646', 'W12041646', 'TXHOUSTD', 'Montgomery Physician Associates', 'Jerome', NULL, 'Young', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '18059 Hwy 105 W Ste 120', 'Montgomery', 'Montgomery', 'TX', '77356', '9365825640', '9365825643', '18059 Hwy 105 W Ste 120', 'Montgomery', 'Montgomery', 'TX', '77356', '9365825640', '9365825643', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518958230', 0, 'N', 0, '2013-12-03', NULL, NULL, 30.3765, -95.6407, NULL, NULL),
('452403057', 'W12041648', 'W12041648', 'UTMH1', 'St. George Children and Family Psychiatric Center', 'Jacob', 'S', 'Roberts', 'NP', 'Mental Health', '', '', NULL, 'O', '115 W 1470 S', 'St George', 'Washington', 'UT', '84770', '4356528488', '4356529959', '115 W 1470 S', 'St George', 'Washington', 'UT', '84770', '4356528488', '4356529959', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952696270', 0, 'N', 1, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('452403057', 'W12041647', 'W12041647', 'UTMH1', 'St. George Children and Family Psychiatric Center', 'Jacob', 'S', 'Roberts', 'NP', 'Mental Health', '', '', NULL, 'O', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '4356749380', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '4356749380', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952696270', 0, 'N', 1, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12041649', 'W12041649', 'UT01', 'Silverton Group', 'Lindsay', '', 'McCauley', 'DO', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285878256', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12041650', 'W12041650', 'UT01', 'Silverton Group', 'Lindsay', '', 'McCauley', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285878256', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('760607945', 'W12041652', 'W12041652', 'TXHOUSTD', 'Subroto Gangopadhyay', 'Subroto', '', 'Gangopadhyay', 'MD', 'Cardiology', '', '', NULL, 'O', '12121 Richmond Ave Ste 200', 'Houston', 'Harris', 'TX', '77082', '2815656999', '2815657045', '12121 Richmond Ave Ste 200', 'Houston', 'Harris', 'TX', '77082', '2815656999', '2815657045', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326004045', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760607945', 'W12041651', 'W12041651', 'TXHOUSTD', 'Subroto Gangopadhyay', 'Subroto', '', 'Gangopadhyay', 'MD', 'Cardiology', '', '', NULL, 'O', '17510 W Grand Pkwys Ste 460', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815656999', '2815657045', '17510 W Grand Pkwys Ste 460', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815656999', '2815657045', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326004045', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5639, -95.688, NULL, NULL),
('272640383', 'W12041653', 'W12041653', 'TXHOUSTD', 'Swarna Balasubramaniam', 'Swarna', '', 'Balasubramaniam', 'MD', 'General Surgery', '', '', NULL, 'O', '16659 SW Fwy Ste 561', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812772121', '2812772125', '16659 SW Fwy Ste 561', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812772121', '2812772125', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1477649929', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('760455988', 'W12041654', 'W12041654', 'TXHOUSTD', 'Audencio Alanis', 'Audencio', '', 'Alanis', 'MD', 'General Surgery', '', '', NULL, 'O', '201 Enterprise Ave Ste 100', 'League City', 'Galveston', 'TX', '77573', '2815381111', '7134554321', '201 Enterprise Ave Ste 100', 'League City', 'Galveston', 'TX', '77573', '2815381111', '7134554321', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'West Houston Medical Center', 'East Houston Regional Medical Center', '', '', 'HCFA|UB|', '1710931159', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5433, -95.0596, NULL, NULL),
('200405981', 'W12041655', 'W12041655', 'UT01', 'Morgan Physical Therapy & Fitness Center Inc', 'Daniel', '', 'Goodrich', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1205273588', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12041657', 'W12041657', 'ID02', 'Mountain Land Maple Grove', 'Kyle', '', 'Herauf', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1435 Maple Grove Rd', 'Boise', 'Ada', 'ID', '83709', '2083226200', '2083226233', '1435 Maple Grove Rd', 'Boise', 'Ada', 'ID', '83709', '2083226200', '2083226233', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|', '1609208156', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12041658', 'W12041658', 'UT01', 'Mountain Land Maple Grove', 'Kyle', '', 'Herauf', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2083226200', '2083226233', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2083226200', '2083226233', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609208156', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('711048468', 'W12041660', 'W12041660', 'UT01', 'Cutting Edge Physical Therapy ', 'Justin', 'W', 'Hofhines', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', '2013-10-30', 0, 0, 0, '', '', '', '', 'HCFA|', '1356426514', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12041669', 'W12041669', 'IDREC', 'The Clinic at Middleton', '', '', 'The Clinic at Middleton', 'GROUP', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '', '', '', '0.00', '0.00', '0.00', 6, '2013-11-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609818483', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12041670', 'W12041670', 'ID02', 'West Valley Clinic at Middleton', 'Steven', 'B', 'Ollie', 'MD', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2012-10-29', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568432888', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12041672', 'W12041672', 'IDREC', 'The Clinic at Middleton', '', '', 'The Clinic at Middleton', 'GROUP', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '0000000000', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '0000000000', '', '', '', '0.00', '0.00', '0.00', 6, '2013-11-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609818483', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12041675', 'W12041675', 'ID02', 'The Clinic at Parma', '', '', 'The Clinic at Parma', 'GROUP', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '0000000000', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740223502', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12041676', 'W12041676', 'ID02', 'The Clinic at Wilder', '', '', 'The Clinic at Wilder', 'GROUP', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553908', '0000000000', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553908', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245267467', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('820513482', 'W12041678', 'W12041678', 'ID02', 'Surgicare Center of Idaho', '', '', 'Surgicare Center of Idaho', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '360 E Mallard Dr Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083368700', NULL, '360 E Mallard Dr Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083368700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1114923471', 0, 'N', 0, '2014-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041684', 'W12041684', 'UTIHCPHY', 'Salt Lake Clinic', '', '', 'Salt Lake Clinic Administration', 'GROUP', 'Clinic', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '3852822000', '3852822201', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '3852822000', '3852822201', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629107305', 0, 'N', 0, '2013-12-05', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12041682', 'W12041682', 'UTIHCPHY', 'Sevier Valley Specialty Clinic', '', '', 'Sevier Valley Specialty Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-25', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396872073', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041683', 'W12041683', 'UTIHCPHY', 'Sevier Valley Clinic', '', '', 'Sevier Valley Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265576326', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041685', 'W12041685', 'UTIHCPHY', 'Rim Rock Orthopaedics-DSC', '', '', 'Rim Rock Orthopaedics-DSC', 'Group', 'Clinic', '', '', NULL, 'O', '225 S 700 E', 'St George', 'Washington', 'UT', '84770', '4352513600', '4352513601', '225 S 700 E', 'St George', 'Washington', 'UT', '84770', '4352513600', '4352513601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508995325', 0, 'N', 0, '2013-12-05', NULL, NULL, 37.1043, -113.568, NULL, NULL),
('942854057', 'W12041687', 'W12041687', 'UTIHCPHY', 'Payson InstaCare', '', '', 'Payson InstaCare', '', 'Clinic', '', '', NULL, 'O', '854 Turf Farm Rd Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014656200', '8014656298', '854 Turf Farm Rd Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014656200', '8014656298', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235562505', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('550801827', 'W12041688', 'W12041688', 'TXDALSTD', 'Mahmood B Panjwani', 'Mahmood', 'B', 'Panjwani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3740 N Josey Ln Ste 206', 'Carrollton', 'Denton', 'TX', '75007', '2147310031', '2147310065', '3740 N Josey Ln Ste 206', 'Carrollton', 'Denton', 'TX', '75007', '2147310031', '2147310065', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|', '1679370174', 0, 'N', 0, '2013-12-16', NULL, NULL, 33.0128, -96.8869, NULL, NULL),
('550801827', 'W12041689', 'W12041689', 'TXDALSTD', 'Mahmood B Panjwani', 'Mahmood', 'B', 'Panjwani', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741028', 'Dallas', 'Dallas', 'TX', '75374', '2147310031', '2147310065', 'PO Box 741028', 'Dallas', 'Dallas', 'TX', '75374', '2147310031', '2147310065', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|', '1679370174', 0, 'N', 0, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('205322140', 'W12041690', 'W12041690', 'TXDALSTD', 'Keith Vasenius', 'Keith', '', 'Vasenius', 'DO', 'Cardiology', '', '', NULL, 'O', '909 9th Ave Ste 202', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178774105', '8173489797', '909 9th Ave Ste 202', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178774105', '8173489797', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1619998572', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.7349, -97.3458, NULL, NULL),
('752893160', 'W12041691', 'W12041691', 'TXDALSTD', 'Farida Farrukh Valliani ', 'Farida', 'F', 'Valliani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3740 N Josey Ln Ste 206', 'Carrollton', 'Denton', 'TX', '75007', '2147310031', '2147310065', '3740 N Josey Ln Ste 206', 'Carrollton', 'Denton', 'TX', '75007', '2147310031', '2147310065', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|', '1386644235', 0, 'N', 0, '2013-12-16', NULL, NULL, 33.0128, -96.8869, NULL, NULL),
('752893160', 'W12041692', 'W12041692', 'TXDALSTD', 'Farida Farrukh Valliani ', 'Farida', 'F', 'Valliani', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741028', 'Dallas', 'Dallas', 'TX', '75374', '2147310031', '2147310065', 'PO Box 741028', 'Dallas', 'Dallas', 'TX', '75374', '2147310031', '2147310065', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|', '1386644235', 0, 'N', 0, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('760438819', 'W12041694', 'W12041694', 'TXHOUSTD', '', 'Jacqueline', '', 'Mostert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16902 SW Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812422719', '2814913299', '16902 SW Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812422719', '2814913299', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194837112', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5906, -95.6366, NULL, NULL),
('760438819', 'W12041695', 'W12041695', 'TXHOUSTD', '', 'Jacqueline', '', 'Mostert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 19729', 'Houston', 'Harris', 'TX', '77224', '2812422719', '2814913299', 'PO Box 19729', 'Houston', 'Harris', 'TX', '77224', '2812422719', '2814913299', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194837112', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('760583276', 'W12041696', 'W12041696', 'TXBEAUSTD', 'Vijesh K Patel', 'Vijesh', 'K', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '876 Magnolia Port Neches', 'Port Neches', 'Jefferson', 'TX', '77651', '4097293787', '4097228660', '876 Magnolia Port Neches', 'Port Neches', 'Jefferson', 'TX', '77651', '4097293787', '4097228660', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154366938', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.9794, -93.9619, NULL, NULL),
('529848010', 'W12041697', 'W12041697', 'UTMH1', '', 'Lynette', 'M', 'Malmstrom', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '522 E 2100 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014864444', '8014864447', '522 E 2100 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014864444', '8014864447', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770706079', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('529848010', 'W12041698', 'W12041698', 'UTMH1', '', 'Lynette', 'M', 'Malmstrom', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 520807', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8014864444', '8014864447', 'PO Box 520807', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8014864444', '8014864447', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770706079', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('463955050', 'W12041699', 'W12041699', 'UT01', 'Integrated Functional Medicine', 'Brett', 'J', 'Earl', 'MD', 'Pain Management', 'Emergency Medicine', 'Family Practice', NULL, 'O', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1568423564', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.8939, -111.892, NULL, NULL),
('463955050', 'W12041700', 'W12041700', 'UT01', 'Integrated Functional Medicine', 'Holly', 'J', 'Green', 'APRN', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205000718', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.8939, -111.892, NULL, NULL),
('870574059', 'W12041703', 'W12041703', 'UT01', 'Mountain Land Rehabilitation West Layton', 'Nylin', 'J', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013010727', 0, 'N', 0, '2013-12-06', NULL, NULL, 41.0747, -112.027, NULL, NULL),
('870285547', 'W12041704', 'W12041704', 'UT01', 'Registered Physical Therapists, Inc', 'Brad', 'Robert', 'Pulsipher', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015664739', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015664739', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073872909', 0, 'N', 0, '2013-12-06', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('870285547', 'W12041705', 'W12041705', 'UT01', 'Registered Physical Therapists, Inc', 'Brad', 'Robert', 'Pulsipher', 'DPT', 'Physical Therapy', '', '', NULL, 'B', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015666301', '8015664739', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073872909', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W12041706', 'W12041706', 'UT01', 'Registered Physical Therapists', 'Jessica', '', 'Wright', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1871746826', 0, 'N', 0, '2013-12-06', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('453888573', 'W12041707', 'W12041707', 'UT01', 'Synergy Soft Tissue Center', 'Matthew', 'Scott', 'Bailey', 'DC', 'Chiropractic', '', '', NULL, 'O', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-11-01', '2014-06-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902036189', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.634, -111.854, NULL, NULL),
('202823178', 'W12041708', 'W12041708', 'UT01', 'Goodman Chiropractic', 'Kenneth', 'Michael', 'Goodman', 'DC', 'Chiropractic', '', '', NULL, 'O', '85 E Crossroads Blvd', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', '85 E Crossroads Blvd', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700971587', 0, 'N', 0, '2013-12-06', NULL, NULL, 40.3874, -111.915, NULL, NULL),
('800341115', 'W12041709', 'W12041709', 'UT01', 'Ulibarri Chiropractic and Rehab', 'Isaiah', '', 'Ulibarri', 'DC', 'Chiropractic', '', '', NULL, 'O', '5630 S Waterbury Way Ste B203', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012723881', '8014163514', '5630 S Waterbury Way Ste B203', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012723881', '8014163514', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-10-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194962621', 0, 'N', 0, '2013-12-06', NULL, NULL, 40.6486, -111.85, NULL, NULL),
('352202717', 'W12041710', 'W12041710', 'UTDT01', 'The Center of Dental Professionals', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('680251097', 'W12041712', 'W12041712', 'UTDT01', 'Tuttle Family Dental', 'Gregory', '', 'Tuttle', 'DDS', 'Dentist', '', '', NULL, 'O', '169 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241997', NULL, '169 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012241997', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1487745188', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12041714', 'W12041714', 'UTDT01', 'The Center of Dental Professionals', 'Shannon', '', 'Young', 'DMD', 'Dentist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478015', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478015', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801027917', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12041715', 'W12041715', 'UTDT01', 'The Center of Dental Professionals', 'Shannon', '', 'Young', 'DMD', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801027917', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('461204337', 'W12041716', 'W12041716', 'UTDT01', 'Southwest Oral & Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'O', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-12-01', '2014-06-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'DEN|', '1326167354', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('371733627', 'W12041717', 'W12041717', 'UTDT01', 'Apex Dental Murray', 'Joseph', '', 'Maio', 'DDS', 'Dentist', '', '', NULL, 'O', '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', NULL, '5642 S 900 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012612202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1047896681', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870352774', 'W12041719', 'W12041719', 'UTDT01', 'Rogers Family Dental', 'Brad', '', 'Rogers', 'DDS', 'Dentist', '', '', NULL, 'O', '201 N State St', 'Orem', 'Utah', 'UT', '84057', '8012257712', NULL, '201 N State St', 'Orem', 'Utah', 'UT', '84057', '8012257712', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1942557657', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'W12041721', 'W12041721', 'UTDT01', 'Wayne Community Health Center', 'Stilson', '', 'Wilford', 'DMD', 'Dentist', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', NULL, '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1750525630', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('208004030', 'W12041723', 'W12041723', 'UTDT01', 'Aspen Dental Of Cache Valley', 'Jeffrey', '', 'Wegener', 'DMD', 'Dentist', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Hooper', 'Weber', 'UT', '84315', '4357534400', NULL, '1451 N 200 E Ste 200', 'Hooper', 'Weber', 'UT', '84315', '4357534400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417211350', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('455361876', 'W12041724', 'W12041724', 'UTDT01', 'Focus Dental Group', 'Shannon', '', 'Young', 'DMD', 'Dentist', '', '', NULL, 'O', '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', NULL, '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801027917', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('461412682', 'W12041725', 'W12041725', 'UTDT01', 'Zion Dental Care', 'Michael', '', 'Rowe', 'DDS', 'Dentist', '', '', NULL, 'O', '350 E 600 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356739904', NULL, '350 E 600 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356739904', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417014762', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('371733627', 'W12041726', 'W12041726', 'UTDT01', 'Apex Dental Murray', 'Jason', '', 'Hodge', 'DMD', 'Dentist', '', '', NULL, 'O', '5642 S 900 E Ste 6', 'Murray', 'Salt Lake', 'UT', '84107', '8012612202', NULL, '5642 S 900 E Ste 6', 'Murray', 'Salt Lake', 'UT', '84107', '8012612202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1053498006', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('270529528', 'W12041727', 'W12041727', 'UTDT01', 'Corner Canyon Family Dentistry', 'Nathan', '', 'Holt', 'DMD', 'Dentist', '', '', NULL, 'O', '245 E Crossroads Blvd', 'Lehi', 'Utah', 'UT', '84043', '8014954440', NULL, '245 E Crossroads Blvd', 'Lehi', 'Utah', 'UT', '84043', '8014954440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', '2013-12-01', 0, 0, 0, '', '', '', '', 'DEN|', '1437384500', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('463491675', 'W12041728', 'W12041728', 'UTDT01', 'Jeppson Endodontics', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', NULL, 'O', '2854 W 4700 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018032397', NULL, '2854 W 4700 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018032397', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('463186011', 'W12041730', 'W12041730', 'UTDT01', 'Corry and Lewis Dental', 'Aaron', '', 'Lewis', 'DMD', 'Dentist', '', '', NULL, 'O', '427 S Main St Ste 101', 'Cedar City', 'Iron', 'UT', '84720', '4355866526', NULL, '427 S Main St Ste 101', 'Cedar City', 'Iron', 'UT', '84720', '4355866526', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013203025', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('203422525', 'W12041732', 'W12041732', 'UTDT01', 'Doc Martin Orthodontics', 'Adam', '', 'Martin', 'DDS', 'Orthodontist', '', '', NULL, 'O', '2779 W 4000 S Ste 103', 'Roy', 'Weber', 'UT', '84067', '8017762290', NULL, '2779 W 4000 S Ste 103', 'Roy', 'Weber', 'UT', '84067', '8017762290', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1184780280', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('270870245', 'W12041736', 'W12041736', 'UTDT01', 'Summit Dental', 'Ryan', '', 'Rush', 'DDS', 'Dentist', '', '', NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015478800', NULL, '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015478800', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1750694907', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('880462437', 'W12041735', 'W12041735', 'UTDT01', 'Drew Richards DDS', 'Drew', '', 'Richards', 'DDS', 'Dentist', '', '', NULL, 'O', '272 E Center St Ste 205', 'Ivins', 'Washington', 'UT', '84738', '4356528111', NULL, '272 E Center St Ste 205', 'Ivins', 'Washington', 