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', 'W12037474', 'W12037474', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'Y', 'Chu', 'MD', 'Orthopedic 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, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB', '1255457180', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037473', 'W12037473', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'Y', 'Chu', 'MD', 'Orthopedic Surgery', '', '', 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, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1255457180', 0, 'N', 0, '2013-09-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752536818', 'W12037475', 'W12037475', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'Y', 'Chu', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Ste 340', 'Plano', 'Collin', 'TX', '75093', '4698007200', '4698007210', '4716 Alliance Blvd Ste 340', 'Plano', 'Collin', 'TX', '75093', '4698007200', '4698007210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1255457180', 0, 'N', 0, '2013-09-11', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'W12037477', 'W12037477', 'TXDALSTD', 'Health Texas Provider Network', 'Misty', '', 'Jones', 'MS', 'Certified Nurse Midwife', '', '', NULL, 'O', '4500 Spring Ave', 'Dallas', 'Dallas', 'TX', '75210', '2149153200', '2149153251', '4500 Spring Ave', 'Dallas', 'Dallas', 'TX', '75210', '2149153200', '2149153251', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2013-11-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194056903', 0, 'Y', 0, '2013-12-09', NULL, NULL, 32.7739, -96.7429, NULL, NULL),
('752536818', 'W12037478', 'W12037478', 'TXDALSTD', 'Health Texas Provider Network', 'Misty', '', 'Jones', 'MS', 'Certified Nurse Midwife', '', '', 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, '2013-09-01', '2013-11-08', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1194056903', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037481', 'W12037481', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'D', 'Heffernan', 'MD', 'Geriatrics', '', '', NULL, 'O', '4004 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', '4004 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2014-04-13', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992781256', 0, 'Y', 0, '2014-04-17', NULL, NULL, 32.7913, -96.7758, NULL, NULL),
('752536818', 'W12037480', 'W12037480', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'D', 'Heffernan', 'MD', 'Geriatrics', '', '', 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, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992781256', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037484', 'W12037484', 'TXDALSTD', 'Health Texas Provider Network', 'Noah', 'Abille', 'Liwag', '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, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1376850131', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037483', 'W12037483', 'TXDALSTD', 'Health Texas Provider Network', 'Noah', 'Abille', 'Liwag', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376850131', 0, 'Y', 0, '2013-09-11', NULL, NULL, 33.2183, -96.6841, NULL, NULL),
('752536818', 'W12037486', 'W12037486', 'TXDALSTD', 'Health Texas Provider Network', 'Karen', 'Louise', 'Oehler', '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, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1710208426', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037487', 'W12037487', 'TXDALSTD', 'Health Texas Provider Network', 'Karen', 'Louise', 'Oehler', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1710208426', 0, 'N', 0, '2013-09-11', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'W12037490', 'W12037490', 'TXDALSTD', 'Health Texas Provider Network', 'Carmen', 'Teresa', 'Ramirez', 'MD', 'Neurology', '', '', 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, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023022357', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12037489', 'W12037489', 'TXDALSTD', 'Health Texas Provider Network', 'Carmen', 'Teresa', 'Ramirez', 'MD', 'Neurology', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 515', 'Irving', 'Dallas', 'TX', '75061', '4698001150', '4698001165', '2021 N MacArthur Blvd Ste 515', 'Irving', 'Dallas', 'TX', '75061', '4698001150', '4698001165', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023022357', 0, 'Y', 0, '2013-09-11', NULL, NULL, 32.835, -96.9592, NULL, NULL),
('456768694', 'W12037491', 'W12037491', 'TXHOUSTD', 'Elisabeth Schmalstieg                    ', 'Elisabeth', '', 'Schmalstieg', 'MD', 'Neurology', '', '', NULL, 'O', '6417 Memorial Dr', 'Texas City', 'Galveston', 'TX', '77591', '4099381077', '4099383876', '6417 Memorial Dr', 'Texas City', 'Galveston', 'TX', '77591', '4099381077', '4099383876', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1699885459', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.3929, -94.9839, NULL, NULL),
('201256230', 'W12037492', 'W12037492', 'TXHOUSTD', 'Subrata Ghosh', 'Subrata', '', 'Ghosh', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6624 Fannin St Ste 1740', 'Houston', 'Harris', 'TX', '77030', '7133353600', '7133353605', '6624 Fannin St Ste 1740', 'Houston', 'Harris', 'TX', '77030', '7133353600', '7133353605', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1477554913', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('742066451', 'W12037493', 'W12037493', 'TXHOUSTD', 'Malcolm H Bremer MD PA', 'Malcolm', 'H', 'Bremer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '18955 Memorial N Ste 550', 'Humble', 'Harris', 'TX', '77338', '2814466464', '2814467869', '18955 Memorial N Ste 550', 'Humble', 'Harris', 'TX', '77338', '2814466464', '2814467869', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1396747630', 0, 'N', 0, '2014-04-02', NULL, NULL, 29.9948, -95.2752, NULL, NULL),
('320047369', 'W12037494', 'W12037494', 'TXDALSTD', 'Muhammad Akram Khan', 'Muhammad', 'A', 'Khan', 'MD', 'Cardiology', '', '', NULL, 'O', '4201 Medical Center Dr Ste 380', 'Mckinney', 'Collin', 'TX', '75069', '9725296939', '9725296935', '4201 Medical Center Dr Ste 380', 'Mckinney', 'Collin', 'TX', '75069', '9725296939', '9725296935', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1356334031', 0, 'N', 0, '2013-09-13', NULL, NULL, 33.1619, -96.6356, NULL, NULL),
('562335026', 'W12037495', 'W12037495', 'TXHOUSTD', 'David T Netscher', 'David', 'T', 'Netscher', 'MD', 'Hand Surgery', '', '', NULL, 'O', '6624 Fannin St', 'Houston', 'Harris', 'TX', '77042', '7137998090', '7137955006', '6624 Fannin St', 'Houston', 'Harris', 'TX', '77042', '7137998090', '7137955006', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, '', '', 'HCFA|UB|', '1346272390', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('742131763', 'W12037496', 'W12037496', 'TXHOUSTD', 'Ranga S Nathan ', 'Ranga', 'S', 'Nathan', 'MD', 'Gastroenterology', '', '', NULL, 'O', '9816 Memorial Blvd Ste 206', 'Humble', 'Harris', 'TX', '77338', '2814468114', '2814461158', '9816 Memorial Blvd Ste 206', 'Humble', 'Harris', 'TX', '77338', '2814468114', '2814461158', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1235326828', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.9942, -95.2748, NULL, NULL),
('820200895', 'W12037500', 'W12037500', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP', 'Autumn', '', 'Freeland', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-10-01', '2013-09-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790926210', 0, 'N', 0, '2013-09-12', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12037505', 'W12037505', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Garrity', 'Lukas', 'T', 'Clark', 'MD', 'Neurology', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659519593', 0, 'N', 0, '2014-05-14', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W12037503', 'W12037503', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Elm', 'Lukas', 'T', 'Clark', 'MD', 'Neurology', '', '', 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, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659519593', 0, 'N', 0, '2014-05-14', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12037501', 'W12037501', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology FHP', 'Lukas', 'T', 'Clark', 'MD', 'Neurology', '', '', NULL, 'O', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659519593', 0, 'N', 0, '2014-05-14', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('204043287', 'W12037506', 'W12037506', 'NM01', 'ABQ Health Partners', 'Pamela', '', 'Blair', 'CNP', 'Family Practice', 'Nurse Practitioner ', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184851446', 0, 'N', 0, '2013-12-31', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12037507', 'W12037507', 'NM01', 'ABQ Health Partners', 'Pamela', '', 'Blair', 'CNP', 'Family Practice', 'Nurse Practitioner ', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184851446', 0, 'Y', 0, '2013-12-31', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037508', 'W12037508', 'NM01', 'ABQ Health Partners', 'Beverly', '', 'Firth', 'CNS', 'Nurse Practitioner', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740431311', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037509', 'W12037509', 'NM01', 'ABQ Health Partners', 'Beverly', '', 'Firth', 'CNS', 'Nurse Practitioner', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052623851', '5052627040', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052623851', '5052627040', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740431311', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12037511', 'W12037511', 'NM01', 'ABQ Health Partners', 'Julie', '', 'Muche', 'MD', 'Pain Management', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627724', '5052623476', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627724', '5052623476', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, 'Lovelace Westside Hospital', 'Lovelace Medical Center', NULL, NULL, 'HCFA|UB|', '1033116298', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037512', 'W12037512', 'NM01', 'ABQ Health Partners', 'Beverly', '', 'Van Wyk Gross', 'CNP', 'Hematology', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052623851', '5052627040', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881789378', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037513', 'W12037513', 'NM01', 'ABQ Health Partners', 'Beverly', '', 'Van Wyk Gross', 'CNP', 'Hematology', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052623851', '5052627040', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052623851', '5052627040', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881789378', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12037517', 'W12037517', 'NM01', 'ABQ Health Partners', 'Julie', '', 'Gober-Wilcox', 'MD', 'Pathology', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891991683', 0, 'Y', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12037515', 'W12037515', 'NM01', 'ABQ Health Partners', 'Julie', '', 'Gober-Wilcox', 'MD', 'Pathology', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891991683', 0, 'Y', 0, '2013-09-06', NULL, NULL, 35.0857, -106.64, NULL, NULL),