'UT', '84738', '4356528111', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1629163555', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('463052565', 'W12041737', 'W12041737', 'UTDT01', 'Redwood Dental', 'James', '', 'Standring', 'DDS', 'Dentist', '', '', NULL, 'O', '4370 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019694100', NULL, '4370 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019694100', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN', '1326483512', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('261603887', 'W12041740', 'W12041740', 'UTDT01', 'Alpenglow Dental', 'Jaron', '', 'Traveller', 'DMD', 'Dentist', '', '', NULL, 'O', '7430 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8015618131', NULL, '7430 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8015618131', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578903670', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('460513020', 'W12041742', 'W12041742', 'UTDT01', 'Cottonwood Endodontics', 'Leslie', '', 'Walker', 'DMD', 'Endodontist', '', '', NULL, 'O', '4252 S Highland Dr Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014240833', NULL, '4252 S Highland Dr Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014240833', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578764437', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12041744', 'W12041744', 'UTDT01', 'North View Dental', 'Jon', '', 'Albrechtsen', 'DMD', 'Dentist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1134289820', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('202799763', 'W12041746', 'W12041746', 'UTDT01', '', 'Daniel', '', 'Asay', 'DMD', 'Dentist', '', '', NULL, 'O', '688 W 400 S Ste 203', 'Springville', 'Utah', 'UT', '84663', '8014899494', NULL, '688 W 400 S Ste 203', 'Springville', 'Utah', 'UT', '84663', '8014899494', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1902948342', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12041749', 'W12041749', 'UTDT01', 'The Center of Dental Professionals', 'Ashley', '', 'Bailey', 'DDS', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478018', NULL, '3798 S 700 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478018', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1043478217', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12041748', 'W12041748', 'UTDT01', 'The Center of Dental Professionals', 'Ashley', '', 'Bailey', 'DDS', 'Dentist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017448018', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017448018', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1043478217', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('261603887', 'W12041754', 'W12041754', 'UTDT01', 'Alpenglow Dental', 'Raymond J', '', 'Curtis', 'DDS', 'Dentist', '', '', NULL, 'O', '425 S Medical Dr Ste 211', 'Bountiful', 'Davis', 'UT', '84010', '8013975220', NULL, '425 S Medical Dr Ste 211', 'Bountiful', 'Davis', 'UT', '84010', '8013975220', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083703649', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('453950326', 'W12041751', 'W12041751', 'UTDT01', 'Family Legacy Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '845 W 100 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012275080', NULL, '845 W 100 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012275080', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('463186011', 'W12041753', 'W12041753', 'UTDT01', 'Corry and Lewis Dental', 'Douglas', '', 'Corry', 'DMD', 'Dentist', '', '', NULL, 'O', '427 S Main St Ste 101', 'Cedar City', 'Iron', 'UT', '84720', '4355866526', NULL, '427 S Main St Ste 101', 'Cedar City', 'Iron', 'UT', '84720', '4355866526', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1891973111', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452693832', 'W12041757', 'W12041757', 'UTDT01', '', 'Brian', '', 'Frandsen', 'DDS', 'Dentist', '', '', NULL, 'O', '3078 W 7800 S Ste 7B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018900030', NULL, '3078 W 7800 S Ste 7B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018900030', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1053472803', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('262785814', 'W12041758', 'W12041758', 'UTDT01', 'Salt Lake Pediatric Dentistry', 'David', 'B', 'Gustafson', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1548 E 4500 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014631900', NULL, '1548 E 4500 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014631900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1871783027', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12041763', 'W12041763', 'UT01', 'Physician Group of Utah', 'Dominika', '', 'Janowski', '', 'Internal Medicine', '', '', 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, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922230770', 0, 'N', 0, '2013-12-06', 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
('870342259', 'W12041760', 'W12041760', 'UTDT01', 'Wayne Community Health Center', 'Christopher', '', 'Harward', 'DDS', 'Dentist', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', NULL, '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1750643763', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12041761', 'W12041761', 'UT01', 'Davis Internal Medicine', 'Dominika', '', 'Janowski', '', 'Internal Medicine', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922230770', 0, 'N', 0, '2013-12-06', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('621801973', 'W12041762', 'W12041762', 'UT01', 'Davis Internal Medicine', 'Dominika', '', 'Janowski', '', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015683480', NULL, '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015683480', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922230770', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041764', 'W12041764', 'UT01', 'Central Utah Clinic PC', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('870281028', 'W12041765', 'W12041765', 'UT01', 'Central Utah Clinic PC', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8013742615', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041766', 'W12041766', 'UT01', 'Central Utah Clinic PC', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8013548225', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8013548225', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041767', 'W12041767', 'UT01', 'Central Utah Clinic PC', 'William', 'W', 'Barney', 'MD', 'Internal Medicine', 'Cardiovascular Disease', 'Hospitalist', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1194799890', 0, 'N', 0, '2014-07-16', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('870281028', 'W12041768', 'W12041768', 'UT01', 'Central Utah Clinic PC', 'William', 'W', 'Barney', 'MD', 'Internal Medicine', 'Cardiovascular Disease', 'Hospitalist', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1194799890', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12041769', 'W12041769', 'UT01', 'Central Utah Clinic PC', 'William', 'W', 'Barney', 'MD', 'Internal Medicine', 'Cardiovascular Disease', 'Hospitalist', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8013548225', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8013548225', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1194799890', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('760540476', 'W12041771', 'W12041771', 'TXHOUSTD', 'Oakbend Medical Group', 'Debbie', '', 'Banks', 'NP', 'Family Practice', '', '', NULL, 'B', '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, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417384363', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5992, -95.6808, NULL, NULL),
('760540476', 'W12041772', 'W12041772', 'TXHOUSTD', 'Oakbend Medical Group', 'Debbie', '', 'Banks', 'NP', 'Family Practice', '', '', NULL, 'O', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2816334930', '2816344933', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2816334930', '2816344933', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417384363', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('810231784', 'W12041774', 'W12041774', 'WYBILLINGS', 'Billings Clinic - Peds', 'Michael', 'S', 'Kappy', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382299', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382299', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336224062', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041775', 'W12041775', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'S', 'Kappy', 'MD', 'Pediatric Endocrinology', '', '', 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, '2013-11-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336224062', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041776', 'W12041776', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'S', 'Kappy', 'MD', 'Pediatric Endocrinology', '', '', 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, '2013-11-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336224062', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041778', 'W12041778', 'WYBILLINGS', 'Billings Clinic', 'Cynthia', 'K', 'Brewer', 'DO', 'Family Practice', '', '', 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, '2013-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063625416', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041779', 'W12041779', 'WYBILLINGS', 'Billings Clinic', 'Cynthia', 'K', 'Brewer', 'DO', 'Family Practice', '', '', 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, '2013-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063625416', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041780', 'W12041780', 'WYBILLINGS', 'Billings Clinic ', 'Cynthia', 'K', 'Brewer', 'DO', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063625416', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'W12041781', 'W12041781', 'ILCHIGSTD', 'Touching Ground Podiatry', 'Joseph', 'S', 'Borreggine', 'DPM', 'Podiatry', '', '', NULL, 'O', '2111 18th St', 'Charleston', 'Coles', 'IL', '61920', '2173480888', '2173458638', '2111 18th St', 'Charleston', 'Coles', 'IL', '61920', '2173480888', '2173458638', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114921483', 0, 'Y', 0, '2013-12-06', NULL, NULL, 39.4771, -88.1629, NULL, NULL),
('364130066', 'W12041782', 'W12041782', 'ILCHIGSTD', 'Touching Ground Podiatry', 'Joseph', 'S', 'Borreggine', 'DPM', 'Podiatry', '', '', NULL, 'O', '511 W Virginia Ave', 'Effingham', 'Effingham', 'IL', '62401', '2173422222', '2173422244', '511 W Virginia Ave', 'Effingham', 'Effingham', 'IL', '62401', '2173422222', '2173422244', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114921483', 0, 'Y', 0, '2013-12-06', NULL, NULL, 39.1258, -88.5478, NULL, NULL),
('870286381', 'W12041783', 'W12041783', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, '', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', '', '', '', '0.00', '0.00', '76.74', 6, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041785', 'W12041785', 'TXDALSTD', '', 'Jafar', 'J', 'Abunasser', 'MD', 'Pulmonary', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1093914327', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'W12041786', 'W12041786', 'TXDALSTD', '', 'Jafar', 'J', 'Abunasser', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1093914327', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'W12041788', 'W12041788', 'TXDALSTD', 'Health Texas Provider Network', 'Pratima', 'R', 'Bakshi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1528057742', 0, 'N', 0, '2014-01-16', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'W12041790', 'W12041790', 'TXDALSTD', '', 'Mary', 'L', 'Caire', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '4698882200', '4698885222', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '4698882200', '4698885222', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649245754', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.8724, -96.7711, NULL, NULL),
('752536818', 'W12041791', 'W12041791', 'TXDALSTD', 'Health Texas Provider Network', 'Mary', 'L', 'Caire', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649245754', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041793', 'W12041793', 'TXDALSTD', 'Health Texas Provider Network', 'Manvinder', 'K', 'Kainth', 'MD', 'Family Practice', '', '', NULL, 'O', '400 W IH 635 Ste 210', 'Irving', 'Dallas', 'TX', '75063', '9728692772', '9728691747', '400 W IH 635 Ste 210', 'Irving', 'Dallas', 'TX', '75063', '9728692772', '9728691747', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1396893491', 0, 'N', 0, '2014-01-16', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'W12041794', 'W12041794', 'TXDALSTD', 'Health Texas Provider Network', 'Manvinder', 'K', 'Kainth', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1396893491', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'W12041796', 'W12041796', 'TXDALSTD', 'Health Texas Provider Network', 'Julie', 'S', 'Parekh', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1124181342', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'W12041797', 'W12041797', 'TXDALSTD', 'Health Texas Provider Network', 'Julie', 'S', 'Parekh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1124181342', 0, 'N', 0, '2014-01-16', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752536818', 'W12041799', 'W12041799', 'TXDALSTD', 'Health Texas Provider Network', 'Anita', 'M', 'Mani', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841457108', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041800', 'W12041800', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Anita', 'M', 'Mani', 'PA', 'Family Practice', '', '', NULL, 'O', '5575 Warren Pkwy Ste 115', 'Frisco', 'Denton', 'TX', '75034', '2148237090', '2148231644', '5575 Warren Pkwy Ste 115', 'Frisco', 'Denton', 'TX', '75034', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841457108', 0, 'N', 0, '2013-12-06', NULL, NULL, 33.1067, -96.8401, NULL, NULL),
('752536818', 'W12041801', 'W12041801', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Anita', 'M', 'Mani', 'PA', 'Family Practice', '', '', NULL, 'O', '7777 Forest Ln Ste C106', 'Dallas', 'Dallas', 'TX', '75230', '2148237090', '2148231644', '7777 Forest Ln Ste C106', 'Dallas', 'Dallas', 'TX', '75230', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841457108', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752536818', 'W12041802', 'W12041802', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Anita', 'M', 'Mani', 'PA', 'Family Practice', '', '', NULL, 'O', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '4698007200', '4698007210', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '4698007200', '4698007210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841457108', 0, 'N', 0, '2013-12-06', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('463597585', 'W12041812', 'W12041812', 'WY01', 'Tailored Nutrition', 'Georgia', '', 'Boley', '', 'Dietician', '', '', NULL, 'O', '37 S Main', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', '37 S Main', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922432277', 0, 'N', 0, '2014-01-10', NULL, NULL, 44.7969, -106.956, NULL, NULL),
('463597585', 'W12041813', 'W12041813', 'WYT1', 'Tailored Nutrition', 'Georgia', '', 'Boley', '', 'Dietician', '', '', NULL, 'O', '37 S Main', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', '37 S Main', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922432277', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('463597585', 'W12041814', 'W12041814', 'WYT1', 'Tailored Nutrition', 'Georgia', '', 'Boley', '', 'Dietician', '', '', NULL, 'B', '66 Box Cross Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', '66 Box Cross Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922432277', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('463597585', 'W12041815', 'W12041815', 'WY01', 'Tailored Nutrition', 'Georgia', '', 'Boley', '', 'Dietician', '', '', NULL, 'B', '66 Box Cross Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', '66 Box Cross Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3077528213', '3076751866', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922432277', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('020718663', 'W12041816', 'W12041816', 'TXHOUSTD', 'Olutomisin M. Adesina', 'Olutomisin', 'M', 'Adesina', 'MD', 'Pediatrics', '', '', NULL, 'O', '8777B S Gessner', 'Houston', 'Harris', 'TX', '77074', '7132729959', '7132729944', '8777B S Gessner', 'Houston', 'Harris', 'TX', '77074', '7132729959', '7132729944', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831185909', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.6884, -95.526, NULL, NULL),
('462769759', 'W12041817', 'W12041817', 'WY01', 'Lander Womens Care ', 'Thomas', 'E', 'Dunaway', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1457454837', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.8327, -108.729, NULL, NULL),
('462769759', 'W12041818', 'W12041818', 'WYT1', 'Lander Womens Care ', 'Thomas', 'E', 'Dunaway', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1457454837', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('462769759', 'W12041819', 'W12041819', 'WY01', 'Lander Womens Care ', 'Karla', '', 'Wagner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1942395652', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.8327, -108.729, NULL, NULL),
('462769759', 'W12041820', 'W12041820', 'WYT1', 'Lander Womens Care ', 'Karla', '', 'Wagner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '206 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357720', '3073357723', '', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1942395652', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('741733584', 'W12041821', 'W12041821', 'TXHOUSTD', 'Northwest Eye Associates', 'Dora', '', 'Cantu', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1740 W 27th St Ste 180', 'Houston', 'Harris', 'TX', '77008', '7138648652', '7138642865', '1740 W 27th St Ste 180', 'Houston', 'Harris', 'TX', '77008', '7138648652', '7138642865', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194725366', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.8104, -95.4298, NULL, NULL),
('741733584', 'W12041822', 'W12041822', 'TXHOUSTD', 'Northwest Eye Associates', 'Betty Jo', '', 'Fredrickson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1740 W 27th St Ste 180', 'Houston', 'Harris', 'TX', '77008', '7138648652', '7138642865', '1740 W 27th St Ste 180', 'Houston', 'Harris', 'TX', '77008', '7138648652', '7138642865', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134129455', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.8104, -95.4298, NULL, NULL),
('454243392', 'W12041823', 'W12041823', 'TXDALSTD', 'Biren H Parikh', 'Biren', 'H', 'Parikh', 'MD', 'Cardiology', '', '', NULL, 'O', '700 Walker Reed Blvd Ste 301A', 'Garland', 'Dallas', 'TX', '75042', '2149193900', '2149193901', '700 Walker Reed Blvd Ste 301A', 'Garland', 'Dallas', 'TX', '75042', '2149193900', '2149193901', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1265501985', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752846234', 'W12041826', 'W12041826', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', '', '', 'Northeast Metroplex Orthopedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'O', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598895377', 0, 'Y', 0, '2013-12-13', NULL, NULL, 32.9173, -96.6589, NULL, NULL),
('454243392', 'W12041825', 'W12041825', 'TXDALSTD', 'Biren H Parikh', 'Biren', 'H', 'Parikh', 'MD', 'Cardiology', '', '', NULL, 'O', '2821 E George Bush Hwy Ste 506', 'Richardson', 'Dallas', 'TX', '75082', '2149193900', '2149193901', '2821 E George Bush Hwy Ste 506', 'Richardson', 'Dallas', 'TX', '75082', '2149193900', '2149193901', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1265501985', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9863, -96.6734, NULL, NULL),
('752846234', 'W12041827', 'W12041827', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', '', '', 'Northeast Metroplex Orthopedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'O', '6435 S FM 549', 'Rockwall', 'Rockwall', 'TX', '75032', '9722760536', '9722766037', '6435 S FM 549', 'Rockwall', 'Rockwall', 'TX', '75032', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598895377', 0, 'Y', 0, '2013-12-13', NULL, NULL, 32.8645, -96.4413, NULL, NULL),
('752846234', 'W12041829', 'W12041829', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'Todd', 'C', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1902856479', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.9173, -96.6589, NULL, NULL),
('752846234', 'W12041830', 'W12041830', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'Todd', 'C', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6435 S FM 549', 'Rockwall', 'Rockwall', 'TX', '75032', '9722760536', '9722766037', '6435 S FM 549', 'Rockwall', 'Rockwall', 'TX', '75032', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1902856479', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.8645, -96.4413, NULL, NULL),
('752846234', 'W12041832', 'W12041832', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'Jeffrey', 'B', 'Klein', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1346291697', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.9173, -96.6589, NULL, NULL),
('752846234', 'W12041834', 'W12041834', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'George', 'N', 'Zoys', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1689624876', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.9173, -96.6589, NULL, NULL),
('752846234', 'W12041835', 'W12041835', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'George', 'N', 'Zoys', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2821 E President George Bush Ste 306', 'Richardson', 'Dallas', 'TX', '75082', '9722760536', '9722766037', '2821 E President George Bush Ste 306', 'Richardson', 'Dallas', 'TX', '75082', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1689624876', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.9863, -96.6734, NULL, NULL),
('752846234', 'W12041838', 'W12041838', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', '', '', 'Northeast Metroplex Orthopedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'O', '2821 E President George Bush Ste 306', 'Richardson', 'Dallas', 'TX', '75082', '9722760536', '9722766037', '2821 E President George Bush Ste 306', 'Richardson', 'Dallas', 'TX', '75082', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598895377', 0, 'Y', 0, '2013-12-13', NULL, NULL, 32.9863, -96.6734, NULL, NULL),
('870543318', 'W12041839', 'W12041839', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12041840', 'W12041840', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'M', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12041841', 'W12041841', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 410017', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012633041', '8012638485', 'PO Box 410017', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041845', 'W12041845', 'TXDALSTD', 'Cardiovascular Consultants of North Texas', 'Juan', 'C', 'MacHannaford', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1600 W College Ste 680', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '1600 W College Ste 680', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902094246', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752536818', 'W12041844', 'W12041844', 'TXDALSTD', 'Cardiac Surgery at Baylor University Medical Center at Dallas', 'Juan', 'C', 'MacHannaford', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148207100', '2148206863', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148207100', '2148206863', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902094246', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752536818', 'W12041843', 'W12041843', 'TXDALSTD', 'Health Texas Provider Network', 'Juan', 'C', 'MacHannaford', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902094246', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12041848', 'W12041848', 'TXDALSTD', 'Health Texas Provider Network', 'Saima', '', 'Rashid', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', '2014-03-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588667356', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12041847', 'W12041847', 'TXDALSTD', '', 'Saima', '', 'Rashid', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', '2014-03-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588667356', 0, 'N', 0, '2014-04-17', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('752536818', 'W12041850', 'W12041850', 'TXDALSTD', 'Health Texas Provider Network', 'Steven', 'G', 'Leeds', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467689604', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041851', 'W12041851', 'TXDALSTD', 'Health Texas Provider Network', 'Steven', 'G', 'Leeds', 'MD', 'General Surgery', '', '', NULL, 'O', '3410 Worth St Ste 860', 'Dallas', 'Dallas', 'TX', '75246', '2148208500', '2148208168', '3410 Worth St Ste 860', 'Dallas', 'Dallas', 'TX', '75246', '2148208500', '2148208168', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467689604', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752536818', 'W12041853', 'W12041853', 'TXDALSTD', 'Southlake Family Medicine', 'Kelley', 'G', 'Schillo', 'DO', 'Internal Medicine', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487685194', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'W12041854', 'W12041854', 'TXDALSTD', 'Health Texas Provider Network', 'Kelley', 'G', 'Schillo', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487685194', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041856', 'W12041856', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'L', 'Smart', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1871770891', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041857', 'W12041857', 'TXDALSTD', 'Baylor Family Medicine at Fort Worth', 'Jennifer', 'L', 'Smart', 'MD', 'Family Practice', '', '', NULL, 'O', '900 W Magnolia Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', '900 W Magnolia Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1871770891', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('911947573', 'W12041858', 'W12041858', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jay', 'D', 'Mabrey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2148207010', '2148207015', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2148207010', '2148207015', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871521229', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'W12041859', 'W12041859', 'TXDALSTD', '', 'Dan', '', 'Schuller', 'MD', 'Critical Care', '', '', NULL, 'O', '621 N Hall St Ste 120', 'Dallas', 'Dallas', 'TX', '75226', '2148206856', '2148201638', '621 N Hall St Ste 120', 'Dallas', 'Dallas', 'TX', '75226', '2148206856', '2148201638', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467566042', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'W12041860', 'W12041860', 'TXDALSTD', 'The Heart Group', 'William', 'T', 'Gray', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '3341 Unicorn Lake Blvd', 'Denton', 'Denton', 'TX', '76210', '4698005350', '4698005386', '3341 Unicorn Lake Blvd', 'Denton', 'Denton', 'TX', '76210', '4698005350', '4698005386', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1467407197', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.1754, -97.0981, NULL, NULL),
('752536818', 'W12041861', 'W12041861', 'TXDALSTD', '', 'Molly', '', 'Szerlip', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5236 W University Dr Ste 4900', 'Mckinney', 'Collin', 'TX', '75071', '4698005350', '4698005360', '5236 W University Dr Ste 4900', 'Mckinney', 'Collin', 'TX', '75071', '4698005350', '4698005360', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1902849631', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('030374787', 'W12041862', 'W12041862', 'TXDALSTD', 'Surgical Institute', 'Ryan', 'D', 'Burkart', 'MD', 'General Surgery', '', '', NULL, 'O', '5236 W University Dr  Ste 2200', 'Irving', 'Dallas', 'TX', '75017', '4698005036', '4698005388', '5236 W University Dr  Ste 2200', 'Irving', 'Dallas', 'TX', '75017', '4698005036', '4698005388', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-04', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063685659', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041863', 'W12041863', 'TXDALSTD', 'Spine Surgery Center', 'Matthew', '', 'Berchuck', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '2148651350', '2148651351', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '2148651350', '2148651351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-08', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245283803', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('752536818', 'W12041864', 'W12041864', 'TXDALSTD', '', 'Matthew', '', 'Berchuck', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1441 S Midlothian Pwy Ste 100', 'Lake Dallas', 'Denton', 'TX', '75065', '2148651350', '2148651351', '1441 S Midlothian Pwy Ste 100', 'Lake Dallas', 'Denton', 'TX', '75065', '2148651350', '2148651351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-08', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245283803', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12041865', 'W12041865', 'TXDALSTD', '', 'Matthew', '', 'Berchuck', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '2148651350', '2148651351', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '2148651350', '2148651351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-08', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245283803', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'W12041866', 'W12041866', 'TXDALSTD', '', 'James', 'W', 'Fleshman', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '2148208768', '2148208769', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '2148208768', '2148208769', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-10', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1689692105', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'W12041867', 'W12041867', 'TXDALSTD', '', 'Sarah', 'Y', 'Boostrom', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '2148208768', '2148208769', '9101 N Central Expwy Ste 150', 'Dallas', 'Dallas', 'TX', '75231', '2148208768', '2148208769', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1336269018', 0, 'N', 0, '2013-12-23', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752600832', 'W12041869', 'W12041869', 'TXDALSTD', 'Health Texas Provider Network', 'Jun', 'J', 'Zhao', 'MS', 'Diabetic Education', '', '', NULL, 'O', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285070573', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'W12041873', 'W12041873', 'TXDALSTD', '', 'Richard', 'J', 'Feingold', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8179128400', '8179128410', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1629070362', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9271, -97.2541, NULL, NULL),
('752536818', 'W12041874', 'W12041874', 'TXDALSTD', '', 'Phillip', 'J', 'Hecht', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1598794802', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12041875', 'W12041875', 'TXDALSTD', '', 'Phillip', 'J', 'Hecht', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '4698000500', '4698000510', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '4698000500', '4698000510', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1598794802', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0789, -97.0789, NULL, NULL),
('752536818', 'W12041876', 'W12041876', 'TXDALSTD', '', 'Vikas', 'C', 'Jain', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1477555092', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12041877', 'W12041877', 'TXDALSTD', '', 'Vikas', 'C', 'Jain', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '8179128400', '8179128410', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1477555092', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'W12041878', 'W12041878', 'TXDALSTD', '', 'John', 'W R', 'Lawson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1386674935', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12041879', 'W12041879', 'TXDALSTD', '', 'David', 'M', 'Scherer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1467482083', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12041880', 'W12041880', 'TXDALSTD', '', 'David', 'M', 'Scherer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '8179128400', '8179128410', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1467482083', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0789, -97.0789, NULL, NULL),
('752536818', 'W12041881', 'W12041881', 'TXDALSTD', '', 'John', 'W R', 'Lawson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1386674935', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0451, -96.8374, NULL, NULL),
('752536818', 'W12041882', 'W12041882', 'TXDALSTD', '', 'Kevin', 'P', 'Theleman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '2020 W Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1346283439', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12041883', 'W12041883', 'TXDALSTD', '', 'Kevin', 'P', 'Theleman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2800 Hwy 114 Ste 130', 'Cotter', 'Baxter', 'AR', '72626', '8179128400', '8179128410', '2800 Hwy 114 Ste 130', 'Cotter', 'Baxter', 'AR', '72626', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1346283439', 0, 'N', 0, '2013-12-09', 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
('752536818', 'W12041884', 'W12041884', 'TXDALSTD', '', 'Trent', 'L', 'Pettijohn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1265468706', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9976, -96.7656, NULL, NULL),
('752536818', 'W12041885', 'W12041885', 'TXDALSTD', '', 'Trent', 'L', 'Pettijohn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1265468706', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752536818', 'W12041886', 'W12041886', 'TXDALSTD', 'Colleyville Family Medicine', 'Kevin', 'P', 'Theleman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8179128400', '8179128410', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1346283439', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.8864, -97.1519, NULL, NULL),
('752536818', 'W12041887', 'W12041887', 'TXDALSTD', '', 'Sabrina', '', 'Stone', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1306104161', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0451, -96.8374, NULL, NULL),
('752536818', 'W12041888', 'W12041888', 'TXDALSTD', '', 'Sabrina', '', 'Stone', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1306104161', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9976, -96.7656, NULL, NULL),
('752536818', 'W12041889', 'W12041889', 'TXDALSTD', '', 'Sabrina', '', 'Stone', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1306104161', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752536818', 'W12041890', 'W12041890', 'TXDALSTD', '', 'Thomas', '', 'Waller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '4708 Alliance Blvd Ste 720', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1760410187', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752536818', 'W12041891', 'W12041891', 'TXDALSTD', '', 'Thomas', '', 'Waller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', '8000 Frankford Rd', 'Dallas', 'Collin', 'TX', '75252', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1760410187', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9976, -96.7656, NULL, NULL),
('752536818', 'W12041892', 'W12041892', 'TXDALSTD', '', 'Raul', 'A', 'Santos', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '4698001030', '4698000138', '2900 Village Pkwy Ste 300', 'Lewisville', 'Denton', 'TX', '75077', '4698001030', '4698000138', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1013926039', 0, 'N', 0, '2014-04-17', NULL, NULL, 33.0789, -97.0789, NULL, NULL),
('752536818', 'W12041893', 'W12041893', 'TXDALSTD', '', 'Raul', 'A', 'Santos', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1013926039', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0451, -96.8374, NULL, NULL),
('452510038', 'W12041898', 'W12041898', 'ID02', 'Boise Family Eye Center', 'Brent ', 'A', 'Galvan', 'OD', 'Optometry', '', '', NULL, 'O', '8102 W Northview St', 'Boise', 'Ada', 'ID', '83704', '2083771102', '2083775853', '8102 W Northview St', 'Boise', 'Ada', 'ID', '83704', '2083771102', '2083775853', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285759753', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12041899', 'W12041899', 'Sinclair', 'St Lukes Clinic Wood River', 'Aaron', '', 'Moos', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '100 Hospital Dr Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2087278600', '2087278601', '100 Hospital Dr Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2087278600', '2087278601', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255657011', 0, 'N', 1, '2014-02-19', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('452715973', 'W12041900', 'W12041900', 'Sinclair', 'St Lukes Clinic Wood River', 'Aaron', '', 'Moos', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255657011', 0, 'N', 1, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('134214083', 'W12041901', 'W12041901', 'UT01', 'Apple Valley Vision', 'Brian', 'F', 'Rowley', 'OD', 'Optometry', '', '', NULL, 'O', '539 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014650355', '8014659238', '539 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014650355', '8014659238', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588771414', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.0361, -111.734, NULL, NULL),
('204043287', 'W12041903', 'W12041903', 'NM01', 'ABQ Health Partners', 'Theresa', '', 'Gutierrez', 'CNP', 'Family Practice', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-29', '2014-02-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528491966', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12041904', 'W12041904', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', 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, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041905', 'W12041905', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', 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, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041906', 'W12041906', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041907', 'W12041907', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', 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, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041908', 'W12041908', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', 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, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041909', 'W12041909', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Charles', '', 'Anstrand', 'PA', 'Ear, Nose and Throat', '', '', 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, '2013-11-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427162874', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.4877, -116.404, NULL, NULL),
('820200895', 'W12041910', 'W12041910', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Kelsey', 'F', 'Babcock', 'PA', 'Family Practice', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12034479', 'W12034479', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise ', 'Kelsey', 'F', 'Babcock', 'PA', 'Family Practice', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'W12041911', 'W12041911', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Kelsey', 'F', 'Babcock', 'PA', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041912', 'W12041912', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Kelsey', 'F', 'Babcock', 'PA', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041913', 'W12041913', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Kelsey', 'F', 'Babcock', 'PA', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041914', 'W12041914', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Kelsey', 'F', 'Babcock', 'PA', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041915', 'W12041915', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Kelsey', 'F', 'Babcock', 'PA', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041916', 'W12041916', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Kelsey', 'F', 'Babcock', 'PA', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1528316700', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041917', 'W12041917', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Jeffrey', 'V', 'Ball', '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, '2013-12-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1598790560', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.4877, -116.404, NULL, NULL),
('820200895', 'W12041918', 'W12041918', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Chelsea', 'E', 'Dedlow', 'NP', 'Family Practice', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041919', 'W12041919', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Chelsea', 'E', 'Dedlow', 'NP', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041920', 'W12041920', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Chelsea', 'E', 'Dedlow', 'NP', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041921', 'W12041921', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Chelsea', 'E', 'Dedlow', 'NP', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041922', 'W12041922', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Chelsea', 'E', 'Dedlow', 'NP', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041923', 'W12041923', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Chelsea', 'E', 'Dedlow', 'NP', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041924', 'W12041924', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Chelsea', 'E', 'Dedlow', 'NP', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205103686', 0, 'Y', 0, '2014-07-10', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041925', 'W12041925', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041926', 'W12041926', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041927', 'W12041927', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041928', 'W12041928', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041929', 'W12041929', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041930', 'W12041930', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041931', 'W12041931', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041932', 'W12041932', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041933', 'W12041933', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Beverlee', 'K', 'Furner', 'NPC', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041934', 'W12041934', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Beverlee', 'K', 'Furner', 'NPC', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041935', 'W12041935', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041936', 'W12041936', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Beverlee', 'K', 'Furner', 'NPC', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041937', 'W12041937', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Beverlee', 'K', 'Furner', 'NPC', '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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041938', 'W12041938', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041939', 'W12041939', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN Nampa', 'Guillermo', '', 'Guzman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1603 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2082884888', '2082884890', '1603 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2082884888', '2082884890', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-09', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1881828010', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5531, -116.573, NULL, NULL),
('820200895', 'W12041940', 'W12041940', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Baker', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415232399', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415232399', '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, 44.7961, -117.846, NULL, NULL),