('204043287', 'W12037516', 'W12037516', 'NM01', 'ABQ Health Partners', 'Julie', '', 'Gober-Wilcox', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891991683', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12037523', 'W12037523', 'NM01', 'ABQ Health Partners', 'Jon', '', 'Hager', 'DO', 'Urgent Care', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588695282', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12037521', 'W12037521', 'NM01', 'ABQ Health Partners', 'Jon', '', 'Hager', 'DO', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588695282', 0, 'Y', 0, '2013-09-04', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037519', 'W12037519', 'NM01', 'ABQ Health Partners', 'Jon', '', 'Hager', 'DO', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588695282', 0, 'Y', 0, '2013-09-04', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12037522', 'W12037522', 'NM01', 'ABQ Health Partners', 'Jon', '', 'Hager', 'DO', 'Urgent Care', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058736400', '5058736403', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058736400', '5058736403', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588695282', 0, 'Y', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12037520', 'W12037520', 'NM01', 'ABQ Health Partners', 'Jon', '', 'Hager', 'DO', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588695282', 0, 'Y', 0, '2013-09-04', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12037526', 'W12037526', 'NM01', 'ABQ Health Partners', 'Sandra', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058736400', '5058736403', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058736400', '5058736403', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801912985', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12037527', 'W12037527', 'NM01', 'ABQ Health Partners', 'Sandra', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801912985', 0, 'N', 0, '2013-09-04', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12037525', 'W12037525', 'NM01', 'ABQ Health Partners', 'Sandra', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801912985', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('352293411', 'W12037529', 'W12037529', 'ID02', 'Four Rivers Anesthesia', 'Michael', '', 'OHara', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817140', '5418817183', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817140', '5418817183', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265497655', 0, 'N', 0, '2013-09-04', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('352293411', 'W12037530', 'W12037530', 'ID02', 'Four Rivers Anesthesia', 'Michael', '', 'OHara', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 2833', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085528773', '0000000000', 'PO Box 2833', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085528773', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265497655', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12037531', 'W12037531', 'ID02', 'St Lukes Neurosurgical Associates', 'W', 'Bruce', 'Cherny', 'MD', 'Neurosurgery', 'Pediatric Neurosurgery', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', '2083817361', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', '2083817361', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-02-05', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1275575839', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('452716222', 'W12037532', 'W12037532', 'SACN', 'St Lukes Neurosurgical Associates', 'W', 'Bruce', 'Cherny', 'MD', 'Neurosurgery', 'Pediatric Neurosurgery', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 8, '2013-02-05', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1275575839', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('271608039', 'W12037534', 'W12037534', 'ID02', 'Ontario Emergency Specialists', 'Brad', 'L', 'Barlow', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1003870536', 0, 'N', 0, '2014-01-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037533', 'W12037533', 'ID02', 'Ontario Emergency Specialists', 'Brad', 'L', 'Barlow', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1003870536', 0, 'N', 0, '2014-01-09', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037535', 'W12037535', 'ID02', 'Ontario Emergency Specialists', 'Kenneth', 'L', 'Bean', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1346274115', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037536', 'W12037536', 'ID02', 'Ontario Emergency Specialists', 'Kenneth', 'L', 'Bean', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1346274115', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037537', 'W12037537', 'ID02', 'Ontario Emergency Specialists', 'Morris', '', 'Smith', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1487911877', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037538', 'W12037538', 'ID02', 'Ontario Emergency Specialists', 'Morris', '', 'Smith', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1487911877', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037539', 'W12037539', 'ID02', 'Ontario Emergency Specialists', 'Harold', 'K', 'Thompson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1336185073', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037540', 'W12037540', 'ID02', 'Ontario Emergency Specialists', 'Harold', 'K', 'Thompson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1336185073', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037541', 'W12037541', 'ID02', 'Ontario Emergency Specialists', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037542', 'W12037542', 'ID02', 'Ontario Emergency Specialists', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037543', 'W12037543', 'ID02', 'Ontario Emergency Specialists', 'Rick', 'L', 'Wright', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1780706283', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037544', 'W12037544', 'ID02', 'Ontario Emergency Specialists', 'Rick', 'L', 'Wright', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1780706283', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037545', 'W12037545', 'ID02', 'Ontario Emergency Specialists', 'Kent', 'M', 'Sandquist', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1407918501', 0, 'N', 0, '2014-03-03', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037546', 'W12037546', 'ID02', 'Ontario Emergency Specialists', 'Kent', 'M', 'Sandquist', 'PA-C', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1407918501', 0, 'N', 0, '2014-01-09', NULL, NULL, 0, 0, NULL, NULL),
('271608039', 'W12037549', 'W12037549', 'ID02', 'Ontario Emergency Specialists', 'Nancy', '', 'Tate', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1023392636', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271608039', 'W12037548', 'W12037548', 'ID02', 'Ontario Emergency Specialists', 'Nancy', '', 'Tate', 'PA-C', 'Emergency Medicine', '', '', NULL, 'B', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', '6500 Bowden Rd Ste 100', 'Jacksonville', 'Duval', 'FL', '32216', '9048051219', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', '2013-07-01', 0, 0, 1, '', '', '', '', 'HCFA', '1023392636', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('820536340', 'W12037550', 'W12037550', 'ID02', 'The Clinic at Eagle', 'Katherine', 'T', 'Coate', 'NP-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 6115', 'Boise', 'Ada', 'ID', '83707', '5284728112', '0000000000', 'PO Box 6115', 'Boise', 'Ada', 'ID', '83707', '5284728112', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-26', '2013-10-21', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1619939451', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W12037551', 'W12037551', 'ID02', 'Ankle & Foot Medical Center', 'Jeffrey', 'L', 'Chandler', 'DPM', 'Podiatry', '', '', NULL, 'O', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-08-26', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659354470', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('200055625', 'W12037552', 'W12037552', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'Ann', '', 'Cordum', 'MD', 'Hospitalist', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '6023242249', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1982653879', 0, 'N', 0, '2013-09-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('200055625', 'W12037553', 'W12037553', 'ID02', 'Saint Alphonsus Medical Center-Ontario  (Apogee)', 'Ann', '', 'Cordum', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'PO Box 708850', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1982653879', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12037555', 'W12037555', 'ID02', 'St Lukes Clinic Family Medicine', 'Ashley', 'J', 'King', 'MD', 'Family Practice', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-08-21', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235440314', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12037556', 'W12037556', 'ID02', 'St Lukes Physician Services', 'Ashley', 'J', 'King', 'MD', 'Family Practice', '', '', 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, '2013-08-21', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235440314', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12037558', 'W12037558', 'ID02', 'OB/GYN Associates PA', 'Darren', 'S', 'Pittard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084541065', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084541065', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-08-21', '2014-07-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164644159', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12037560', 'W12037560', 'ID02', 'OB/GYN Associates PA', 'Darren', 'S', 'Pittard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-08-21', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164644159', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12037559', 'W12037559', 'ID02', 'OB/GYN Associates PA', 'Darren', 'S', 'Pittard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '0000000000', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-08-21', '2013-09-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164644159', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('460544997', 'W12037562', 'W12037562', 'ID02', 'Simply Womens Health', 'Kelly', '', 'Siudzinski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2273 E Gala St Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2089945700', '2089945700', '2273 E Gala St Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2089945700', '2089945700', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417906405', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('460544997', 'W12037563', 'W12037563', 'ID02', 'Simply Womens Health', 'Kelly', '', 'Siudzinski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 190780', 'Boise', 'Ada', 'ID', '83719', '2089945700', '2089945700', 'PO Box 190780', 'Boise', 'Ada', 'ID', '83719', '2089945700', '2089945700', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-08-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417906405', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12037565', 'W12037565', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Eagle', 'Jennifer', 'S', 'Anderson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093825903', 0, 'N', 0, '2014-07-15', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('260553931', 'W12037570', 'W12037570', 'IDBOISTD', '', 'Joanmarie', '', 'Pellegrini', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1265402242', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12037571', 'W12037571', 'IDBOISTD', 'Saint Alphonsus Medical Group Comprehensive Breast Surgery', 'Elizabeth', 'M', 'Prier', 'MD', 'General Surgery', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635997', '2084635490', '4400 E Flamingo Ave   ', 'Nampa', 'Canyon', 'ID', '83687', '2084635997', '2084635490', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-26', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1306983689', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('260553931', 'W12037573', 'W12037573', 'IDBOISTD', '', 'David', 'B', 'Safran', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659488674', 0, 'N', 0, '2014-05-13', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12037577', 'W12037577', 'IDBOISTD', 'Saint Alphonsus Medical Group Vascular Services', 'Matthew', 'G', 'Whitten', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Cassia Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1215058011', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('271627637', 'W12037583', 'W12037583', 'TXDALSTD', 'Hunt Regional Medical Partners', 'Roxana', 'L', 'Cruz', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1359', 'Greenville', 'Hunt', 'TX', '75403', '9034087751', '9034087802', 'PO Box 1359', 'Greenville', 'Hunt', 'TX', '75403', '9034087751', '9034087802', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063438919', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('271627637', 'W12037582', 'W12037582', 'TXDALSTD', 'Hunt Regional Medical Partners', 'Roxana', 'L', 'Cruz', 'MD', 'Internal Medicine', '', '', NULL, 'M', '4221 Ridgecrest St Ste 105', 'Greenville', 'Hunt', 'TX', '75402', '9034087980', '9034087989', '4221 Ridgecrest St Ste 105', 'Greenville', 'Hunt', 'TX', '75402', '9034087980', '9034087989', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063438919', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1207, -96.1244, NULL, NULL),