('820200895', 'W12041941', 'W12041941', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Cory', '', 'Huffine', 'NP-C', 'Wound 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041942', 'W12041942', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Cory', '', 'Huffine', 'NP-C', 'Wound 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041943', 'W12041943', 'IDBOISTD', 'Saint Alphonsus Inpatient Pain ', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674030', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674030', '2083674051', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12041945', 'W12041945', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041946', 'W12041946', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Cory', '', 'Huffine', 'NP-C', 'Wound 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041947', 'W12041947', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Cory', '', 'Huffine', 'NP-C', 'Wound 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('271789847', 'W12041948', 'W12041948', 'IDBOISTD', 'Saint Alphonsus Medical Center Ontario', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', '2014-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457669863', 0, 'N', 0, '2014-05-19', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('820200895', 'W12041949', 'W12041949', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041950', 'W12041950', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('453218632', 'W12041951', 'W12041951', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', '', '', 'Houston Orthopedic and Spine Physicians', '', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275608788', 0, 'Y', 0, '2013-12-10', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('453218632', 'W12041952', 'W12041952', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', '', '', 'Houston Orthopedic and Spine Physicians', '', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275608788', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('453218632', 'W12041953', 'W12041953', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'Cecil', '', 'Christensen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1295842896', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('453218632', 'W12041954', 'W12041954', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'Cecil', '', 'Christensen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1295842896', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('453218632', 'W12041955', 'W12041955', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'William', 'H', 'Hadnott', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194832709', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('453218632', 'W12041956', 'W12041956', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'William', 'H', 'Hadnott', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194832709', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('453218632', 'W12041957', 'W12041957', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'Jonathan', 'G', 'Lee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', '1200 Binz Ste 1430', 'Houston', 'Harris', 'TX', '77004', '7135269986', '7135225200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1104933704', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('453218632', 'W12041958', 'W12041958', 'TXHOUSTD', 'Houston Orthopedic and Spine Physicians', 'Jonathan', 'G', 'Lee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'PO Box 11295', 'Belfast', 'Waldo', 'ME', '04915', '7133144600', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1104933704', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12042150', 'W12042150', 'ID02', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Cynthia', '', 'Reed', 'NP-C', 'Family Practice', '', '', NULL, 'O', '910 NW 16th Str', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th Str', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2013-12-17', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1902119423', 0, 'N', 0, '2014-01-23', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820200895', 'W12041961', 'W12041961', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN Nampa', 'Jeffrey', 'R', 'Jacobs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1603 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2082884888', '2082884890', '1603 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2082884888', '2082884890', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-09', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1154454098', 0, 'N', 0, '2014-03-10', NULL, NULL, 43.5531, -116.573, NULL, NULL),
('820200895', 'W12041962', 'W12041962', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041963', 'W12041963', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041964', 'W12041964', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041965', 'W12041965', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041966', 'W12041966', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041967', 'W12041967', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041968', 'W12041968', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Robyn', '', 'Jones', 'NP', 'Pulmonary', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790034312', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041969', 'W12041969', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Jennifer', '', 'Nordquist', 'NP-C', 'Family Practice', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12041970', 'W12041970', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Jennifer', '', 'Nordquist', 'NP-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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041971', 'W12041971', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jennifer', '', 'Nordquist', 'NP-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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041972', 'W12041972', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Jennifer', '', 'Nordquist', 'NP-C', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041973', 'W12041973', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Jennifer', '', 'Nordquist', 'NP-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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041974', 'W12041974', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Jennifer', '', 'Nordquist', 'NP-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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041975', 'W12041975', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Jennifer', '', 'Nordquist', 'NP-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041976', 'W12041976', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6229, -116.209, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820200895', 'W12041977', 'W12041977', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12041978', 'W12041978', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12041979', 'W12041979', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041980', 'W12041980', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041981', 'W12041981', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12041982', 'W12041982', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041984', 'W12041984', 'IDBOISTD', 'CARE Maternal/Child Health Program', 'Debbie', 'L', 'Young', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437109873', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'W12041985', 'W12041985', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Debbie', 'L', 'Young', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437109873', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12041986', 'W12041986', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Kristine', 'M', 'Reinhardt', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1639490006', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12041987', 'W12041987', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Kristine', 'M', 'Reinhardt', 'NPC', 'Family Practice', 'Nurse Practitioner', '', 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, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1639490006', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12041988', 'W12041988', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Kristine', 'M', 'Reinhardt', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1639490006', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.7, -116.35, NULL, NULL),
('820200895', 'W12041989', 'W12041989', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery', 'Molly', 'C', 'Piccono', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083677090', '2083677092', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083677090', '2083677092', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1881739274', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('203926185', 'W12041990', 'W12041990', 'ID02', 'Meridian Vision', 'Kevin', 'W', 'McElroy', 'OD', 'Optometry', '', '', NULL, 'O', '50 E Carmel Dr', 'Meridian', 'Ada', 'ID', '83646', '2088885252', '2088844280', '50 E Carmel Dr', 'Meridian', 'Ada', 'ID', '83646', '2088885252', '2088844280', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528154242', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12041991', 'W12041991', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Steven', '', 'Von Flue', 'MD', 'Hospitalist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', '1512 12th Ave Rd   ', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-20', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1871553248', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('452716222', 'W12041995', 'W12041995', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Bradley', 'D', 'Raisher', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '111 Broadway Ste 101 & 165', 'Boise', 'Ada', 'ID', '83702', '2083817384', '2083817387', '111 Broadway Ste 101 & 165', 'Boise', 'Ada', 'ID', '83702', '2083817384', '2083817387', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-11-15', '2014-03-26', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912965237', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12041993', 'W12041993', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Bradley', 'D', 'Raisher', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-11-15', '2014-03-26', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912965237', 0, 'N', 0, '2014-05-09', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('452716222', 'W12041994', 'W12041994', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Bradley', 'D', 'Raisher', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-11-15', '2014-03-26', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912965237', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('453948727', 'W12041996', 'W12041996', 'ID02', 'Emmett Eye Center', 'Thomas', 'W', 'Woodward', 'OD', 'Optometry', '', '', NULL, 'O', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982792180', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('453948727', 'W12041997', 'W12041997', 'SACN', 'Emmett Eye Center', 'Thomas', 'W', 'Woodward', 'OD', 'Optometry', '', '', NULL, 'O', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2013-11-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982792180', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12041999', 'W12041999', 'ID02', 'St Lukes Clinic Saltzer Medical Group', 'Nichole', '', 'Palmer-George', 'PT', 'Physical Therapy', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2082884991', '2082884987', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2082884991', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-11-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619318847', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W12042000', 'W12042000', 'ID02', 'Ankle & Foot Medical Center', 'Jeffrey', 'L', 'Chandler', 'DPM', 'Podiatry', '', '', NULL, 'O', '1828 S Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088840313', '2083444349', '1828 S Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088840313', '2083444349', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-10-23', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659354470', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820408637', 'W12042002', 'W12042002', 'ID02', 'Ankle & Foot Medical Center', 'Jeffrey', 'L', 'Chandler', 'DPM', 'Podiatry', '', '', NULL, 'B', '222 N 2nd St Ste 301', 'Boise', 'Ada', 'ID', '83702', '2083443324', '2083444349', '222 N 2nd St Ste 301', 'Boise', 'Ada', 'ID', '83702', '2083443324', '2083444349', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-10-23', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659354470', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('820161600', 'W12042003', 'W12042003', 'ID02', 'St Lukes Regional Medical Center', 'Nichole', '', 'Palmer-George', 'PT', 'Physical Therapy', '', '', NULL, 'B', '217 W Georgia Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084654825', '217 W Georgia Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084654825', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-11-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619318847', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12042005', 'W12042005', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Jay', 'B', 'Richman', 'AUD', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578991196', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042115', 'W12042115', 'ID02', 'Advanced Physical Therapy', 'Gary', '', 'Hoopes', 'PT', 'Physical Therapy', '', '', NULL, 'O', '275 E 7th St', 'Weiser', 'Washington', 'ID', '83672', '2085491008', '2085491396', '275 E 7th St', 'Weiser', 'Washington', 'ID', '83672', '2085491008', '2085491396', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083692701', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('123456789', 'W12042006', 'W12042006', 'test', 'lame', 'Dan', '', 'Hansens', '', 'Pathology', '', '', NULL, 'O', 'Change ', 'West Jordan', 'Salt Lake', 'UT', '84084', '          ', '          ', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'AZ000A', 'CARDIONET', 'OP-1', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|DEN|', '1234567891', 0, 'N', 1, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870489855', 'W12042008', 'W12042008', 'UTMH1', 'Richard King Mower', 'Richard', 'K', 'Mower', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '336 E 900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8012926101', '8012985349', '336 E 900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8012926101', '8012985349', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831174515', 0, 'N', 0, '2014-01-23', NULL, NULL, 40.7498, -111.881, NULL, NULL),
('870489855', 'W12042009', 'W12042009', 'UTMH1', 'Richard King Mower', 'Richard', 'K', 'Mower', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 S Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012926101', '8012985349', '505 S Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012926101', '8012985349', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831174515', 0, 'N', 0, '2014-01-23', NULL, NULL, 40.8841, -111.881, NULL, NULL),
('043610299', 'W12042012', 'W12042012', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Takeisha', '', 'Ikeda', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326203266', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('043610299', 'W12042011', 'W12042011', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Takeisha', '', 'Ikeda', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326203266', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('043610299', 'W12042013', 'W12042013', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Takeisha', '', 'Ikeda', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326203266', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('043610299', 'W12042014', 'W12042014', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Takeisha', '', 'Ikeda', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326203266', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.56, -95.2796, NULL, NULL),
('043610299', 'W12042016', 'W12042016', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Maria', 'I', 'Rosas', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144422346', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('043610299', 'W12042015', 'W12042015', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Maria', 'I', 'Rosas', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144422346', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('043610299', 'W12042017', 'W12042017', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Maria', 'I', 'Rosas', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144422346', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('043610299', 'W12042018', 'W12042018', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Maria', 'I', 'Rosas', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144422346', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.56, -95.2796, NULL, NULL),
('043610299', 'W12042021', 'W12042021', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Rene', '', 'Amaya', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', '11302 Fallbrook Ste 110', 'Houston', 'Harris', 'TX', '77065', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134125370', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('043610299', 'W12042022', 'W12042022', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Rene', '', 'Amaya', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', '1140 Business Ctr Dr Ste 300 ', 'Houston', 'Harris', 'TX', '77043', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134125370', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('043610299', 'W12042020', 'W12042020', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Rene', '', 'Amaya', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', '250 Blossom Ste 350', 'Webster', 'Harris', 'TX', '77598', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134125370', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('043610299', 'W12042019', 'W12042019', 'TXHOUSTD', 'Pediatric Infectious Disease', 'Rene', '', 'Amaya', 'MD', 'Pediatric Infectious Diseases', '', '', NULL, 'B', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'PO Box 3278', 'Pearland', 'Brazoria', 'TX', '77588', '7134649776', '7134649771', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134125370', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.56, -95.2796, NULL, NULL),
('742581471', 'W12042023', 'W12042023', 'TXSATSTD', 'John Alukal', 'John', '', 'Alukal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1620 McCullough Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102264091', '2102291116', '1620 McCullough Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102264091', '2102291116', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|', '1306886403', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.4447, -98.4918, NULL, NULL),
('204473802', 'W12042024', 'W12042024', 'TXHOUSTD', 'Houston Metro Urology ', '', '', 'Houston Metro Urology ', '', 'Urology', '', '', NULL, 'O', '4223 Richmond Ave', 'Houston', 'Harris', 'TX', '77027', '7133510630', '7133510636', '4223 Richmond Ave', 'Houston', 'Harris', 'TX', '77027', '7133510630', '7133510636', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245281922', 0, 'Y', 0, '2013-12-16', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'W12042026', 'W12042026', 'TXHOUSTD', 'Houston Metro Urology ', '', '', 'Houston Metro Urology ', '', 'Urology', '', '', NULL, 'B', 'PO Box 1400', 'Houston', 'Harris', 'TX', '77251', '7133510630', '7133510636', 'PO Box 1400', 'Houston', 'Harris', 'TX', '77251', '7133510630', '7133510636', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245281922', 0, 'N', 0, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('760570343', 'W12042027', 'W12042027', 'TXHOUSTD', 'Shanaz K Ali', 'Shanaz', 'K', 'Ali', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '1111 Hwy 6 Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814910909', '2814912829', '1111 Hwy 6 Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814910909', '2814912829', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-16', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871562272', 0, 'N', 0, '2013-12-16', NULL, NULL, 29.6051, -95.6372, NULL, NULL),
('870543318', 'W12042038', 'W12042038', 'UT01', 'Utah Gastroenterology', 'Andrew', '', 'Fedoravicius ', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1851585087', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042029', 'W12042029', 'UT01', 'Gastroenterology Associates', '', '', 'Gastroenterology Associates', '', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009889', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042028', 'W12042028', 'UT01', 'Gastroenterology Associates', '', '', 'Gastroenterology Associates', '', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009889', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'W12042036', 'W12042036', 'UT01', 'Gastroenterology Associates', '', '', 'Gastroenterology Associates', '', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISESTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009889', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042039', 'W12042039', 'UT01', 'Gastroenterology Associates', 'Christopher', '', 'Maxwell', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114107026', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042040', 'W12042040', 'UT01', 'Gastroenterology Associates', 'Christopher', '', 'Maxwell', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114107026', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042041', 'W12042041', 'UT01', 'Gastroenterology Associates', 'Peder', 'J', 'Pedersen', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568558211', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042042', 'W12042042', 'UT01', 'Gastroenterology Associates', 'Peder', 'J', 'Pedersen', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568558211', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042043', 'W12042043', 'UT01', 'Gastroenterology Associates', 'Ronald', 'D', 'Joseph', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033205760', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042044', 'W12042044', 'UT01', 'Gastroenterology Associates', 'Ronald', 'D', 'Joseph', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033205760', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042045', 'W12042045', 'UT01', 'Utah Gastroenterology', 'Holly', 'B', 'Clark', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376639047', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042046', 'W12042046', 'UT01', 'Utah Gastroenterology', 'Holly', 'B', 'Clark', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376639047', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042047', 'W12042047', 'UT01', 'Gastroenterology Associates', 'Chaya', '', 'Krishnamurthy', 'MD', 'Internal Medicine', 'Gastroenterology', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679767842', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042049', 'W12042049', 'UT01', 'Gastroenterology Associates', 'Chaya', '', 'Krishnamurthy', 'MD', 'Internal Medicine', 'Gastroenterology', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854850', '8012548331', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854850', '8012548331', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679767842', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('870543318', 'W12042048', 'W12042048', 'UT01', 'Gastroenterology Associates', 'Chaya', '', 'Krishnamurthy', 'MD', 'Internal Medicine', 'Gastroenterology', '', NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679767842', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042050', 'W12042050', 'UT01', 'Gastroenterology Associates', 'D', 'B', 'Trowbridge', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134215809', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042051', 'W12042051', 'UT01', 'Gastroenterology Associates', 'D', 'B', 'Trowbridge', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134215809', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042052', 'W12042052', 'UT01', 'Gastroenterology Associates', 'Jason', 'C', 'Wills', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871689554', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870543318', 'W12042053', 'W12042053', 'UT01', 'Gastroenterology Associates', 'Jason', 'C', 'Wills', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019443188', '8019443180', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871689554', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W12042054', 'W12042054', 'UT01', 'Gastroenterology Associates', '', '', 'Gastroenterology Associates', '', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854850', '8012548331', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854850', '8012548331', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009889', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042055', 'W12042055', 'ID02', 'Foothills Physical Therapy', 'Jerret', 'K', 'Hopstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083620553', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042056', 'W12042056', 'ID02', 'Foothills Physical Therapy', 'J', 'B', 'Aberg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982611836', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042057', 'W12042057', 'ID02', 'Foothills Physical Therapy', 'David', 'D', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265870117', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042058', 'W12042058', 'ID02', 'Foothills Physical Therapy', 'Bret', 'A', 'Bastian', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760798375', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042059', 'W12042059', 'ID02', 'Foothills Physical Therapy', 'Frank', '', 'Culbertson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1467466201', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042060', 'W12042060', 'ID02', 'Foothills Physical Therapy', 'Teresa', 'A', 'DeBlieck', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1184635427', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042061', 'W12042061', 'ID02', 'Foothills Physical Therapy', 'James', 'D', 'Hammer', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245494269', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042062', 'W12042062', 'ID02', 'Foothills Physical Therapy', 'Pamela', 'A', 'Martin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154380293', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042063', 'W12042063', 'ID02', 'Foothills Physical Therapy', 'Brian', 'C', 'O Neal', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093970675', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042064', 'W12042064', 'ID02', 'Foothills Physical Therapy', 'Nicole', '', 'Olsen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740439470', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042065', 'W12042065', 'ID02', 'Foothills Physical Therapy', 'Linda', 'M', 'Owen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558677021', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042066', 'W12042066', 'ID02', 'Foothills Physical Therapy', 'Lauren', '', 'Scott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1437266723', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042067', 'W12042067', 'ID02', 'Foothills Physical Therapy', 'Lisa', 'M', 'Swan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275603086', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12042068', 'W12042068', 'ID02', 'Foothills Physical Therapy', 'Nick', 'L', 'Woods', 'PT', 'Physical Therapy', '', '', NULL, 'O', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', '645 E State St Ste 101', 'Eagle', 'Ada', 'ID', '83616', '2089399594', '2089399828', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2014-01-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790792646', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('273225359', 'W12042069', 'W12042069', 'TXHOUSTD', 'Calder Urgent Care', '', '', 'Calder Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010153', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('273225359', 'W12042070', 'W12042070', 'TXHOUSTD', 'Calder Urgent Care', '', '', 'Calder Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1108 S Gulf Fwy  Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', '1108 S Gulf Fwy  Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010153', 0, 'N', 0, '2013-12-12', NULL, NULL, 29.495, -95.1088, NULL, NULL),
('870281028', 'W12042073', 'W12042073', 'UT01', 'Central Utah Clinic PC', 'David ', 'S', 'Slade', 'MD', 'Ophthalmology', '', '', NULL, 'O', '52 S 850 W Ste 202A', 'Hurricane', 'Washington', 'UT', '84737', '4356284507', '4356283748', '52 S 850 W Ste 202A', 'Hurricane', 'Washington', 'UT', '84737', '4356284507', '4356283748', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598918666', 0, 'N', 0, '2013-12-12', NULL, NULL, 37.1756, -113.305, NULL, NULL),
('751894946', 'W12042075', 'W12042075', 'TXDALSTD', 'Craig Paul, MD', 'Craig', 'H', 'Paul', 'MD', 'Internal Medicine', '', '', NULL, 'O', '403 W Campbell Rd Ste 410', 'Richardson', 'Dallas', 'TX', '75080', '9724988670', '9724988676', '403 W Campbell Rd Ste 410', 'Richardson', 'Dallas', 'TX', '75080', '9724988670', '9724988676', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154483410', 0, 'N', 0, '2014-03-17', NULL, NULL, 32.9754, -96.7254, NULL, NULL),
('263133338', 'W12042079', 'W12042079', 'TXDALSTD', '', 'Niti', '', 'Randhawa', 'MD', 'Family Practice', '', '', NULL, 'O', '12200 Park Central Dr Ste 415', 'Dallas', 'Dallas', 'TX', '75251', '4695878480', '4695878484', '12200 Park Central Dr Ste 415', 'Dallas', 'Dallas', 'TX', '75251', '4695878480', '4695878484', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376518761', 0, 'N', 0, '2013-12-12', NULL, NULL, 32.9142, -96.7757, NULL, NULL),
('751745406', 'W12042077', 'W12042077', 'TXDALSTD', '', 'Ashfaq', 'A', 'Rasheed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2698 N Galloway Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722881662', '9722893075', '2698 N Galloway Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722881662', '9722893075', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750488110', 0, 'N', 0, '2013-12-12', NULL, NULL, 32.8012, -96.6111, NULL, NULL),
('202695503', 'W12042081', 'W12042081', 'TXDALSTD', 'Allen Family First Clinic', 'Chandana', '', 'Reddy', 'DO', 'Family Practice', '', '', NULL, 'O', '977 Raintree Cir Ste 110', 'Allen', 'Collin', 'TX', '75013', '9726784600', '9726784602', '977 Raintree Cir Ste 110', 'Allen', 'Collin', 'TX', '75013', '9726784600', '9726784602', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700851128', 0, 'N', 0, '2013-12-12', NULL, NULL, 33.1111, -96.6793, NULL, NULL),
('272203782', 'W12042083', 'W12042083', 'TXDALSTD', 'Singh Medical Practice', 'Kuldeep', '', 'Singh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4104 W 15th St Ste 102', 'Plano', 'Collin', 'TX', '75093', '9729431916', '9729431917', '4104 W 15th St Ste 102', 'Plano', 'Collin', 'TX', '75093', '9729431916', '9729431917', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174571979', 0, 'N', 0, '2013-12-12', NULL, NULL, 33.0176, -96.771, NULL, NULL),
('201460039', 'W12042085', 'W12042085', 'TXDALSTD', 'Fehmida Zahabi MD PA', 'Fehmida', '', 'Zahabi', 'MD', 'Rheumatology', '', '', NULL, 'O', '6300 Stonewood Dr Ste 412', 'Plano', 'Collin', 'TX', '75024', '4694672478', '4694678146', '6300 Stonewood Dr Ste 412', 'Plano', 'Collin', 'TX', '75024', '4694672478', '4694678146', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740397603', 0, 'N', 0, '2013-12-12', NULL, NULL, 33.0581, -96.7745, NULL, NULL),
('810231784', 'W12042089', 'W12042089', 'WYBILLINGS', 'Billings Clinic', 'Jodee', 'M', 'Etchart', 'PA', 'Family Practice', '', '', 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, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568456044', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12042087', 'W12042087', 'WYBILLINGS', 'Billings Clinic - Family Practice', 'Jodee', 'M', 'Etchart', 'PA', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1568456044', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12042088', 'W12042088', 'WYBILLINGS', 'Billings Clinic', 'Jodee', 'M', 'Etchart', 'PA', 'Family Practice', '', '', 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, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568456044', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12042091', 'W12042091', 'WYBILLINGS', 'Billings Clinic', 'Cindy', 'L', 'Murray', 'PA', 'Family Practice', '', '', 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, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235443425', 0, 'N', 0, '2013-12-12', 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
('810231784', 'W12042093', 'W12042093', 'WYBILLINGS', 'Billings Clinic - Family Practice', 'Cindy', 'L', 'Murray', 'PA', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235443425', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12042092', 'W12042092', 'WYBILLINGS', 'Billings Clinic', 'Cindy', 'L', 'Murray', 'PA', 'Family Practice', '', '', 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, '2013-12-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235443425', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('463999144', 'W12042094', 'W12042094', 'UT01', 'Brigham Internal Medicine', 'John', 'R', 'Markeson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '950 S Medical Dr Ste 106', 'Brigham City', 'Box Elder', 'UT', '84302', '4357344088', '4357344249', '950 S Medical Dr Ste 106', 'Brigham City', 'Box Elder', 'UT', '84302', '4357344088', '4357344249', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-11', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861503419', 0, 'N', 0, '2013-12-12', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('463999144', 'W12042095', 'W12042095', 'UT01', 'Brigham Internal Medicine', 'John', 'R', 'Markeson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '4357344088', '4357344249', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '4357344088', '4357344249', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-11', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861503419', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('752846234', 'W12041837', 'W12041837', 'TXDALSTD', 'Orthopedics and Sports Medicine Center', 'Duc', 'P', 'Vo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', '2241 Peggy Ln Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722760536', '9722766037', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1056346254', 0, 'N', 0, '2013-12-13', NULL, NULL, 32.9173, -96.6589, NULL, NULL),
('271789847', 'W12042107', 'W12042107', 'ID02', 'Saint Alphonsus Medical Group - Ontario Surgical Services', 'Frank', '', 'Spokas', 'MD', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 2600', 'Ontario', 'Malheur', 'OR', '97914', '5418811601', '5418811244', '1050 SW 3rd Ave Ste 2600', 'Ontario', 'Malheur', 'OR', '97914', '5418811601', '5418811244', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801892104', 0, 'N', 0, '2014-01-09', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('271789847', 'W12042108', 'W12042108', 'ID02', 'Saint Alphonsus Medical Group - Ontario Surgical Services', 'Frank', '', 'Spokas', 'MD', 'General Surgery', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817035', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817035', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801892104', 0, 'N', 0, '2014-01-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('611520683', 'W12042110', 'W12042110', 'ID02', 'The Sleep Specialist', 'Patrick', '', 'Plummer', 'MD', 'Sleep Medicine', 'Ear, Nose and Throat', '', NULL, 'O', '1050 SW 3rd Ave Ste 2500', 'Ontario', 'Malheur', 'OR', '97914', '5418897075', '5418897538', '1050 SW 3rd Ave Ste 2500', 'Ontario', 'Malheur', 'OR', '97914', '5418897075', '5418897538', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508848474', 0, 'N', 0, '2013-12-17', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('203495271', 'W12037103', 'W12037103', 'ID02', 'John D Foote MD', 'Bradley', '', 'Heninger', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-26', '2014-04-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205103389', 0, 'N', 0, '2014-06-05', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('203495271', 'W12037102', 'W12037102', 'ID02', 'John D Foote MD', 'Bradley', '', 'Heninger', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205103389', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('271789847', 'W12042112', 'W12042112', 'ID02', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-12-17', '2014-04-01', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457669863', 0, 'Y', 0, '2014-05-19', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12042113', 'W12042113', 'ID02', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '910 NW 16th Str', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th Str', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-12-17', '2014-04-01', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457669863', 0, 'Y', 0, '2014-05-19', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820501898', 'W12042117', 'W12042117', 'ID02', 'Tri-City Physical Therapy', 'Craig', 'L', 'Hamann', 'PT', 'Physical Therapy', '', '', NULL, 'O', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942248596', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042118', 'W12042118', 'ID02', 'Tri-City Physical Therapy', 'Craig', 'L', 'Hamann', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942248596', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042120', 'W12042120', 'ID02', 'Tri-City Physical Therapy', 'Janeil', '', 'Heaton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245205665', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042121', 'W12042121', 'ID02', 'Tri-City Physical Therapy', 'Janeil', '', 'Heaton', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245205665', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042124', 'W12042124', 'ID02', 'Tri-City Physical Therapy', 'Cody', 'D', 'Stephens', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'PO Box 876', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174598593', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('820501898', 'W12042125', 'W12042125', 'ID02', 'Tri-City Physical Therapy', 'Cody', 'D', 'Stephens', 'PT', 'Physical Therapy', '', '', NULL, 'O', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', '215 N Whitley Dr Ste 1', 'Fruitland', 'Payette', 'ID', '83619', '2084526366', '2084526399', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174598593', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('900426273', 'W12042126', 'W12042126', 'ID02', 'Richard Davis, MD', 'Kacey', '', 'Andreasen', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215160510', 0, 'N', 0, '2014-06-05', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('900426273', 'W12042128', 'W12042128', 'ID02', 'Richard Davis, MD', 'Richard', '', 'Davis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124017652', 0, 'N', 0, '2013-12-20', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('900426273', 'W12042129', 'W12042129', 'ID02', 'Richard Davis, MD', 'Bradley', '', 'Heninger', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205103389', 0, 'N', 0, '2014-06-05', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('930715396', 'W12042130', 'W12042130', 'ID02', 'John Phillips, MD', 'John', 'H', 'Phillips', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '1037 SW 5th Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418897277', '5418892392', '1037 SW 5th Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418897277', '5418892392', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1477567485', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042166', 'W12042166', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Mary', '', 'James', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982907747', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042164', 'W12042164', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Stephen', '', 'Ames', 'MD', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, 'Saint Alphonsus Medical Center - Ontario', '', '', '', 'HCFA|UB|', '1033155767', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('931161658', 'W12042136', 'W12042136', 'ID02', 'Treasure Valley Womens Clinic', 'Furm', '', 'Duncan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-04-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447233341', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('931211011', 'W12042138', 'W12042138', 'ID02', 'Paul C Gering, Jr. MD', 'JoAnn', '', 'Buhr-Cote', 'NP-C', 'Family Practice', '', '', NULL, 'O', '915 SW 3rd Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418890771', '5418898788', '915 SW 3rd Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418890771', '5418898788', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881812691', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('931211011', 'W12042140', 'W12042140', 'ID02', 'Paul C Gering, Jr. MD', 'Paul', '', 'Gering', 'MD', 'Family Practice', '', '', NULL, 'O', '915 SW 3rd Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418890771', '5418898788', '915 SW 3rd Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418890771', '5418898788', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235198995', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('931234415', 'W12042142', 'W12042142', 'ID02', 'Treasure Valley Womens Clinic', 'Robert', '', 'Mairs', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124001862', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12042310', 'W12042310', 'UT01', 'Standard Optical', 'Nathan', 'D', 'Broschinsky', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012728861', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012728861', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467894998', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042163', 'W12042163', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Patricia', '', 'Barfield', 'NP-C', 'Mental Health', 'Counseling', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386860930', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042162', 'W12042162', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Sage', '', 'Benintendi', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1902985740', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042161', 'W12042161', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Matthew', '', 'Berria', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982791810', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042159', 'W12042159', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Michelle', 'F', 'DeVoe', 'DO', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, 'Saint Alphonsus Medical Center - Ontario', '', '', '', 'HCFA|UB|', '1265437529', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042158', 'W12042158', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Sandra', '', 'Dunbrasky', 'MD', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, 'Saint Alphonsus Medical Center - Ontario', '', '', '', 'HCFA|UB|', '1477640944', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042160', 'W12042160', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'DeeAnn', '', 'Davis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750493847', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042168', 'W12042168', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Chelsie', '', 'Lewis', 'NP-C', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235329707', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042170', 'W12042170', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Lacey', 'J', 'Mackenzie-Yraguen', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447480215', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042172', 'W12042172', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Roberto', '', 'Olvera', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306094941', 0, 'N', 0, '2014-05-07', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042174', 'W12042174', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'John', 'M', 'Peterson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, 'Saint Alphonsus Medical Center - Ontario', '', '', '', 'HCFA|UB|', '1245396662', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042176', 'W12042176', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Margo', '', 'Smedshammer', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932110939', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12042178', 'W12042178', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Marisue', '', 'Susman', 'NP', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', '2014-05-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205124377', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('820313684', 'W12042180', 'W12042180', 'ID02', 'Cascade Medical Center', '', '', 'Cascade Medical Center', '', 'Hospital', '', '', NULL, 'O', '402 Lake Cascade Pkwy', 'Cascade', 'Valley', 'ID', '83611', '2083824242', NULL, '402 Lake Cascade Pkwy', 'Cascade', 'Valley', 'ID', '83611', '2083824242', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-04', '2013-12-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689720435', 0, 'N', 0, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('820313684', 'W12042181', 'W12042181', 'ID02', 'Cascade Medical Center', '', '', 'Cascade Medical Center', '', 'Hospital', '', '', NULL, 'O', 'PO Box 1330', 'Cascade', 'Valley', 'ID', '83611', '2083823857', NULL, 'PO Box 1330', 'Cascade', 'Valley', 'ID', '83611', '2083823857', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-04', '2013-12-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689720435', 0, 'N', 0, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000065', 'HMU000065', 'TXHOUSTD', 'Houston Metro Urology', 'Samuel', NULL, 'Axelrad', 'MD', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134197544', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('363330928', 