('271627637', 'W12037581', 'W12037581', 'TXDALSTD', 'Hunt Regional Medical Partners', 'Roxana', 'L', 'Cruz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4501 Joe Ramsey Blvd Ste 100', 'Greenville', 'Hunt', 'TX', '75402', '9034085800', '9034087989', '4501 Joe Ramsey Blvd Ste 100', 'Greenville', 'Hunt', 'TX', '75402', '9034085800', '9034087989', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1063438919', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1247, -96.1263, NULL, NULL),
('750747197', 'W12037585', 'W12037585', 'TXDALSTD', 'Drs Carter, Hays and Martin', 'Lauren', 'A', 'Dew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1311 N Washington Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242563', '2148243353', '1311 N Washington Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242563', '2148243353', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1851534374', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7947, -96.7824, NULL, NULL),
('752743990', 'W12037587', 'W12037587', 'TXDALSTD', 'Comprehensive Womens Healthcare', 'Kerry', 'D', 'Neal', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1054 Texan Trl Ste 100', 'Grapevine', 'Tarrant', 'TX', '76051', '8174243112', '8174882820', '1054 Texan Trl Ste 100', 'Grapevine', 'Tarrant', 'TX', '76051', '8174243112', '8174882820', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1417073701', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.934, -97.0615, NULL, NULL),
('751506487', 'W12037589', 'W12037589', 'TXDALSTD', 'Associates in Oral and Maxillofacial Surgery', 'Mau', 'K', 'Pham', 'DDS MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '4224 Heritage Trace Pkwy Ste 304', 'Keller', 'Tarrant', 'TX', '76244', '8177412200', '8177412216', '4224 Heritage Trace Pkwy Ste 304', 'Keller', 'Tarrant', 'TX', '76244', '8177412200', '8177412216', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', '', '', '', 'HCFA|UB|', '1174708119', 0, 'N', 0, '2014-06-09', NULL, NULL, 32.9153, -97.295, NULL, NULL),
('463256382', 'W12037591', 'W12037591', 'TXDALSTD', 'Eric I Ray MD', 'Eric', 'I', 'Ray', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '731 Southlake Blvd Ste 110', 'Southlake', 'Tarrant', 'TX', '76092', '2147505162', '2147505162', '731 Southlake Blvd Ste 110', 'Southlake', 'Tarrant', 'TX', '76092', '2147505162', '2147505162', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1598965428', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('205870870', 'W12037593', 'W12037593', 'TXDALSTD', 'Dermatology Treatment and Research Center', 'Stephanie', 'A', 'Saxton-Daniels', 'MD', 'Dermatology', '', '', NULL, 'O', '5310 Harvest Hill Rd Ste 160', 'Dallas', 'Dallas', 'TX', '75230', '9726612729', '9726610227', '5310 Harvest Hill Rd Ste 160', 'Dallas', 'Dallas', 'TX', '75230', '9726612729', '9726610227', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578882247', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9217, -96.8172, NULL, NULL),
('752924037', 'W12037595', 'W12037595', 'TXDALSTD', 'Women''s Integrated Healthcare', 'Courtney', 'G', 'Walters', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1625 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8174162229', '8174163667', '1625 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8174162229', '8174163667', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1063495554', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('274127777', 'W12037597', 'W12037597', 'TXHOUSTD', 'Jeanne Smith, MD', 'Jeanne', '', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8714 Spring Cypress Rd Ste 200', 'Spring', 'Harris', 'TX', '77379', '2812516394', '8325597745', '8714 Spring Cypress Rd Ste 200', 'Spring', 'Harris', 'TX', '77379', '2812516394', '8325597745', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|', '1912086950', 0, 'N', 0, '2013-09-13', NULL, NULL, 30.0337, -95.5549, NULL, NULL),
('760520222', 'W12037600', 'W12037600', 'TXHOUSTD', '', 'Ronald', '', 'Vilela', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1700088739', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('760520222', 'W12037601', 'W12037601', 'TXHOUSTD', '', 'Ronald', '', 'Vilela', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1700088739', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('760520222', 'W12037602', 'W12037602', 'TXHOUSTD', '', 'Ronald', '', 'Vilela', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '915 Gessner Rd Ste 560', 'Houston', 'Harris', 'TX', '77024', '7137220411', '7137227411', '915 Gessner Rd Ste 560', 'Houston', 'Harris', 'TX', '77024', '7137220411', '7137227411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1700088739', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760520222', 'W12037603', 'W12037603', 'TXHOUSTD', '', 'Ronald', '', 'Vilela', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1700088739', 0, 'N', 0, '2013-09-27', 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
('760678455', 'W12037604', 'W12037604', 'TXHOUSTD', '', 'Chau', 'M', 'Vu', 'MD', 'Nephrology', '', '', NULL, 'O', '1567 Live Oak Ste A', 'Webster', 'Harris', 'TX', '77598', '2813322400', '2813322442', '1567 Live Oak Ste A', 'Webster', 'Harris', 'TX', '77598', '2813322400', '2813322442', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1689671497', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.5457, -95.1305, NULL, NULL),
('460906063', 'W12037605', 'W12037605', 'UTMH1', 'The Counseling Center', 'Gina', 'D', 'Francis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619023207', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.9214, -111.879, NULL, NULL),
('760520222', 'W12037607', 'W12037607', 'TXHOUSTD', 'Joseph Edmonds MD', 'Joseph', 'L', 'Edmonds', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1457346710', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('760520222', 'W12037608', 'W12037608', 'TXHOUSTD', '', 'Joseph', 'L', 'Edmonds', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1457346710', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('760520222', 'W12037609', 'W12037609', 'TXHOUSTD', 'Joseph Edmonds MD', 'Joseph', 'L', 'Edmonds', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1457346710', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12037611', 'W12037611', 'ID02', 'Idaho Gastroenterology Associates', 'Cory', 'A', 'Shuler', 'NP', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St  ', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295177541', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12037610', 'W12037610', 'ID02', 'Idaho Gastroenterology Associates', 'Cory', 'A', 'Shuler', 'NP', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', '425 W Bannock St  ', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295177541', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('760520222', 'W12037613', 'W12037613', 'TXHOUSTD', '', 'Newton', '', 'Duncan', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', '16651 SW Fwy Ste 320', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813403200', '2813403222', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1144215302', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('760520222', 'W12037612', 'W12037612', 'TXHOUSTD', '', 'Newton', '', 'Duncan', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1144215302', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('760520222', 'W12037614', 'W12037614', 'TXHOUSTD', '', 'Newton', '', 'Duncan', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1144215302', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('270437667', 'W12037615', 'W12037615', 'UT01', 'New Horizon Medical Care', 'Shauna', '', 'Albrecht', 'NP', 'Family Practice', '', '', NULL, 'O', '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '8012549670', '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '8012549670', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1003258252', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.5223, -111.928, NULL, NULL),
('760363583', 'W12037616', 'W12037616', 'TXHOUSTD', 'Fondren Orthopedic Group', '', '', 'Fondren Orthopedic Group', '', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '7137943380', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '7137943380', 'FONDREN', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609830595', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760542990', 'W12037617', 'W12037617', 'TXHOUSTD', 'Sugar Land Allergy Asthma and Immunology Center', 'David', '', 'Arman', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '4820 Sweetwater Blvd', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814944600', '2814944605', '4820 Sweetwater Blvd', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814944600', '2814944605', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841294261', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.5851, -95.6313, NULL, NULL),
('363383867', 'W12037619', 'W12037619', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Patricia', 'L', 'Clark', 'MD', 'General Surgery', '', '', NULL, 'O', '2800 W 87th St 1st Fl, Ste W1515', 'Evergreen Park', 'Cook', 'IL', '60805', '7082294050', '7082294051', '2800 W 87th St 1st Fl, Ste W1515', 'Evergreen Park', 'Cook', 'IL', '60805', '7082294050', '7082294051', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053335349', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7354, -87.6923, NULL, NULL),
('454054843', 'W12037623', 'W12037623', 'UT01', 'Plastic Surgery Associates', 'Rodney', 'Evan', 'Schmelzer', 'MD', 'Plastic Surgery', 'Emergency Medicine', NULL, NULL, 'O', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', '5089 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017430700', '8017430701', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487626297', 0, 'N', 0, '2013-09-17', NULL, NULL, 40.6591, -111.866, NULL, NULL),
('454054843', 'W12037624', 'W12037624', 'UT01', 'Plastic Surgery Associates', 'Rodney', 'Evan', 'Schmelzer', 'MD', 'Plastic Surgery', 'Emergency Medicine', NULL, NULL, 'O', '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8017430700', '8017430701', '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8017430700', '8017430701', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487626297', 0, 'N', 0, '2013-09-17', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870549057', 'W12037625', 'W12037625', 'UT01', 'Utah Valley Pediatrics', 'Jonathan', 'P', 'Peterson', 'MD', 'Pediatrics', '', '', NULL, 'O', '15 S 1000 E  Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652235', '0000000000', '15 S 1000 E  Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652235', '0000000000', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053535930', 0, 'N', 0, '2013-09-05', NULL, NULL, 40.044, -111.716, NULL, NULL),
('364088232', 'W12037627', 'W12037627', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'M', 'Mateas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648639', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648639', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225462955', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12037628', 'W12037628', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'M', 'Mateas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225462955', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12037629', 'W12037629', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'M', 'Mateas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225462955', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'W12037631', 'W12037631', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'M', 'Mateas', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225462955', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037630', 'W12037630', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'M', 'Mateas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512810', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512810', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225462955', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'W12037633', 'W12037633', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037634', 'W12037634', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12037635', 'W12037635', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597284', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597284', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12037636', 'W12037636', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'W12037637', 'W12037637', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512752', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512752', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'W12037638', 'W12037638', 'ILCHIGSTD', 'Dreyer Medical Clinic', '', '', 'Dreyer Medical Clinic', '', 'Clinics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010021', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037639', 'W12037639', 'ILCHIGSTD', 'Dreyer Medical Clinic', '', '', 'Dreyer Medical Clinic', '', 'Clinics', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010021', 0, 'Y', 0, '2014-04-22', NULL, NULL, 41.805, -88.352, NULL, NULL),
('270573539', 'W12037598', 'W12037598', 'UT01', 'Utah Orthopaedics', 'Jeremy', 'J', 'Kokkonen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Washington Terrace', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Washington Terrace', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750549424', 0, 'N', 0, '2014-01-31', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12037599', 'W12037599', 'UT01', 'Utah Orthopaedics', 'Jeremy', 'J', 'Kokkonen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750549424', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12037641', 'W12037641', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Michael', 'J', 'Hoilien', 'DO', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881739076', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12037642', 'W12037642', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', 'Michael', 'J', 'Hoilien', 'DO', 'Family Practice', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881739076', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0255, -116.975, NULL, NULL),
('460500210', 'W12037644', 'W12037644', 'IDBOISTD', 'Saint Alphonsus Pathology Physician Services', 'Mark', 'O', 'Moore', 'MD', 'Pathology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672153', '2083673991', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672153', '2083673991', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821261918', 0, 'Y', 0, '2014-06-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12037646', 'W12037646', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Kristi', 'A', 'Clukey', 'MD', '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, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1699723072', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.4877, -116.404, NULL, NULL),
('820200895', 'W12037650', 'W12037650', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Kylee', 'M', 'Domby', 'NP', 'Family Practice', '', '', NULL, 'O', '1000 N Curtis Rd Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083676130', '2083677316', '1000 N Curtis Rd Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1124398458', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('820200895', 'W12037651', 'W12037651', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Kylee', 'M', 'Domby', 'NP', 'Family Practice', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676127', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676127', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1124398458', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12037652', 'W12037652', 'IDBOISTD', 'Saint Alphonsus Medical Group Glycemic Liberty', 'Kylee', 'M', 'Domby', 'NP', 'Family Practice', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083676130', '2083677316', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1124398458', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'W12037653', 'W12037653', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Kylee', 'M', 'Domby', 'NP', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083676130', '2083677316', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1124398458', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12037654', 'W12037654', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5903, -116.31, NULL, NULL),
('820200895', 'W12037655', 'W12037655', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W12037656', 'W12037656', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'W12037657', 'W12037657', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '0000000000', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'W12037658', 'W12037658', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('820200895', 'W12037659', 'W12037659', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5913, -116.204, NULL, NULL),
('820200895', 'W12037660', 'W12037660', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('820200895', 'W12037661', 'W12037661', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('820200895', 'W12037662', 'W12037662', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12037663', 'W12037663', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12037664', 'W12037664', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine ', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W12037665', 'W12037665', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12037666', 'W12037666', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med NHP', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12037667', 'W12037667', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'W12037668', 'W12037668', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'W12037669', 'W12037669', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12037670', 'W12037670', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med Emerald', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-22', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1497773196', 0, 'N', 0, '2014-02-07', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'W12037671', 'W12037671', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Michael', 'L', 'Roach', 'MD', '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, '2013-08-26', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1528004389', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12037672', 'W12037672', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Kathryn', '', 'Schneider', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|', '1457589640', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820425454', 'W12037673', 'W12037673', 'ID01', 'Boise Anesthesia', 'Clark', 'L', 'Brinton', 'CRNA', 'Anesthesia', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd  ', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-08-14', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1750315792', 0, 'Y', 0, '2014-01-08', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('826041596', 'W12037675', 'W12037675', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('826041596', 'W12037676', 'W12037676', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653651', '          ', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653651', '          ', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('826041596', 'W12037677', 'W12037677', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553730', '2084553735', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553730', '2084553735', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('826041596', 'W12037678', 'W12037678', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.5998, -116.358, NULL, NULL),
('826041596', 'W12037679', 'W12037679', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', '2083678273', '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', '2083678273', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('826041596', 'W12037680', 'W12037680', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415238137', '5415231788', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415238137', '5415231788', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 44.7961, -117.848, NULL, NULL),
('826041596', 'W12037681', 'W12037681', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '927 W Myrtle St', 'Boise', 'Ada', 'ID', '83702', '2083677510', '2083676367', '927 W Myrtle St', 'Boise', 'Ada', 'ID', '83702', '2083677510', '2083676367', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6133, -116.208, NULL, NULL),
('826041596', 'W12037682', 'W12037682', 'ID01', 'Advanced Vein Therapy', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'B', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089915201', '2086396625', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089915201', '2086396625', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W12037683', 'W12037683', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'B', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', '          ', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', '          ', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W12037684', 'W12037684', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('826041596', 'W12037685', 'W12037685', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '351 SW Ninth St', 'Ontario', 'Malheur', 'OR', '97914', '5418817120', '5418817388', '351 SW Ninth St', 'Ontario', 'Malheur', 'OR', '97914', '5418817120', '5418817388', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 44.0255, -116.975, NULL, NULL),
('826041596', 'W12037686', 'W12037686', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('826041596', 'W12037687', 'W12037687', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '486 W 1st Ave', 'Glenns Ferry', 'Elmore', 'ID', '83623', '2083667416', '2083662717', '486 W 1st Ave', 'Glenns Ferry', 'Elmore', 'ID', '83623', '2083667416', '2083662717', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 42.9538, -115.305, NULL, NULL),
('826041596', 'W12037688', 'W12037688', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '6533 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('826041596', 'W12037689', 'W12037689', 'ID01', 'Gem State Radiology LLP', 'Michael', 'J', 'Modica', 'MD', 'Radiology', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083752217', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295926061', 0, 'Y', 0, '2014-06-02', NULL, NULL, 43.6116, -116.264, NULL, NULL),