'W12042297', 'W12042297', 'ILCHIGSTD', '', 'Kristin', '', 'Duque', 'MD', 'Cardiology', '', '', NULL, 'O', '2222 W Division St Ste 216-W', 'Chicago', 'Cook', 'IL', '60622', '7733262244', '7773262253', '2222 W Division St Ste 216-W', 'Chicago', 'Cook', 'IL', '60622', '7733262244', '7773262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104058379', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('204473802', 'HMU000066', 'HMU000066', 'TXHOUSTD', 'Houston Metro Urology', 'Samuel', NULL, 'Axelrad', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134197544', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000064', 'HMU000064', 'TXHOUSTD', 'Houston Metro Urology', 'Samuel', NULL, 'Axelrad', 'MD', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134197544', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000063', 'HMU000063', 'TXHOUSTD', 'Houston Metro Urology', 'Samuel', NULL, 'Axelrad', 'MD', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134197544', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000067', 'HMU000067', 'TXHOUSTD', 'Houston Metro Urology', 'Samuel', NULL, 'Axelrad', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134197544', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000037', 'HMU000037', 'TXHOUSTD', 'Houston Metro Urology', 'Larry', NULL, 'Baum', 'MD ', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336375484', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000038', 'HMU000038', 'TXHOUSTD', 'Houston Metro Urology', 'Larry', NULL, 'Baum', 'MD ', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336375484', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000036', 'HMU000036', 'TXHOUSTD', 'Houston Metro Urology', 'Larry', NULL, 'Baum', 'MD ', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336375484', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000035', 'HMU000035', 'TXHOUSTD', 'Houston Metro Urology', 'Larry', NULL, 'Baum', 'MD ', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336375484', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000039', 'HMU000039', 'TXHOUSTD', 'Houston Metro Urology', 'Larry', NULL, 'Baum', 'MD ', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336375484', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000049', 'HMU000049', 'TXHOUSTD', 'Houston Metro Urology', 'Paolo', 'C', 'Champion', 'MD', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982670998', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000050', 'HMU000050', 'TXHOUSTD', 'Houston Metro Urology', 'Paolo', 'C', 'Champion', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982670998', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000048', 'HMU000048', 'TXHOUSTD', 'Houston Metro Urology', 'Paolo', 'C', 'Champion', 'MD', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982670998', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000047', 'HMU000047', 'TXHOUSTD', 'Houston Metro Urology', 'Paolo', 'C', 'Champion', 'MD', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982670998', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000051', 'HMU000051', 'TXHOUSTD', 'Houston Metro Urology', 'Paolo', 'C', 'Champion', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982670998', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000017', 'HMU000017', 'TXHOUSTD', 'Houston Metro Urology', 'Darren', 'M', 'Chapman', 'MD', 'Urology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 255', 'Pearland', 'Brazoria', 'TX', '77584', '7136344470', '7136344471', '10970 Shadow Creek Pkwy Ste 255', 'Pearland', 'Brazoria', 'TX', '77584', '7136344470', '7136344471', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1184831893', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('204473802', 'HMU000018', 'HMU000018', 'TXHOUSTD', 'Houston Metro Urology', 'Darren', 'M', 'Chapman', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1184831893', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000028', 'HMU000028', 'TXHOUSTD', 'Houston Metro Urology', 'Karen', 'A', 'Delhey', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1900', 'Houston ', 'Harris', 'TX', '77030', '7137919900', '7137919020', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235180597', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000029', 'HMU000029', 'TXHOUSTD', 'Houston Metro Urology', 'Karen', 'A', 'Delhey', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235180597', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000024', 'HMU000024', 'TXHOUSTD', 'Houston Metro Urology', 'Gillad', 'A', 'Filmar', 'MD', 'Urology', NULL, NULL, NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'The Womans Hospital of Texas', NULL, '', NULL, 'HCFA|UB|', '1659511731', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000025', 'HMU000025', 'TXHOUSTD', 'Houston Metro Urology', 'Gillad', 'A', 'Filmar', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'The Womans Hospital of Texas', NULL, '', NULL, 'HCFA|UB|', '1659511731', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000022', 'HMU000022', 'TXHOUSTD', 'Houston Metro Urology', 'Emily', 'H', 'Fisher', 'PA-C', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 2030', 'Houston ', 'Harris', 'TX', '77030', '7137909779', '7137940719', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447436209', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000023', 'HMU000023', 'TXHOUSTD', 'Houston Metro Urology', 'Emily', 'H', 'Fisher', 'PA-C', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447436209', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000020', 'HMU000020', 'TXHOUSTD', 'Houston Metro Urology', 'David', 'W', 'Goldfarb', 'MD', 'Urology', '', '', NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'The Womans Hospital of Texas', '', '', 'HCFA|UB|', '1225265168', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000019', 'HMU000019', 'TXHOUSTD', 'Houston Metro Urology', 'David', 'W', 'Goldfarb', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin Ste 1440', 'Houston ', 'Harris', 'TX', '77030', '7137909700', '7137901328', '6560 Fannin Ste 1440', 'Houston ', 'Harris', 'TX', '77030', '7137909700', '7137901328', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'The Womans Hospital of Texas', '', '', 'HCFA|UB|', '1225265168', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000021', 'HMU000021', 'TXHOUSTD', 'Houston Metro Urology', 'David', 'W', 'Goldfarb', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'The Womans Hospital of Texas', '', '', 'HCFA|UB|', '1225265168', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000055', 'HMU000055', 'TXHOUSTD', 'Houston Metro Urology', 'Richard', 'A', 'Goldfarb', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1440', 'Houston ', 'Harris', 'TX', '77030', '7137909700', '7137901328', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1649224924', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000056', 'HMU000056', 'TXHOUSTD', 'Houston Metro Urology', 'Richard', 'A', 'Goldfarb', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1649224924', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000053', 'HMU000053', 'TXHOUSTD', 'Houston Metro Urology', 'Ricardo', 'R', 'Gonzalez', 'MD', 'Urology', NULL, NULL, NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629020292', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000052', 'HMU000052', 'TXHOUSTD', 'Houston Metro Urology', 'Ricardo', 'R', 'Gonzalez', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 2030', 'Houston ', 'Harris', 'TX', '77030', '7137909779', '7137940719', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629020292', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000054', 'HMU000054', 'TXHOUSTD', 'Houston Metro Urology', 'Ricardo', 'R', 'Gonzalez', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629020292', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000003', 'HMU000003', 'TXHOUSTD', 'Houston Metro Urology', 'Alan', 'E', 'Hananel', 'MD', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|UB|', '1861460040', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000004', 'HMU000004', 'TXHOUSTD', 'Houston Metro Urology', 'Alan', 'E', 'Hananel', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|UB|', '1861460040', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000002', 'HMU000002', 'TXHOUSTD', 'Houston Metro Urology', 'Alan', 'E', 'Hananel', 'MD', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|UB|', '1861460040', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000001', 'HMU000001', 'TXHOUSTD', 'Houston Metro Urology', 'Alan', 'E', 'Hananel', 'MD', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|UB|', '1861460040', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000005', 'HMU000005', 'TXHOUSTD', 'Houston Metro Urology', 'Alan', 'E', 'Hananel', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|UB|', '1861460040', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000026', 'HMU000026', 'TXHOUSTD', 'Houston Metro Urology', 'Gregory', 'D', 'Hester', 'MD', 'Urology', NULL, NULL, NULL, 'O', '915 Gessner Ste 370', 'Houston ', 'Harris', 'TX', '77024', '7136344441', '7136344442', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508952870', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('204473802', 'HMU000027', 'HMU000027', 'TXHOUSTD', 'Houston Metro Urology', 'Gregory', 'D', 'Hester', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508952870', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000008', 'HMU000008', 'TXHOUSTD', 'Houston Metro Urology', 'Anthony', 'N', 'Hoang', 'MD', 'Urology', '', '', NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', 'Houston Methodist Willowbrook Hospital', '', 'HCFA|UB|', '1194012310', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000009', 'HMU000009', 'TXHOUSTD', 'Houston Metro Urology', 'Anthony', 'N', 'Hoang', 'MD', 'Urology', '', '', NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', 'Houston Methodist Willowbrook Hospital', '', 'HCFA|UB|', '1194012310', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000007', 'HMU000007', 'TXHOUSTD', 'Houston Metro Urology', 'Anthony', 'N', 'Hoang', 'MD', 'Urology', '', '', NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', 'Houston Methodist Willowbrook Hospital', '', 'HCFA|UB|', '1194012310', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000006', 'HMU000006', 'TXHOUSTD', 'Houston Metro Urology', 'Anthony', 'N', 'Hoang', 'MD', 'Urology', '', '', NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', 'Houston Methodist Willowbrook Hospital', '', 'HCFA|UB|', '1194012310', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000010', 'HMU000010', 'TXHOUSTD', 'Houston Metro Urology', 'Anthony', 'N', 'Hoang', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', 'Houston Methodist Willowbrook Hospital', '', 'HCFA|UB|', '1194012310', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000068', 'HMU000068', 'TXHOUSTD', 'Houston Metro Urology', 'Stephen ', 'L', 'Lapin', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1440', 'Houston ', 'Harris', 'TX', '77030', '7137909700', '7137901328', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1073567376', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000069', 'HMU000069', 'TXHOUSTD', 'Houston Metro Urology', 'Stephen ', 'L', 'Lapin', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1073567376', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000042', 'HMU000042', 'TXHOUSTD', 'Houston Metro Urology', 'Michael', NULL, 'Lewitton', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1440', 'Houston ', 'Harris', 'TX', '77030', '7137909700', '7137901328', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1558313692', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000045', 'HMU000045', 'TXHOUSTD', 'Houston Metro Urology', 'Michael', NULL, 'Lewitton', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1558313692', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000059', 'HMU000059', 'TXHOUSTD', 'Houston Metro Urology', 'Robert', 'A', 'Light', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1900', 'Houston ', 'Harris', 'TX', '77030', '7137919900', '7137919020', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518919711', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000060', 'HMU000060', 'TXHOUSTD', 'Houston Metro Urology', 'Robert', 'A', 'Light', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518919711', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('204473802', 'HMU000012', 'HMU000012', 'TXHOUSTD', 'Houston Metro Urology', 'Brian', NULL, 'Lord', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1140 Westmont Ste 425', 'Houston ', 'Harris', 'TX', '77015', '7134534395', '7134534397', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568460954', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.773, -95.1947, NULL, NULL),
('204473802', 'HMU000014', 'HMU000014', 'TXHOUSTD', 'Houston Metro Urology', 'Brian', NULL, 'Lord', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568460954', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000044', 'HMU000044', 'TXHOUSTD', 'Houston Metro Urology', 'Michael', 'T', 'Mineo', 'MD', 'Urology', NULL, NULL, NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1801849385', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000043', 'HMU000043', 'TXHOUSTD', 'Houston Metro Urology', 'Michael', 'T', 'Mineo', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 1900', 'Houston ', 'Harris', 'TX', '77030', '7137919900', '7137919020', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1801849385', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000046', 'HMU000046', 'TXHOUSTD', 'Houston Metro Urology', 'Michael', 'T', 'Mineo', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1801849385', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000032', 'HMU000032', 'TXHOUSTD', 'Houston Metro Urology', 'Kevin', 'G', 'Nickell', 'MD', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053388785', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000033', 'HMU000033', 'TXHOUSTD', 'Houston Metro Urology', 'Kevin', 'G', 'Nickell', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053388785', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000031', 'HMU000031', 'TXHOUSTD', 'Houston Metro Urology', 'Kevin', 'G', 'Nickell', 'MD', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053388785', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000030', 'HMU000030', 'TXHOUSTD', 'Houston Metro Urology', 'Kevin', 'G', 'Nickell', 'MD', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053388785', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000034', 'HMU000034', 'TXHOUSTD', 'Houston Metro Urology', 'Kevin', 'G', 'Nickell', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053388785', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000015', 'HMU000015', 'TXHOUSTD', 'Houston Metro Urology', 'Carl', 'W', 'Ogletree', 'MD', 'Urology', NULL, NULL, NULL, 'O', '15200 SW Fwy Ste 380', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2815653569', '2815651911', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194778258', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6072, -95.6143, NULL, NULL),
('204473802', 'HMU000016', 'HMU000016', 'TXHOUSTD', 'Houston Metro Urology', 'Carl', 'W', 'Ogletree', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194778258', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000061', 'HMU000061', 'TXHOUSTD', 'Houston Metro Urology', 'Sachin', 'S', 'Patil', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881899730', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000062', 'HMU000062', 'TXHOUSTD', 'Houston Metro Urology', 'Sachin', 'S', 'Patil', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881899730', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000011', 'HMU000011', 'TXHOUSTD', 'Houston Metro Urology', 'Brian', 'C', 'Powers', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 2030', 'Houston ', 'Harris', 'TX', '77030', '7137909779', '7137940719', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154315166', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000013', 'HMU000013', 'TXHOUSTD', 'Houston Metro Urology', 'Brian', 'C', 'Powers', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154315166', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000074', 'HMU000074', 'TXHOUSTD', 'Houston Metro Urology', 'Zvi ', 'J', 'Schiffman', 'MD', 'Urology', NULL, NULL, NULL, 'O', '12121 Richmond Ste 112', 'Houston ', 'Harris', 'TX', '77082', '2814939966', '2817520127', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528036779', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('204473802', 'HMU000075', 'HMU000075', 'TXHOUSTD', 'Houston Metro Urology', 'Zvi ', 'J', 'Schiffman', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1601 Main  Ste 203', 'Richmond', 'Fort Bend', 'TX', '77469', '2813440049', '2813440661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528036779', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('204473802', 'HMU000073', 'HMU000073', 'TXHOUSTD', 'Houston Metro Urology', 'Zvi ', 'J', 'Schiffman', 'MD', 'Urology', NULL, NULL, NULL, 'O', '16605 SW Fwy Ste 250', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813251090', '2813250242', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528036779', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('204473802', 'HMU000072', 'HMU000072', 'TXHOUSTD', 'Houston Metro Urology', 'Zvi ', 'J', 'Schiffman', 'MD', 'Urology', NULL, NULL, NULL, 'O', '7777 SW Fwy Ste 1032', 'Houston ', 'Harris', 'TX', '77074', '7137719224', '7137713340', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528036779', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('204473802', 'HMU000076', 'HMU000076', 'TXHOUSTD', 'Houston Metro Urology', 'Zvi ', 'J', 'Schiffman', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528036779', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000040', 'HMU000040', 'TXHOUSTD', 'Houston Metro Urology', 'Mark', 'A', 'Sutton', 'MD', 'Urology', NULL, NULL, NULL, 'O', '6560 Fannin Ste 2030', 'Houston ', 'Harris', 'TX', '77030', '7137909779', '7137940719', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699769935', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('204473802', 'HMU000041', 'HMU000041', 'TXHOUSTD', 'Houston Metro Urology', 'Mark', 'A', 'Sutton', 'MD', 'Urology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699769935', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000057', 'HMU000057', 'TXHOUSTD', 'Houston Metro Urology', 'Rita', 'F', 'Tibbs', 'MD', 'Pathology', '', '', NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598727232', 0, 'N', 0, '2014-04-28', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000058', 'HMU000058', 'TXHOUSTD', 'Houston Metro Urology', 'Rita', 'F', 'Tibbs', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598727232', 0, 'Y', 0, '2014-04-28', NULL, NULL, 0, 0, NULL, NULL),
('204473802', 'HMU000070', 'HMU000070', 'TXHOUSTD', 'Houston Metro Urology', 'Thanh ', 'J', 'Van', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '4223 Richmond', 'Houston ', 'Harris', 'TX', '77027', '7133510630', '7133510636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548252430', 0, 'N', 0, '2013-12-17', NULL, NULL, 29.7324, -95.4462, NULL, NULL),
('204473802', 'HMU000071', 'HMU000071', 'TXHOUSTD', 'Houston Metro Urology', 'Thanh ', 'J', 'Van', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 1400', 'Houston ', 'Harris', 'TX', '77521', '7133510644', '7133510633', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON4', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2014-01-13', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548252430', 0, 'Y', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('462500960', 'W12042203', 'W12042203', 'NM01', 'NextCare Urgent Care', '', '', 'NextCare Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '9551 Paseo del Norte NE Ste D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5058007050', '5058007051', '9551 Paseo del Norte NE Ste D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5058007050', '5058007051', '', '', 'NMOP', '0.00', '100.00', '0.00', 3, '2013-12-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619300118', 0, 'N', 1, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('263664561', 'W12042204', 'W12042204', 'TXSATSTD', 'Mayank Pandya', 'Mayank', '', 'Pandya', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '14080 Nacogdoches Rd Ste 313', 'San Antonio', 'Bexar', 'TX', '78247', '2102811701', '2105473323', '14080 Nacogdoches Rd Ste 313', 'San Antonio', 'Bexar', 'TX', '78247', '2102811701', '2105473323', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|', '1982869350', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.57, -98.3828, NULL, NULL),
('200383232', 'W12042205', 'W12042205', 'TXSATSTD', 'Westover Hills Clinic', 'Caroline', '', 'Hernanadez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11212 State Hwy 151 Ste 190, Medical Plaza I', 'San Antonio', 'Bexar', 'TX', '78251', '2105239933', '2106470242', '11212 State Hwy 151 Ste 190, Medical Plaza I', 'San Antonio', 'Bexar', 'TX', '78251', '2105239933', '2106470242', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346318052', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('264077637', 'W12042206', 'W12042206', 'TXHOUSTD', 'Xavier Villa ', 'Xavier', '', 'Villa', 'MD', 'Pediatric Gastroenterology', 'Pediatric Critical Care', '', NULL, 'O', '21212 NW Fwy Ste 235', 'Cypress', 'Harris', 'TX', '77429', '8323344004', '8323344005', '21212 NW Fwy Ste 235', 'Cypress', 'Harris', 'TX', '77429', '8323344004', '8323344005', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205074499', 0, 'Y', 0, '2014-04-01', NULL, NULL, 29.9265, -95.6349, NULL, NULL),
('452656602', 'W12042207', 'W12042207', 'UTMH1', 'Deseret Counseling', 'James', 'M', 'Noorlander', 'LCSW', 'Mental Health', '', '', NULL, 'O', '383 N State St Ste 202', 'Orem', 'Utah', 'UT', '84057', '8013603166', '8018232254', '383 N State St Ste 202', 'Orem', 'Utah', 'UT', '84057', '8013603166', '8018232254', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972941938', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('352276788', 'W12042208', 'W12042208', 'TXSATSTD', 'Sudhir R Gogu MD', 'Sudhir', 'R', 'Gogu', 'MD', 'Family Practice', '', '', NULL, 'O', '104 Gallery Cir Ste 114', 'San Antonio', 'Bexar', 'TX', '78258', '2104816060', '2104816068', '104 Gallery Cir Ste 114', 'San Antonio', 'Bexar', 'TX', '78258', '2104816060', '2104816068', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1942270400', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.6128, -98.4932, NULL, NULL),