('942854057', 'W12037692', 'W12037692', 'UTIHCPHY', 'North Cache Valley Clinic', 'David', 'S', 'Aamodt', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355633222', '4355633390', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355633222', '4355633390', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619928140', 0, 'Y', 0, '2013-11-19', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037691', 'W12037691', 'UTIHCPHY', 'North Cache Valley Instacare', 'David', 'S', 'Aamodt', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619928140', 0, 'Y', 0, '2013-11-19', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037693', 'W12037693', 'UTIHCPHY', 'Mt Pleasant Clinic', 'Thomas', 'J', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245254739', 0, 'Y', 0, '2013-09-05', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12037694', 'W12037694', 'UTIHCPHY', 'Moroni Clinic', 'Thomas', 'J', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245254739', 0, 'Y', 0, '2013-09-05', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12037695', 'W12037695', 'UTIHCPHY', 'Ephraim Clinic', 'Thomas', 'J', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245254739', 0, 'Y', 0, '2013-09-05', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12037696', 'W12037696', 'UTIHCPHY', 'Manti Family Clinic', 'Thomas', 'J', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245254739', 0, 'Y', 0, '2013-09-05', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12037698', 'W12037698', 'UTIHCPHY', 'Utah Valley Radiation Oncology', 'Brandon', 'M', 'Barney', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194961789', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12037699', 'W12037699', 'UTIHCPHY', 'American Fork Radiation Oncology', 'Brandon', 'M', 'Barney', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '170 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8013572480', '8014423263', '170 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8013572480', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194961789', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.3806, -111.769, NULL, NULL),
('942854057', 'W12037701', 'W12037701', 'UTIHCPHY', 'Bountiful Clinic', 'Tyler', 'J', 'Bickel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861717837', 0, 'N', 0, '2013-09-05', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12037703', 'W12037703', 'UTIHCPHY', 'Heber Valley Clinic', 'Samuel', 'S', 'Blake', 'MD', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518194687', 0, 'Y', 0, '2013-09-05', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12037705', 'W12037705', 'UTIHCPHY', 'River Road Internal Medicine', 'Michael', 'A', 'Codiga', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-19', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306888219', 0, 'N', 0, '2013-09-05', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12037707', 'W12037707', 'UTIHCPHY', 'Valley View Heart Clinic', 'Thomas', '', 'Denhalter', 'APRN', 'Family Practice', '', '', NULL, 'O', '1303 N Main St Ste H', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste H', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871594002', 0, 'Y', 0, '2013-09-06', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12037709', 'W12037709', 'UTIHCPHY', 'Southern Utah Neurosciences Institute', 'Benjamin', 'D', 'Fox', 'MD', 'Neurosurgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184955734', 0, 'N', 0, '2013-09-05', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12037711', 'W12037711', 'UTIHCPHY', 'Bountiful KidsCare', 'Danae', '', 'Goerl', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154648327', 0, 'Y', 0, '2013-09-05', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12037712', 'W12037712', 'UTIHCPHY', 'North Sevier Medical Clinic', 'Charlie', 'R', 'Jacques', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', 'Pulmonary', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336162890', 0, 'Y', 0, '2013-09-05', NULL, NULL, 38.9534, -111.863, NULL, NULL),
('942854057', 'W12037713', 'W12037713', 'UTIHCPHY', 'Bountiful Clinic', 'Ashley', 'L', 'Kernan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346558517', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.8935, -111.881, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12037719', 'W12037719', 'UTIHCPHY', 'Int Heart Cardiology-RVH', 'Armond', 'M', 'LaPine', 'MD', 'Cardiology', '', '', NULL, 'O', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457331365', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12037718', 'W12037718', 'UTIHCPHY', 'Int Heart Cardiology-SL Clinic', 'Armond', 'M', 'LaPine', 'MD', 'Cardiology', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457331365', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037720', 'W12037720', 'UTIHCPHY', 'Int Heart Cardiology', 'Armond', 'M', 'LaPine', 'MD', 'Cardiology', '', '', NULL, 'O', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457331365', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12037716', 'W12037716', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Armond', 'M', 'LaPine', 'MD', 'Cardiology', '', '', NULL, 'O', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457331365', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12037717', 'W12037717', 'UTIHCPHY', 'Int Heart Cardiology-AVH', 'Armond', 'M', 'LaPine', 'MD', 'Cardiology', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457331365', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('942854057', 'W12037722', 'W12037722', 'UTIHCPHY', 'Heber Valley Clinic', 'Curtis', 'A', 'Nielsen', 'DO', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013237502', 0, 'Y', 0, '2013-09-05', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12037723', 'W12037723', 'UTIHCPHY', 'Int Heart Cardiology-PKMC', 'Kelly', 'R', 'O Neal', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073505', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053401240', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037724', 'W12037724', 'UTIHCPHY', 'Dixie Hospitalists', 'Richard', 'R', 'Patilano', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512992', '4356886222', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512992', '4356886222', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417157876', 0, 'Y', 0, '2013-09-05', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12037727', 'W12037727', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Fatma', 'A', 'Reda', 'MD', 'Psychiatry', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043238934', 0, 'Y', 0, '2013-09-05', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12037728', 'W12037728', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Fatma', 'A', 'Reda', 'MD', 'Psychiatry', '', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043238934', 0, 'Y', 0, '2013-09-05', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('942854057', 'W12037729', 'W12037729', 'UTIHCPHY', 'Park City Clinic-Round Valley', 'Mary', 'C', 'Schindeler', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', '750 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639406705', 0, 'Y', 0, '2013-09-05', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12037731', 'W12037731', 'UTIHCPHY', 'Logan Regional Orthopedics', 'Jonathan', 'B', 'Swenson', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-15', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740456680', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12037733', 'W12037733', 'UTIHCPHY', 'Logan Regional Orthopedics', 'Brian', 'A', 'Vernon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-09', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1265639280', 0, 'N', 0, '2014-06-27', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12037734', 'W12037734', 'UTIHCPHY', 'Budge Clinic Radiology', 'Brian', 'A', 'Vernon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-09', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1265639280', 0, 'N', 0, '2014-06-27', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12037737', 'W12037737', 'UTIHCPHY', 'Budge Clinic Pediatrics', 'Yohanna', 'S', 'Vernon', 'MD', 'Pediatrics', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '4357921692', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '4357921692', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396943494', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12037736', 'W12037736', 'UTIHCPHY', 'Budge Clinic Radiology', 'Yohanna', 'S', 'Vernon', 'MD', 'Pediatrics', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396943494', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('462611243', 'W12037740', 'W12037740', 'UTDT01', 'DeMille MacKay Dental', 'David', '', 'MacKay', 'DMD', 'Dentist', '', '', NULL, 'O', '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', NULL, '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1023213287', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('462611243', 'W12037741', 'W12037741', 'UTDT01', 'Demille MacKay Dental', 'David', '', 'MacKay', 'DMD', 'Dentist', '', '', NULL, 'O', '3550 S 4800 W Ste J', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019693025', NULL, '3550 S 4800 W Ste J', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019693025', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1023213287', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('462611243', 'W12037742', 'W12037742', 'UTDT01', 'Demille MacKay Dental', 'Christopher C', '', 'Demille', 'DMD', 'Dentist', '', '', NULL, 'O', '3550 S 4800 W Ste J', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019693025', NULL, '3550 S 4800 W Ste J', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019693025', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1952506636', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('462611243', 'W12037743', 'W12037743', 'UTDT01', 'DeMille MacKay Dental', 'Christopher C', '', 'Demille', 'DMD', 'Dentist', '', '', NULL, 'O', '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', NULL, '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1952506636', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('452688615', 'W12037746', 'W12037746', 'UTDT01', 'Utah Valley Oral Surgery', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '76 E Commerce Dr Ste 203', 'Saratoga Springs', 'Utah', 'UT', '84045', '8012241200', NULL, '76 E Commerce Dr Ste 203', 'Saratoga Springs', 'Utah', 'UT', '84045', '8012241200', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('273629873', 'W12037744', 'W12037744', 'UTDT01', 'Mountain Ridge Dental', 'Ryan M', '', 'Workman', 'DDS', 'Dentist', '', '', NULL, 'O', '1256 S State St Ste 103', 'Orem', 'Utah', 'UT', '84097', '8012247182', NULL, '1256 S State St Ste 103', 'Orem', 'Utah', 'UT', '84097', '8012247182', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801991674', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('461978008', 'W12037747', 'W12037747', 'UTDT01', 'Bountiful Ridge Dental', 'Mark', '', 'McGowan', 'DMD', 'Dentist', '', '', NULL, 'O', '415 Medical Dr Ste A200', 'Bountiful', 'Davis', 'UT', '84010', '8012030290', NULL, '415 Medical Dr Ste A200', 'Bountiful', 'Davis', 'UT', '84010', '8012030290', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1659661288', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('261475323', 'W12037748', 'W12037748', 'UTDT01', 'Wisdom Teeth Only', 'Raymond K', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '2230 N University Pkwy Bldg 8 Ste A', 'Provo', 'Utah', 'UT', '84604', '8013700050', NULL, '2230 N University Pkwy Bldg 8 Ste A', 'Provo', 'Utah', 'UT', '84604', '8013700050', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013120245', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('261475323', 'W12037749', 'W12037749', 'UTDT01', 'Wisdom Teeth Only', 'Raymond K', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '7001 S 900 E Ste 350', 'Midvale', 'Salt Lake', 'UT', '84047', '8013700050', NULL, '7001 S 900 E Ste 350', 'Midvale', 'Salt Lake', 'UT', '84047', '8013700050', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013120245', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('270471253', 'W12037750', 'W12037750', 'UTDT01', 'Huntington Family Dental', 'Gavin', '', 'Huntington', 'DDS', 'Dentist', '', '', NULL, 'O', '151 E Main St Ste 