('272917106', 'W12042210', 'W12042210', 'TXHOUSTD', 'Albert Lin', 'Albert', '', 'Lin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9999 Bellaire Blvd Ste 760', 'Houston', 'Harris', 'TX', '77036', '8327675877', '8327675964', '9999 Bellaire Blvd Ste 760', 'Houston', 'Harris', 'TX', '77036', '8327675877', '8327675964', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|', '1891734117', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.7045, -95.5556, NULL, NULL),
('330255266', 'W12042212', 'W12042212', 'Sinclair', 'Meier Clinic', 'Lisa', 'A', 'Day', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '360 E Ave Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2097209342', '4254874884', '360 E Ave Ste 200', 'Ketchum', 'Blaine', 'ID', '83340', '2097209342', '4254874884', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790866366', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('841693098', 'W12042213', 'W12042213', 'TXSATSTD', 'Step By Step Pediatrics', 'Letisha', 'A', 'Sneed', 'MD', 'Pediatrics', '', '', NULL, 'O', '540 Madison Oak Dr Ste 560', 'San Antonio', 'Bexar', 'TX', '78259', '2104967837', '2104967855', '540 Madison Oak Dr Ste 560', 'San Antonio', 'Bexar', 'TX', '78259', '2104967837', '2104967855', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|', '1750385027', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.6212, -98.4921, NULL, NULL),
('455239064', 'W12042216', 'W12042216', 'UT01', 'Wasatch Foot & Ankle', 'Jason', 'D', 'Campbell', 'DPM', 'Podiatry', '', '', NULL, 'O', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '0000000000', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '0000000000', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Ogden Regional Medical Center', 'Lakeview Hospital', '', 'HCFA|UB', '1700193711', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042214', 'W12042214', 'UT01', 'Wasatch Foot & Ankle', 'Jason', 'D', 'Campbell', 'DPM', 'Podiatry', '', '', NULL, 'O', '3590 Harrision Blvd Ste G-1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', '3590 Harrision Blvd Ste G-1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Ogden Regional Medical Center', 'Lakeview Hospital', '', 'HCFA|UB', '1700193711', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042217', 'W12042217', 'UT01', 'Wasatch Foot & Ankle', 'Jason', 'D', 'Campbell', 'DPM', 'Podiatry', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352799995', '0000000000', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352799995', '0000000000', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Ogden Regional Medical Center', 'Lakeview Hospital', '', 'HCFA|UB', '1700193711', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042215', 'W12042215', 'UT01', 'Wasatch Foot & Ankle', 'Jason', 'D', 'Campbell', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8016272122', '8016272125', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Ogden Regional Medical Center', 'Lakeview Hospital', '', 'HCFA|UB', '1700193711', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('952824270', 'W12042219', 'W12042219', 'TXDALSTD', 'June E Beamer', 'June', 'E', 'Beamer', 'MD', 'Dermatology', '', '', NULL, 'O', '719 W Coke Rd Bldg 3, Ste 3', 'Winnsboro', 'Wood', 'TX', '75494', '9033423376', '9033423373', '719 W Coke Rd Bldg 3, Ste 3', 'Winnsboro', 'Wood', 'TX', '75494', '9033423376', '9033423373', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1639232952', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.9465, -95.3094, NULL, NULL),
('820511003', 'W12042225', 'W12042225', 'ID02', 'Dudley Chiropractic', 'Ryan', 'B', 'Weed', 'DC', 'Chiropractic', '', '', NULL, 'O', '404 E Park Ctr Blvd Ste 170', 'Boise', 'Ada', 'ID', '83706', '2083443610', '2083444695', '404 E Park Ctr Blvd Ste 170', 'Boise', 'Ada', 'ID', '83706', '2083443610', '2083444695', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386966315', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W12042226', 'W12042226', 'UTMH1', 'Alpine Center for Personal Growth', 'Steve', '', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'ma', '', '', '0.00', '40.00', '0.00', 6, '2014-03-01', '2014-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376856286', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('463049020', 'W12042227', 'W12042227', 'UT01', 'Clarus Vision  Clinic', 'David', 'A', 'Meyer', 'OD', 'Optometry', '', '', NULL, 'O', '6412 S 900 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018928222', '8019043436', '6412 S 900 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018928222', '8019043436', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255562740', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.6343, -111.866, NULL, NULL),
('752512142', 'CFC000077', 'CFC000077', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Joshua', 'J', 'Allred', 'PA C', 'Oncology', '', '', NULL, 'O', '11805 S I-35 W Ste 201', 'Burleson', 'Johnson', 'TX', '76028', '8175515312', '8175511389', '11805 S I-35 W Ste 201', 'Burleson', 'Johnson', 'TX', '76028', '8175515312', '8175511389', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447691944', 0, 'Y', 0, '2014-01-06', NULL, NULL, 32.5409, -97.3169, NULL, NULL),
('870543318', 'W12042228', 'W12042228', 'UT01', 'Utah Gastroenterology', 'Oscar', 'A', 'Batista', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962443465', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042229', 'W12042229', 'UT01', 'Utah Gastroenterology', 'Mark', 'E', 'Boschert', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1346252236', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042230', 'W12042230', 'UT01', 'Utah Gastroenterology', 'James', 'W', 'Bown', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629081260', 0, 'N', 0, '2013-12-18', NULL, NULL, 37.0834, -113.575, NULL, NULL),
('942854057', 'W12042232', 'W12042232', 'UTIHCPHY', 'North Cache Valley Instacare', 'Gabriel', 'K', 'Andeen', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720343296', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('455239064', 'W12042221', 'W12042221', 'UT01', 'Wasatch Foot & Ankle', 'Colby', 'H', 'Frost', 'DPM', 'Podiatry', '', '', NULL, 'O', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '0000000000', '14 N 100 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357341823', '0000000000', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Lakeview Hospital', 'Ogden Regional Medical Center', '', 'HCFA|UB', '1619284627', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042220', 'W12042220', 'UT01', 'Wasatch Foot & Ankle', 'Colby', 'H', 'Frost', 'DPM', 'Podiatry', '', '', NULL, 'O', '3590 Harrision Blvd Ste G-1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', '3590 Harrision Blvd Ste G-1', 'Ogden', 'Weber', 'UT', '84403', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Lakeview Hospital', 'Ogden Regional Medical Center', '', 'HCFA|UB', '1619284627', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042222', 'W12042222', 'UT01', 'Wasatch Foot & Ankle', 'Colby', 'H', 'Frost', 'DPM', 'Podiatry', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352799995', '0000000000', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352799995', '0000000000', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Lakeview Hospital', 'Ogden Regional Medical Center', '', 'HCFA|UB', '1619284627', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('455239064', 'W12042223', 'W12042223', 'UT01', 'Wasatch Foot & Ankle', 'Colby', 'H', 'Frost', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8016272122', '8016272125', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8016272122', '8016272125', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital ', 'Lakeview Hospital', 'Ogden Regional Medical Center', '', 'HCFA|UB', '1619284627', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'W12042512', 'W12042512', 'ILCHIGSTD', 'Presence St Joseph Hospital Chicago', 'Bishwas', '', 'Upadhyay', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2913 N Commonwealth', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '6309142499', '2913 N Commonwealth', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1720394992', 0, 'N', 0, '2013-12-26', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('455567952', 'W12042476', 'W12042476', 'TXDALSTD', 'Questcare Matrix PLLC', 'Steven', 'R', 'Bray', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1417971474', 0, 'N', 0, '2013-12-26', NULL, NULL, 32.9138, -96.7726, NULL, NULL),
('942854057', 'W12042233', 'W12042233', 'UTIHCPHY', 'Logan InstaCare', 'Gabriel', 'K', 'Andeen', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720343296', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042235', 'W12042235', 'UTIHCPHY', 'North Cache Valley Instacare', 'Brennan', 'J', 'Benjamin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700165412', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12038058', 'W12038058', 'UTIHC04', 'Bear River Valley Hospital', 'Brennan', 'J', 'Benjamin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-08-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700165412', 0, 'N', 0, '2013-12-23', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12042234', 'W12042234', 'UTIHCPHY', 'Logan InstaCare', 'Brennan', 'J', 'Benjamin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700165412', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042236', 'W12042236', 'UTIHCPHY', 'Sevier Valley Clinic', 'Jeffrey', 'J', 'Brown', 'DO', 'Family Practice', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205840642', 0, 'N', 0, '2013-12-18', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12042238', 'W12042238', 'UTIHCPHY', 'Fillmore Clinic', 'Stephen', 'J', 'Carter', 'MD', 'General Surgery', '', '', NULL, 'O', '700 S Hwy 99 Ste 3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', '700 S Hwy 99 Ste 3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427051747', 0, 'N', 0, '2014-04-08', NULL, NULL, 38.953, -112.341, NULL, NULL),
('942854057', 'W12042239', 'W12042239', 'UTIHCPHY', 'Sevier Valley Specialty Clinic', 'Stephen', 'J', 'Carter', 'MD', 'General Surgery', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-14', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427051747', 0, 'N', 0, '2014-04-08', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12042240', 'W12042240', 'UTIHCPHY', 'Park City Specialty Clinic', 'Robert', 'Wallace', 'Chalmers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-01', '2014-05-08', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1114973708', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12042241', 'W12042241', 'UTIHCPHY', 'Sevier Valley Clinic', 'David', 'Ray', 'Crimin', 'DO', 'Family Practice', '', '', NULL, 'O', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225044431', 0, 'N', 0, '2013-12-18', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12038061', 'W12038061', 'UTIHC04', 'Bear River Valley Hospital', 'Daniel', 'J', 'Flanagan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-08-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982983755', 0, 'N', 0, '2013-12-18', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12042242', 'W12042242', 'UTIHCPHY', 'Logan InstaCare', 'Daniel', 'J', 'Flanagan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982983755', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042243', 'W12042243', 'UTIHCPHY', 'North Cache Valley Instacare', 'Daniel', 'J', 'Flanagan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982983755', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042244', 'W12042244', 'UTIHCPHY', 'Logan InstaCare', 'Jonathan', 'M', 'Gardner', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154600922', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042245', 'W12042245', 'UTIHCPHY', 'North Cache Valley Instacare', 'Jonathan', 'M', 'Gardner', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154600922', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042246', 'W12042246', 'UTIHCPHY', 'Mountain View Pediatrics', 'Lisa', 'E', 'Giles', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '9720 S 1300 E Ste E100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', '9720 S 1300 E Ste E100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1841408309', 0, 'Y', 0, '2014-05-08', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W12042247', 'W12042247', 'UTIHCPHY', 'Park City Clinic-Canyons', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356152235', '4356457768', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356152235', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.6839, -111.553, NULL, NULL),
('942854057', 'W12042249', 'W12042249', 'UTIHCPHY', 'North Cache Valley Instacare', 'Vanna', 'K', 'Irving', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740545227', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042250', 'W12042250', 'UTIHCPHY', 'Logan InstaCare', 'Vanna', 'K', 'Irving', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740545227', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042252', 'W12042252', 'UTIHCPHY', 'Holladay Pediatrics', 'Melissa', 'J', 'Kleschen', 'MD', 'Pediatrics', '', '', NULL, 'O', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831415850', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6372, -111.834, NULL, NULL),
('942854057', 'W12042253', 'W12042253', 'UTIHCPHY', 'Mountain View Pediatrics', 'Travis', 'S', 'Mickelson', 'MD', 'Pediatric Psychiatry', '', '', NULL, 'O', '9720 S 1300 E Ste E100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', '9720 S 1300 E Ste E100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831364249', 0, 'Y', 0, '2014-06-18', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W12042255', 'W12042255', 'UTIHCPHY', 'Logan InstaCare', 'Spencer', 'T', 'Naser', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760747240', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042256', 'W12042256', 'UTIHCPHY', 'North Cache Valley Instacare', 'Spencer', 'T', 'Naser', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760747240', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042258', 'W12042258', 'UTIHCPHY', 'North Cache Valley Instacare', 'Michelle', 'R', 'Richards', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114282787', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042259', 'W12042259', 'UTIHCPHY', 'Logan InstaCare', 'Michelle', 'R', 'Richards', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114282787', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042261', 'W12042261', 'UTIHCPHY', 'Logan InstaCare', 'Daniel', 'S', 'Sharp', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902161482', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042262', 'W12042262', 'UTIHCPHY', 'North Cache Valley Instacare', 'Daniel', 'S', 'Sharp', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902161482', 0, 'Y', 0, '2014-07-24', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042263', 'W12042263', 'UTIHCPHY', 'Sevier Valley Clinic', 'Daniel', 'C', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-06', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1669672366', 0, 'N', 0, '2014-07-23', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12042264', 'W12042264', 'UTIHCPHY', 'Southern Utah Surgical-Delta', 'John', 'B', 'Sutherland', 'MD', 'General Surgery', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4358644186', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4358644186', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-16', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932387198', 0, 'N', 0, '2013-12-18', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12042265', 'W12042265', 'UTIHCPHY', 'Southern Utah Surgical-Garfield', 'John', 'B', 'Sutherland', 'MD', 'General Surgery', '', '', NULL, 'O', '224 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355868192', '4355867564', '224 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-16', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932387198', 0, 'N', 0, '2013-12-18', NULL, NULL, 37.8262, -112.428, NULL, NULL),
('942854057', 'W12042266', 'W12042266', 'UTIHCPHY', 'Sevier Valley Clinic', 'James', 'A', 'Thomson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', '1000 N Main St Ste A', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358930585', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-06', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1396070611', 0, 'N', 0, '2014-03-18', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12042267', 'W12042267', 'UTIHCPHY', 'Logan InstaCare', 'Natalie', 'A', 'Trent', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467731232', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042268', 'W12042268', 'UTIHCPHY', 'North Cache Valley Instacare', 'Natalie', 'A', 'Trent', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467731232', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12042269', 'W12042269', 'UTIHCPHY', 'Holladay Pediatrics', 'Jed', 'B', 'VanDenBerghe', 'MD', 'Pediatrics', '', '', NULL, 'O', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', '6272 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018716200', '8018716250', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922011576', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6372, -111.834, NULL, NULL),
('942854057', 'W12042271', 'W12042271', 'UTIHCPHY', 'Logan InstaCare', 'Kathryn', 'K', 'Wolpert', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386909851', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12042272', 'W12042272', 'UTIHCPHY', 'North Cache Valley Instacare', 'Kathryn', 'K', 'Wolpert', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386909851', 0, 'Y', 0, '2013-12-18', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('870543318', 'W12042273', 'W12042273', 'UT01', 'Utah Gastroenterology', 'Christopher', 'C', 'Canale', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598952145', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870543318', 'W12042274', 'W12042274', 'UT01', 'Utah Gastroenterology', 'Brett', 'W', 'Doxey', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', NULL, '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386775682', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870543318', 'W12042275', 'W12042275', 'UT01', 'Utah Gastroenterology', 'Brett', 'W', 'Doxey', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386775682', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.5222, -111.98, 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
('870543318', 'W12042276', 'W12042276', 'UT01', 'Utah Gastroenterology', 'Peter', 'C', 'Fenton', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1952311797', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042277', 'W12042277', 'UT01', 'Utah Gastroenterology', 'Peter', 'C', 'Fenton', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1952311797', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('870543318', 'W12042278', 'W12042278', 'UT01', 'Utah Gastroenterology', 'Andrew', '', 'Fedoravicius ', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1851585087', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('870543318', 'W12042279', 'W12042279', 'UT01', 'Utah Gastroenterology', 'Edward', 'J', 'Frech', 'MD', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1942496757', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870543318', 'W12042280', 'W12042280', 'UT01', 'Utah Gastroenterology', 'Gordon', 'E', 'Harmston', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1972516748', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042281', 'W12042281', 'UT01', 'Utah Gastroenterology', 'Michael', 'J', 'Sossenheimer', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1508876350', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042282', 'W12042282', 'UT01', 'Utah Gastroenterology', 'Clarke', 'A', 'Hilbig', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861404758', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870543318', 'W12042283', 'W12042283', 'UT01', 'Utah Gastroenterology', 'Lee', 'J', 'Hixson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '368 E Riverside Dr Ste A', 'St George', 'Washington', 'UT', '84790', '4356731149', NULL, '368 E Riverside Dr Ste A', 'St George', 'Washington', 'UT', '84790', '4356731149', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952314593', 0, 'N', 0, '2013-12-18', NULL, NULL, 37.0834, -113.575, NULL, NULL),
('870543318', 'W12042284', 'W12042284', 'UT01', 'Utah Gastroenterology', 'Robert', 'G', 'Jones', 'MD', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1164465647', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870543318', 'W12042285', 'W12042285', 'UT01', 'Utah Gastroenterology', 'D Rayburn ', '', 'Moore', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215969837', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('870543318', 'W12042286', 'W12042286', 'UT01', 'Utah Gastroenterology', 'D Rayburn ', '', 'Moore', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215969837', 0, 'N', 0, '2013-12-18', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870543318', 'W12042287', 'W12042287', 'UT01', 'Utah Gastroenterology', 'Randall', 'J', 'Ryser', 'MD', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1528071156', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870543318', 'W12042288', 'W12042288', 'UT01', 'Utah Gastroenterology', 'Roger', 'L', 'Siddoway', 'MD', 'Gastroenterology', '', '', NULL, 'O', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1548240310', 0, 'N', 0, '2014-04-17', NULL, NULL, 37.0834, -113.575, NULL, NULL),
('870543318', 'W12042289', 'W12042289', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012633041', '8012638485', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('870543318', 'W12042290', 'W12042290', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', '620 E Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870543318', 'W12042291', 'W12042291', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', '5770 S 250 E Ste 445', 'Murray', 'Salt Lake', 'UT', '84107', '8013144222', '8019443186', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870543318', 'W12042292', 'W12042292', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', '368 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '4356731149', '0000000000', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 37.0834, -113.575, NULL, NULL),
('870543318', 'W12042293', 'W12042293', 'UT01', 'Utah Gastroenterology', '', '', 'Utah Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', NULL, '3741 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8012980057', '          ', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972510717', 0, 'Y', 0, '2013-12-18', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('200383232', 'W12042295', 'W12042295', 'TXSATSTD', 'Westover Hills Clinic', 'Caroline', '', 'Hernanadez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 760488', 'San Antonio', 'Bexar', 'TX', '78251', '2105239933', '2106470242', 'PO Box 760488', 'San Antonio', 'Bexar', 'TX', '78251', '2105239933', '2106470242', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346318052', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12042296', 'W12042296', 'ILCHIGSTD', '', 'Kristin', '', 'Duque', 'MD', 'Cardiology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 466', 'Chicago', 'Cook', 'IL', '60631', '7733262244', '7733262253', '7447 W Talcott Ave Ste 466', 'Chicago', 'Cook', 'IL', '60631', '7733262244', '7733262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104058379', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363330928', 'W12042298', 'W12042298', 'ILCHIGSTD', '', 'Kristin', '', 'Duque', 'MD', 'Cardiology', '', '', NULL, 'O', '62311 Collections Center Dr', 'Chicago', 'Cook', 'IL', '60693', '7733262244', '7733262253', '62311 Collections Center Dr', 'Chicago', 'Cook', 'IL', '60693', '7733262244', '7733262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104058379', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.8787, -87.6323, NULL, NULL),
('800701770', 'W12042299', 'W12042299', 'UT01', 'Coral Desert Spine Center', 'Kristoffer', 'R', 'West', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 210', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', '1490 E Foremaster Dr Ste 210', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285898650', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12042304', 'W12042304', 'UT01', 'Standard Optical', 'Farrell', 'M', 'Roe', 'OD', 'Optometry', '', '', NULL, 'O', '3754 W 5400 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019649911', NULL, '3754 W 5400 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019649911', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225104110', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.6532, -111.98, NULL, NULL),
('800701770', 'W12042302', 'W12042302', 'UT01', 'Wasatch Neurosurgery & Spine Asso at St Marks', 'Kristoffer', 'R', 'West', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285898650', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12042301', 'W12042301', 'UT01', 'MountainStar Medical Group Neurosurgery St Marks LLC', 'Kristoffer', 'R', 'West', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285898650', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12042303', 'W12042303', 'UT01', 'St Marks Hospital Comprehensive Spine Center', 'Kristoffer', 'R', 'West', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 1F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012625711', '8012625741', '1220 E 3900 S Ste 1F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012625711', '8012625741', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285898650', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12042305', 'W12042305', 'UT01', 'Standard Optical', 'Farrell', 'M', 'Roe', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225104110', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('201435671', 'W12042308', 'W12042308', 'TXHOUSTD', 'Diabetes America', 'Gloria', 'L', 'Ocampo', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417968306', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12042307', 'W12042307', 'TXHOUSTD', 'Diabetes America', 'Gloria', 'L', 'Ocampo', 'MD', 'Endocrinology', '', '', NULL, 'O', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417968306', 0, 'N', 0, '2013-12-19', NULL, NULL, 29.6121, -98.491, NULL, NULL),
('201435671', 'W12042306', 'W12042306', 'TXHOUSTD', 'Diabetes America', 'Gloria', 'L', 'Ocampo', 'MD', 'Endocrinology', '', '', NULL, 'O', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78229', '8666934223', '8882377954', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78229', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417968306', 0, 'N', 0, '2013-12-19', NULL, NULL, 29.5092, -98.5544, NULL, NULL),
('870179340', 'W12042309', 'W12042309', 'UT01', 'Standard Optical', 'Nathan', 'D', 'Broschinsky', 'OD', 'Optometry', '', '', NULL, 'O', '1153 N Main St Ste A 120', 'Logan', 'Cache', 'UT', '84341', '4357522092', NULL, '1153 N Main St Ste A 120', 'Logan', 'Cache', 'UT', '84341', '4357522092', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467894998', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.753, -111.834, NULL, NULL),
('452937060', 'W12042311', 'W12042311', 'UT01', 'Cook Foot and Ankle Specialists', 'Gregory', 'B', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2013-12-15', NULL, 0, 35, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558504548', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12042313', 'W12042313', 'UT01', 'MountainStar Cardiology St Marks', 'Kurt', 'F', 'Francis', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1578588018', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12042312', 'W12042312', 'UT01', 'MountainStar Cardiology St Marks', 'Kurt', 'F', 'Francis', 'MD', 'Pulmonary', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1578588018', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371697234', 'W12042314', 'W12042314', 'UTMH1', 'Associated Psychotherapists', 'Aaron ', '', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952666232', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.5132, -112.016, NULL, NULL),
('870286381', 'W12042315', 'W12042315', 'UT01', 'Ogden Clinic Womens Center McKay', 'Robert', 'D', 'Wayment', 'MD', 'Urology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295957280', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870286381', 'W12042316', 'W12042316', 'UT01', 'Ogden Clinic', 'Robert', 'D', 'Wayment', 'MD', 'Urology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295957280', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12042317', 'W12042317', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Brian', 'L', 'Wolsey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316986714', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12042318', 'W12042318', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Brian', 'L', 'Wolsey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316986714', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12042319', 'W12042319', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Dena', 'R', 'Walker', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750312831', 0, 'N', 0, '2014-03-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12042320', 'W12042320', 'UT01', 'Southern Utah Womens Health Center', 'Tracy', 'W', 'Winward', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922008846', 0, 'N', 0, '2013-12-19', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('262072378', 'W12042321', 'W12042321', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Dena', 'R', 'Walker', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014045588', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014045588', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-16', '2014-03-06', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750312831', 0, 'N', 0, '2014-03-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870286381', 'W12042322', 'W12042322', 'UT01', 'Ogden Clinic Womens Center McKay', 'Tyler', 'L', 'Christensen', 'MD', 'Urology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84405', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84405', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811097629', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870286381', 'W12042323', 'W12042323', 'UT01', 'Ogden Clinic', 'Tyler', 'L', 'Christensen', 'MD', 'Urology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811097629', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12042324', 'W12042324', 'TXHOUSTD', 'Diabetes America', 'Dina', '', 'Rivera', 'MD', 'Endocrinology', '', '', NULL, 'O', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78229', '8666934223', '8882377954', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78229', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932384807', 0, 'N', 0, '2013-12-19', NULL, NULL, 29.5092, -98.5544, NULL, NULL),
('201435671', 'W12042326', 'W12042326', 'TXHOUSTD', 'Diabetes America', 'Dina', '', 'Rivera', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932384807', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12042325', 'W12042325', 'TXHOUSTD', 'Diabetes America', 'Dina', '', 'Rivera', 'MD', 'Endocrinology', '', '', NULL, 'O', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932384807', 0, 'N', 0, '2013-12-19', NULL, NULL, 29.6121, -98.491, NULL, NULL),
('201435671', 'W12042327', 'W12042327', 'TXHOUSTD', 'Diabetes America', 'Dina', '', 'Rivera', 'MD', 'Endocrinology', '', '', NULL, 'O', '13422 Star Heights Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8666934223', '8882377954', '13422 Star Heights Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932384807', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12042328', 'W12042328', 'UT01', 'MountainStar Behavioral Health', 'Elia', 'R', 'Gonzalez-Rodriguez', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992416', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992416', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1609979558', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12042329', 'W12042329', 'UT01', 'MountainStar Behavioral Health', 'Elia', 'R', 'Gonzalez-Rodriguez', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '0000000000', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1609979558', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12042330', 'W12042330', 'TXHOUSTD', 'Diabetes America', 'Gloria', 'L', 'Ocampo', 'MD', 'Endocrinology', '', '', NULL, 'O', '8250 San Fidel Way', 'San Antonio', 'Bexar', 'TX', '78255', '8666934223', '8882377954', '8250 San Fidel Way', 'San Antonio', 'Bexar', 'TX', '78255', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417968306', 0, 'N', 0, '2013-12-19', NULL, NULL, 29.6612, -98.6484, NULL, NULL),
('364314354', 'W12042331', 'W12042331', 'ILCHIGSTD', 'Provena Medical Group', 'Marina', '', 'Bekic', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8557647687', '6309142469', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104863919', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364314354', 'W12042332', 'W12042332', 'ILCHIGSTD', 'Provena Medical Group', 'Marina', '', 'Bekic', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104863919', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12042334', 'W12042334', 'UT01', 'Granger Medical Clinic', 'Denise', 'M', 'Morita', 'MD', 'Pediatric Neurology', 'Neurology', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1366640864', 0, 'N', 1, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12042333', 'W12042333', 'UT01', 'Granger Medical Clinic', 'Denise', 'M', 'Morita', 'MD', 'Pediatric Neurology', 'Neurology', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1366640864', 0, 'N', 1, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12042335', 'W12042335', 'UT01', 'Granger Medical Clinic', 'Denise', 'M', 'Morita', 'MD', 'Pediatric Neurology', 'Neurology', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1366640864', 0, 'N', 1, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12042337', 'W12042337', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Jenifer', '', 'Stewart Greene', 'NP-C', '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', 6, '2013-12-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'Y', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820200895', 'W12042338', 'W12042338', 'IDBOISTD', 'Saint Alphonsus Medical Group Fruitland Heights Plaza', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', NULL, '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('820200895', 'W12042339', 'W12042339', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Cynthia', '', 'Reed', 'NP-C', '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', 6, '2013-12-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1902119423', 0, 'N', 0, '2014-01-23', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820200895', 'W12042340', 'W12042340', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Cynthia', '', 'Reed', 'NP-C', 'Family Practice', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', NULL, '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-12-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1902119423', 0, 'N', 0, '2014-01-23', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('363330928', 'W12042343', 'W12042343', 'ILCHIGSTD', '', 'Erica', '', 'Engelstein', 'MD', 'Cardiology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7733262244', '7733262253', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7733262244', '7733262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093712481', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12042342', 'W12042342', 'ILCHIGSTD', '', 'Erica', '', 'Engelstein', 'MD', 'Cardiology', '', '', NULL, 'O', '2222 W Division St Ste 216-W', 'Chicago', 'Cook', 'IL', '60622', '7733262244', '7773262253', '2222 W Division St Ste 216-W', 'Chicago', 'Cook', 'IL', '60622', '7733262244', '7773262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093712481', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('363330928', 'W12042341', 'W12042341', 'ILCHIGSTD', '', 'Erica', '', 'Engelstein', 'MD', 'Cardiology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 466', 'Chicago', 'Cook', 'IL', '60631', '7733262244', '7733262253', '7447 W Talcott Ave Ste 466', 'Chicago', 'Cook', 'IL', '60631', '7733262244', '7733262253', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093712481', 0, 'N', 0, '2013-12-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('870286381', 'W12042344', 'W12042344', 'UT01', 'Ogden Clinic Womens Center McKay', 'John', 'S', 'Wolthuis', 'MD', 'Urology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', '2014-05-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093703811', 0, 'N', 0, '2014-06-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870286381', 'W12042345', 'W12042345', 'UT01', 'Ogden Clinic', 'John', 'S', 'Wolthuis', 'MD', 'Urology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', '2014-05-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093703811', 0, 'N', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12042346', 'W12042346', 'UT01', 'Ogden Clinic', '', '', 'Ogden Clinic', '', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009775', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752488356', 'W12042356', 'W12042356', 'TXDALSTD', 'Center for Family Medicine', 'Lacie', 'D', 'Mitchell', 'PA', 'Family Practice', '', '', NULL, 'O', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1225277106', 0, 'Y', 0, '2013-12-19', NULL, NULL, 33.6675, -96.5984, NULL, NULL),
('752488356', 'W12042358', 'W12042358', 'TXDALSTD', 'Center for Family Medicine', 'Karen', 'L', 'Young', 'NP', 'Family Practice', '', '', NULL, 'O', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1568600740', 0, 'Y', 0, '2013-12-19', NULL, NULL, 33.6675, -96.5984, NULL, NULL),
('752488356', 'W12042360', 'W12042360', 'TXDALSTD', 'Center for Family Medicine', 'Rose', 'M', 'Marr', 'NP', 'Family Practice', '', '', NULL, 'O', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', '1906 US Hwy 82 W Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038928398', '9038927903', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1427166917', 0, 'Y', 0, '2013-12-19', NULL, NULL, 33.6675, -96.5984, NULL, NULL),
('752788839', 'W12042361', 'W12042361', 'TXDALSTD', 'Urology Clinics of North Texas', '', '', 'Urology Clinics of North Texas', '', 'Urology', '', '', NULL, 'O', '8315 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147500808', '2147500120', '8315 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147500808', '2147500120', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114186616', 0, 'Y', 0, '2013-12-19', NULL, NULL, 32.8834, -96.762, NULL, NULL),
('752788839', 'W12042362', 'W12042362', 'TXDALSTD', 'Urology Clinics of North Texas', '', '', 'Urology Clinics of North Texas', '', 'Urology', '', '', NULL, 'O', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114186616', 0, 'Y', 0, '2013-12-19', NULL, NULL, 33.0191, -96.7671, NULL, NULL),
('752387191', 'W12042365', 'W12042365', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Neena', '', 'Bhagat', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '504 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8178775858', '8173354418', '504 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1992806632', 0, 'N', 0, '2013-12-19', NULL, NULL, 32.754, -97.789, NULL, NULL),
('752387191', 'W12042364', 'W12042364', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Neena', '', 'Bhagat', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1992806632', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('752387191', 'W12042368', 'W12042368', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Radha', '', 'Pasala', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '504 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8178775858', '8173354418', '504 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1871753780', 0, 'N', 0, '2013-12-19', NULL, NULL, 32.754, -97.789, NULL, NULL),
('752387191', 'W12042369', 'W12042369', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Radha', '', 'Pasala', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '2611 Hwy 180 W', 'Mineral Wells', 'Palo Pinto', 'TX', '76067', '8178775858', '8173354418', '2611 Hwy 180 W', 'Mineral Wells', 'Palo Pinto', 'TX', '76067', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1871753780', 0, 'N', 0, '2013-12-19', NULL, NULL, 32.8036, -98.1581, NULL, NULL),
('752387191', 'W12042367', 'W12042367', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Radha', '', 'Pasala', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1871753780', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('752387191', 'W12042372', 'W12042372', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Imran', 'A', 'Memon', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '1000 W Cannon St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178775858', '8173354418', '1000 W Cannon St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1952582157', 0, 'N', 0, '2013-12-19', NULL, NULL, 32.7373, -97.3353, NULL, NULL),
('752387191', 'W12042371', 'W12042371', 'TXDALSTD', 'Tarrant Nephrology Associates', 'Imran', 'A', 'Memon', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'PO Box 29900 Dept 904', 'Phoenix', 'Maricopa', 'AZ', '85038', '8178775858', '8173354418', 'TARNA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1952582157', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('752780119', 'W12042374', 'W12042374', 'TXDALSTD', 'Heart Center of North Texas', 'Srujana', '', 'Chakilam', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1629215587', 0, 'N', 0, '2013-12-19', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('752780119', 'W12042376', 'W12042376', 'TXDALSTD', 'Heart Center of North Texas', 'Robyn', 'L', 'Ward', 'PA-C', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1033401252', 0, 'Y', 0, '2013-12-19', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('752780119', 'W12042378', 'W12042378', 'TXDALSTD', 'Heart Center of North Texas', 'Aaron', 'W', 'Tungate', 'PA', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518911106', 0, 'Y', 0, '2013-12-19', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('271789847', 'W12042379', 'W12042379', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'B', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('900426273', 'W12042380', 'W12042380', 'ID02', 'Richard Davis, MD', 'Richard', '', 'Davis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124017652', 0, 'N', 0, '2013-12-20', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('262345602', 'W12042386', 'W12042386', 'TXDALSTD', 'Christine Holland', 'Christine', '', 'Holland', 'MD', 'Family Practice', '', '', NULL, 'O', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 6, '2014-01-20', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1821046616', 0, 'N', 0, '2014-03-26', NULL, NULL, 33.2044, -97.6024, NULL, NULL),
('743022433', 'W12042387', 'W12042387', 'TXSATSTD', 'Huyen Nguyen', 'Huyen', '', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2105994086', '2106551401', '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2105994086', '2106551401', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1629167929', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.5509, -98.3506, NULL, NULL),
('743022433', 'W12042388', 'W12042388', 'TXSATSTD', 'Huyen Nguyen', 'Huyen', '', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 11585', 'Belfast', 'Waldo', 'ME', '04915', '2105994086', '2106551401', 'PO Box 11585', 'Belfast', 'Waldo', 'ME', '04915', '2105994086', '2106551401', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1629167929', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('741906929', 'W12042389', 'W12042389', 'TXHOUSTD', 'Family Practice Clinic of Alvin', 'Dale', 'L', 'Messer', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W Sidnor', 'Alvin', 'Brazoria', 'TX', '77511', '2813315953', '2813312221', '711 W Sidnor', 'Alvin', 'Brazoria', 'TX', '77511', '2813315953', '2813312221', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063403244', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.4228, -95.2498, NULL, NULL),
('030374787', 'W12042390', 'W12042390', 'TXDALSTD', 'Surgical Institute', 'Howard', 'C', 'Derrick', 'MD', 'General Surgery', '', '', NULL, 'O', '3409 Worth St Ste 640', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', '3409 Worth St Ste 640', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1528086907', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('030374787', 'W12042391', 'W12042391', 'TXDALSTD', 'Health Texas Provider Network', 'Howard', 'C', 'Derrick', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 842001 Heather', 'Dallas', 'Dallas', 'TX', '75284', '2148266276', '2148266223', 'PO Box 842001 Heather', 'Dallas', 'Dallas', 'TX', '75284', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1528086907', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('030374787', 'W12042392', 'W12042392', 'TXDALSTD', 'Surgical Institute', 'Howard', 'C', 'Derrick', 'MD', 'General Surgery', '', '', NULL, 'O', '4708 Alliance Blvd Ste 270, Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', '4708 Alliance Blvd Ste 270, Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1528086907', 0, 'N', 0, '2013-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL);