1', 'Santaquin', 'Utah', 'UT', '84655', '8017543100', NULL, '151 E Main St Ste 1', 'Santaquin', 'Utah', 'UT', '84655', '8017543100', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1992933840', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('383909602', 'W12037751', 'W12037751', 'UTDT01', 'Platinum Dental Care', 'Michael', '', 'Eggett', 'DDS', 'Dentist', '', '', NULL, 'O', '1963 S 1200 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014661212', NULL, '1963 S 1200 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014661212', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1316108772', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('261475323', 'W12037752', 'W12037752', 'UTDT01', 'Wisdom Teeth Only', 'Heath', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '7001 S 900 E Ste 350', 'Midvale', 'Salt Lake', 'UT', '84047', '8013700050', NULL, '7001 S 900 E Ste 350', 'Midvale', 'Salt Lake', 'UT', '84047', '8013700050', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1932116589', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('261475323', 'W12037753', 'W12037753', 'UTDT01', 'Wisdom Teeth Only', 'Heath', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '2148 N Hill Field Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013700050', NULL, '2148 N Hill Field Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013700050', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1932116589', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870502538', 'W12037755', 'W12037755', 'UTDT01', 'Institute of Facial and Cosmetic Surgery', 'Brent', '', 'Kennedy', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '5929 Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012613637', NULL, '5929 Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012613637', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1174747109', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('273424060', 'W12037757', 'W12037757', 'UTDT01', 'Salt Lake Dental ', 'Bradley', '', 'Carter', 'DMD', 'Dentist', '', '', NULL, 'O', '2120 S 700 E Ste I', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014870760', NULL, '2120 S 700 E Ste I', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014870760', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1760748826', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('900404141', 'W12037758', 'W12037758', 'UTDT01', '39th Street Dental', 'Darin', '', 'Hartvigsen', 'DDS', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721199', NULL, '1377 E 3900 S Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721199', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1003983297', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('752780597', 'W12037760', 'W12037760', 'UTDT01', 'Snow Country Dental Care', 'Tyler', '', 'Caruso', 'DMD', 'Dentist', '', '', NULL, 'O', '1729 Sidewinder Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356499492', NULL, '1729 Sidewinder Dr Ste 102', 'Park City', 'Summit', 'UT', '84060', '4356499492', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', '2013-12-01', 0, 0, 0, '', '', '', '', 'DEN|', '1538424189', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('463038739', 'W12037762', 'W12037762', 'UTDT01', 'Canyon Cove Dental', 'Andrew', '', 'Theurer', 'DDS', 'Dentist', '', '', NULL, 'O', '12465 S Fort St Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015761167', NULL, '12465 S Fort St Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015761167', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1881034551', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('272133292', 'W12037764', 'W12037764', 'UTDT01', 'Judd E Partridge', 'Matthew', '', 'Maxfield', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '4775 W Daybreak Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012805535', NULL, '4775 W Daybreak Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012805535', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN', '1851528244', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('272133292', 'W12037765', 'W12037765', 'UTDT01', 'Judd E Partridge', 'Matthew', '', 'Maxfield', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '7138 S Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019438703', NULL, '7138 S Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019438703', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN', '1851528244', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('124300622', 'W12037766', 'W12037766', 'UTDT01', 'Professional Smile Center', 'David', '', 'Wright', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '575 E 4500 S Ste B250', 'Murray', 'Salt Lake', 'UT', '84107', '8012665455', NULL, '575 E 4500 S Ste B250', 'Murray', 'Salt Lake', 'UT', '84107', '8012665455', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1376090834', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('202670861', 'W12037768', 'W12037768', 'UTDT01', 'ABC Pediatric Dentistry', 'Kurt', '', 'Vest', 'DMD', 'Pedodontist', '', '', NULL, 'O', '169 N Gateway Dr Ste 200', 'Providence', 'Cache', 'UT', '84332', '4357872223', NULL, '169 N Gateway Dr Ste 200', 'Providence', 'Cache', 'UT', '84332', '4357872223', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1457794315', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('202330319', 'W12037770', 'W12037770', 'UTDT01', 'Dixie Pediatric Dental', 'Tyler', '', 'Torres', 'DDS', 'Pedodontist', '', '', NULL, 'O', '368 E Riverside Dr Bldg 6', 'St George', 'Washington', 'UT', '84790', '4356888827', NULL, '368 E Riverside Dr Bldg 6', 'St George', 'Washington', 'UT', '84790', '4356888827', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN', '1033405873', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('141960192', 'W12037772', 'W12037772', 'UTDT01', 'Copperfield Family Dental', 'Jonathan', '', 'Elmer', 'DDS', 'Dentist', '', '', NULL, 'O', '8846 S Redwood Rd  Ste N201', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660631', NULL, '8846 S Redwood Rd  Ste N201', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660631', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1730192980', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12037773', 'W12037773', 'IDBOISTD', 'Primary Health Medical Group', 'Eli', 'G', 'Thornton', 'NP', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427480201', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.5903, -116.294, NULL, NULL),
('202630141', 'W12037774', 'W12037774', 'IDBOISTD', 'Primary Health Medical Group', 'Eli', 'G', 'Thornton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427480201', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12037775', 'W12037775', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', 'D', 'Eifling', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295921989', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12037776', 'W12037776', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', 'D', 'Eifling', 'MD', 'Cardiology', '', '', 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, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295921989', 0, 'N', 0, '2013-11-13', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('454180391', 'W12037777', 'W12037777', 'TXDALSTD', 'Steven M Pounders MD', 'Steven', 'M', 'Pounders', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Oak Lawn Ave Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', NULL, '3500 Oak Lawn Ave Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1124073614', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8119, -96.8055, NULL, NULL),
('205934739', 'W12037778', 'W12037778', 'ID02', 'Family Medicine Health Center', 'Kelsey', 'E', 'Ruszel', 'RD', 'Dietician', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144654377', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12037779', 'W12037779', 'ID02', 'Family Medicine Health Center', 'Kelsey', 'E', 'Ruszel', 'RD', 'Dietician', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144654377', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12037780', 'W12037780', 'ID02', 'Family Medicine Health Center', 'Kelsey', 'E', 'Ruszel', 'RD', 'Dietician', '', '', NULL, 'O', '2275 S Eagle Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2275 S Eagle Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144654377', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12037781', 'W12037781', 'ID02', 'Family Medicine Health Center', 'Kelsey', 'E', 'Ruszel', 'RD', 'Dietician', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144654377', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('753143209', 'W12037782', 'W12037782', 'WY01', 'Big Horn Basin Bone and Joint', 'Stephen', '', 'Emery', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781918', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781918', '', '', '', '0.00', '25.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720189335', 0, 'N', 0, '2013-11-26', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('753143209', 'W12037783', 'W12037783', 'WYT1', 'Big Horn Basin Bone and Joint', 'Stephen', '', 'Emery', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781918', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781918', '', '', '', '0.00', '25.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720189335', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('320047747', 'W12037784', 'W12037784', 'TXHOUSTD', 'Rajesh K Bindal', 'Rajesh', 'K', 'Bindal', 'MD', 'Neurosurgery', '', '', NULL, 'O', '16605 SW Fwy Ste 285', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130031', '2813130032', '16605 SW Fwy Ste 285', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|', '1306876768', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('320047747', 'W12037785', 'W12037785', 'TXHOUSTD', 'Rajesh K Bindal', 'Rajesh', 'K', 'Bindal', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|', '1306876768', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870438731', 'W12037795', 'W12037795', 'UTDT01', 'Bingham Dental & Orthodontics', 'Tab', '', 'Bingham', 'DDS', 'Dentist', '', '', NULL, 'O', '8370 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012507422', NULL, '8370 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012507422', '          ', 'UT000A', '', '', '0.00', '10.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1699986497', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('208116606', 'W12037798', 'W12037798', 'UTDT01', 'Utah County Smiles', 'Justin', '', 'Broadbent', 'DDS', 'Dentist', '', '', NULL, 'O', '1344 S 800 E Ste 220', 'Orem', 'Utah', 'UT', '84097', '8012246165', NULL, '1344 S 800 E Ste 220', 'Orem', 'Utah', 'UT', '84097', '8012246165', '          ', 'UT000B', '', '', '0.00', '0.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1982839676', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('462733613', 'W12037800', 'W12037800', 'UTDT01', 'Creek Road Dental', 'Tyler', '', 'Carlson', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1952558652', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870507022', 'W12037803', 'W12037803', 'UTDT01', 'David M Christiansen', 'David', '', 'Christiansen', 'DDS', 'Orthodontist', '', '', NULL, 'O', '3707 N Canyon Rd #8D', 'Provo', 'Utah', 'UT', '84604', '8012249900', NULL, '3707 N Canyon Rd #8D', 'Provo', 'Utah', 'UT', '84604', '8012249900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1376756726', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('462503470', 'W12037804', 'W12037804', 'UTDT01', 'Starzz Dental', 'Dan', '', 'Dansie', 'DDS', 'Dentist', '', '', NULL, 'O', '2222 W 3500 S Ste A1', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019085474', NULL, '2222 W 3500 S Ste A1', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019085474', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1720094733', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12037806', 'W12037806', 'UTDT01', 'All Around Dental Care', 'Devin', '', 'Davidson', 'DMD', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', NULL, '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', '8013588420', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861755571', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12037807', 'W12037807', 'UTDT01', 'All Around Dental Care', 'Devin', '', 'Davidson', 'DMD', 'Dentist', '', '', NULL, 'O', '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', NULL, '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861755571', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12037808', 'W12037808', 'UTDT01', 'All Around Dental Care', 'Devin', '', 'Davidson', 'DMD', 'Dentist', '', '', NULL, 'O', '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', NULL, '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861755571', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12037809', 'W12037809', 'UTDT01', 'All Around Dental Care', 'Devin', '', 'Davidson', 'DMD', 'Dentist', '', '', NULL, 'O', '1144 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015663118', NULL, '1144 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015663118', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861755571', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12037811', 'W12037811', 'UTDT01', 'Monarch Dental', 'Santiago', '', 'Gardois', 'DDS', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014754797', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014754797', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1336494780', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12037812', 'W12037812', 'UTDT01', 'Monarch Dental', 'Santiago', '', 'Gardois', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1336494780', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12037813', 'W12037813', 'UTDT01', 'Monarch Dental', 'Santiago', '', 'Gardois', 'DDS', 'Dentist', '', '', NULL, 'O', '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', NULL, '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1336494780', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12037814', 'W12037814', 'UTDT01', 'Monarch Dental', 'Santiago', '', 'Gardois', 'DDS', 'Dentist', '', '', NULL, 'O', '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', NULL, '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1336494780', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('453178359', 'W12037816', 'W12037816', 'UTDT01', 'Washington Terrace Dental', 'Christopher', '', 'Dorny', 'DMD', 'Dentist', '', '', NULL, 'O', '128 E 4600 S', 'Ogden', 'Weber', 'UT', '84405', '8016260996', NULL, '128 E 4600 S', 'Ogden', 'Weber', 'UT', '84405', '8016260996', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1558642355', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('208285431', 'W12037818', 'W12037818', 'UTDT01', 'Westways Dental', 'Laura', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '3451 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019691400', NULL, '3451 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019691400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255778247', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('760363583', 'FON000001', 'FON000001', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Juliette', '', 'Zumwalt', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1003000738', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000003', 'FON000003', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'P', 'Loncarich', 'MD', 'Orthopedic Surgery', 'Surgery of the Foot and Ankle', '', NULL, 'O', '4001 Preston', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', NULL, '4001 Preston', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003804428', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('760363583', 'FON000002', 'FON000002', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'P', 'Loncarich', 'MD', 'Orthopedic Surgery', 'Surgery of the Foot and Ankle', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003804428', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000076', 'FON000076', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Susan', '', 'Ball', 'RN', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1013987278', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000005', 'FON000005', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'W', 'Wimberley', 'MD', 'Orthopedic Surgery', 'Spine Surgery', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', 'Texas Orthopedic Hospital', NULL, NULL, 'HCFA|UB|', '1023006491', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000004', 'FON000004', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'W', 'Wimberley', 'MD', 'Orthopedic Surgery', 'Spine Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', 'Texas Orthopedic Hospital', NULL, NULL, 'HCFA|UB|', '1023006491', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000006', 'FON000006', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Yigal', '', 'Samocha', 'MD', 'Orthopedic Surgery', 'Surgery of the Spine', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053633040', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000123', 'FON000123', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Lee', '', 'Jones', 'LPO', 'Durable Medical Equipment', '', '', NULL, 'O', '2525 W Bellfort Ste 150', 'Houston', 'Harris', 'TX', '77054', '7133499335', NULL, '2525 W Bellfort Ste 150', 'Houston', 'Harris', 'TX', '77054', '7133499335', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1073871653', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.6729, -95.4186, NULL, NULL),
('760363583', 'FON000122', 'FON000122', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Lee', '', 'Jones', 'LPO', 'Durable Medical Equipment', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1073871653', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000010', 'FON000010', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wayne', 'O', 'Alani', 'MD', 'Orthopedic Surgery', 'General / Pediatric Orthopedic', '', NULL, 'O', '12121 Richmond Ave Ste 112', 'Houston', 'Harris', 'TX', '77082', '7137774785', NULL, '12121 Richmond Ave Ste 112', 'Houston', 'Harris', 'TX', '77082', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093708745', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760363583', 'FON000009', 'FON000009', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wayne', 'O', 'Alani', 'MD', 'Orthopedic Surgery', 'General / Pediatric Orthopedic', '', NULL, 'O', '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', NULL, '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093708745', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.584, -95.6309, NULL, NULL),
('760363583', 'FON000007', 'FON000007', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wayne', 'O', 'Alani', 'MD', 'Orthopedic Surgery', 'General / Pediatric Orthopedic', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093708745', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000008', 'FON000008', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wayne', 'O', 'Alani', 'MD', 'Orthopedic Surgery', 'General / Pediatric Orthopedic', '', NULL, 'O', '7777 Southwest Fwy Ste 432', 'Houston', 'Harris', 'TX', '77074', '7137774785', NULL, '7777 Southwest Fwy Ste 432', 'Houston', 'Harris', 'TX', '77074', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093708745', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('760363583', 'FON000011', 'FON000011', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Vasilios', '', 'Mathews', 'MD', 'Orthopedic Surgery', 'Joint Replacement', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104814532', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000012', 'FON000012', 'TXHOUSTD', 'Fondren Orthopedic Group', 'James', 'B', 'Bennett', 'MD', 'Orthopedic Surgery', 'Hand and Upper', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154314714', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000111', 'FON000111', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Alisha', '', 'Smith', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', NULL, '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1164721460', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'FON000112', 'FON000112', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Alisha', '', 'Smith', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1164721460', 0, 'Y', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000110', 'FON000110', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Alisha', '', 'Smith', 'PT-A', 'Physical Therapy', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1164721460', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000077', 'FON000077', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Pedro', '', 'Colunga', 'RN', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1184606584', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000093', 'FON000093', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mary Jo', '', 'Chapman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', NULL, '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1184762619', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'FON000094', 'FON000094', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mary Jo', '', 'Chapman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1184762619', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000092', 'FON000092', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mary Jo', '', 'Chapman', 'PT', 'Physical Therapy', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1184762619', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000014', 'FON000014', 'TXHOUSTD', 'Fondren Orthopedic Group', 'C', 'Robert', 'Boone', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194713602', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('760363583', 'FON000013', 'FON000013', 'TXHOUSTD', 'Fondren Orthopedic Group', 'C', 'Robert', 'Boone', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194713602', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000117', 'FON000117', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Brenda', '', 'Shoemaker', 'PT', 'Physical Therapy', '', '', NULL, 'O', '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', NULL, '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1194821439', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.5561, -95.378, NULL, NULL),
('760363583', 'FON000116', 'FON000116', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Brenda', '', 'Shoemaker', 'PT', 'Physical Therapy', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1194821439', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000016', 'FON000016', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Ken', 'M', 'Korthauer', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215925508', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000015', 'FON000015', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Ken', 'M', 'Korthauer', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215925508', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, 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
('760363583', 'FON000018', 'FON000018', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Kenneth', 'M', 'Warnock', 'MD', 'Orthopedic Surgery', 'Shoulder and Elbow Surgery', '', NULL, 'O', '18220 Tomball Pkwy Ste 330', 'Houston', 'Harris', 'TX', '77070', '2818074380', NULL, '18220 Tomball Pkwy Ste 330', 'Houston', 'Harris', 'TX', '77070', '2818074380', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1215925680', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('760363583', 'FON000017', 'FON000017', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Kenneth', 'M', 'Warnock', 'MD', 'Orthopedic Surgery', 'Shoulder and Elbow Surgery', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1215925680', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000089', 'FON000089', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Brandon', '', 'Thompson', 'CFA', 'Surgical Assistant', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1235129495', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000118', 'FON000118', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Dorit', '', 'Aaron', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1255416517', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000020', 'FON000020', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Tomiko', '', 'Fukuda', 'MD', 'Orthopedic Surgery', 'Foot and Ankle Surgery', '', NULL, 'O', '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', NULL, '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255542999', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.584, -95.6309, NULL, NULL),
('760363583', 'FON000019', 'FON000019', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Tomiko', '', 'Fukuda', 'MD', 'Orthopedic Surgery', 'Foot and Ankle Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255542999', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000021', 'FON000021', 'TXHOUSTD', 'Fondren Orthopedic Group', 'W', 'Grant', 'Braly', 'MD', 'Orthopedic Surgery', 'Surgery of the Foot and Ankle', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285622795', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000022', 'FON000022', 'TXHOUSTD', 'Fondren Orthopedic Group', 'G', 'William', 'Woods', 'MD', 'Orthopedic Surgery', 'Surgery of the Knee', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366430688', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000023', 'FON000023', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joshua', 'T', 'Woody', 'MD', 'Orthopedic Surgery', 'Surgery of the Knee', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366621872', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000024', 'FON000024', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Hussein', 'A', 'Elkousy', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376531954', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000025', 'FON000025', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Yomna', 'T', 'Monla', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376585851', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000119', 'FON000119', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barbara', '', 'Rose', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1376628651', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000026', 'FON000026', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Samantha', 'E', 'Nedelman', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1376832329', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000029', 'FON000029', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Robert', 'L', 'Burke', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', NULL, '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386632966', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.5561, -95.378, NULL, NULL),
('760363583', 'FON000028', 'FON000028', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Robert', 'L', 'Burke', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '4001 Preston Ste 150', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', '          ', '4001 Preston Ste 150', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', '          ', 'FONDREN', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', '', '', '', 'HCFA|UB|', '1386632966', 0, 'N', 0, '2014-07-21', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('760363583', 'FON000027', 'FON000027', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Robert', 'L', 'Burke', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386632966', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000030', 'FON000030', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Sarah', 'Z', 'Reber', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '          ', 'FONDREN', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396044798', 0, 'Y', 0, '2014-02-14', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000032', 'FON000032', 'TXHOUSTD', 'Fondren Orthopedic Group', 'J', 'Kevin', 'Horn', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '2635 Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2818378550', NULL, '2635 Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2818378550', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407844814', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7697, -94.9901, NULL, NULL),
('760363583', 'FON000031', 'FON000031', 'TXHOUSTD', 'Fondren Orthopedic Group', 'J', 'Kevin', 'Horn', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407844814', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000033', 'FON000033', 'TXHOUSTD', 'Fondren Orthopedic Group', 'J', 'Bryan', 'Williamson', 'MD', 'Orthopedic Surgery', 'Reconstructive Spinal', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437147642', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000035', 'FON000035', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joseph', 'C', 'Allen', 'MD', 'Orthopedic Surgery', 'Spine Surgery', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813325011', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813325011', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447243001', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('760363583', 'FON000034', 'FON000034', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joseph', 'C', 'Allen', 'MD', 'Orthopedic Surgery', 'Spine Surgery', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447243001', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000108', 'FON000108', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wade', '', 'Batson', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', NULL, '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1467600064', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'FON000109', 'FON000109', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wade', '', 'Batson', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1467600064', 0, 'Y', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000107', 'FON000107', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Wade', '', 'Batson', 'PT-A', 'Physical Therapy', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1467600064', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000036', 'FON000036', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'R', 'Goldhoff', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1467782284', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000037', 'FON000037', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Jeffrey', 'A', 'Kozak', 'MD', 'Orthopedic Surgery', 'Reconstructive Spinal', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487642898', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000039', 'FON000039', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joseph', 'O', 'Muscat', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497743835', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000038', 'FON000038', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joseph', 'O', 'Muscat', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497743835', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000040', 'FON000040', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Thomas', 'Bradley', 'Edwards', 'MD', 'Orthopedic Surgery', 'Shoulder Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528056033', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000041', 'FON000041', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Jay', 'C', 'Oates', 'MD', 'Orthopedic Surgery', 'Surgery of the Foot and Ankle', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528056959', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000043', 'FON000043', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Arthur', 'F', 'Chau', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '14861 Southwest Fwy Ste C 302', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813401234', NULL, '14861 Southwest Fwy Ste C 302', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813401234', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528088622', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.612, -95.6085, NULL, NULL),
('760363583', 'FON000042', 'FON000042', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Arthur', 'F', 'Chau', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '6550 Mapleridge Ste 108', 'Houston', 'Harris', 'TX', '77081', '7136610066', NULL, '6550 Mapleridge Ste 108', 'Houston', 'Harris', 'TX', '77081', '7136610066', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528088622', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.71, -95.4742, NULL, NULL),
('760363583', 'FON000081', 'FON000081', 'TXHOUSTD', 'Fondren Orthopedic Group', 'William', '', 'Morton', 'OPA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1528220019', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000044', 'FON000044', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Robin', 'N', 'Goytia', 'MD', 'Orthopedic Surgery', 'Joint Replacement Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538284534', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000080', 'FON000080', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Jimmie', '', 'Edmonds', 'OPA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1548250707', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000046', 'FON000046', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Magdalena', 'J', 'Klien', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', NULL, '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558669234', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.584, -95.6309, NULL, NULL),
('760363583', 'FON000045', 'FON000045', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Magdalena', 'J', 'Klien', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558669234', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000090', 'FON000090', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mark', 'R', 'Hornick', 'PT', 'Physical Therapy', '', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', NULL, '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568408631', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'FON000091', 'FON000091', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mark', 'R', 'Hornick', 'PT', 'Physical Therapy', '', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568408631', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000047', 'FON000047', 'TXHOUSTD', 'Fondren Orthopedic Group', 'C', 'Craig', 'Crouch', 'MD', 'Orthopedic Surgery', 'Hand Surgeon', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619965126', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000086', 'FON000086', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Aaron', '', 'Maksymowski', 'LSA', 'Orthopedic Surgery', '', '', NULL, 'O', '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', NULL, '10223 Broadway Ste A', 'Pearland', 'Brazoria', 'TX', '77584', '7134363488', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619967882', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.5561, -95.378, NULL, NULL),
('760363583', 'FON000085', 'FON000085', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Aaron', '', 'Maksymowski', 'LSA', 'Orthopedic Surgery', '', '', NULL, 'O', '4001 Preston', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', NULL, '4001 Preston', 'Pasadena', 'Harris', 'TX', '77505', '2819918000', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619967882', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('760363583', 'FON000084', 'FON000084', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Aaron', '', 'Maksymowski', 'LSA', 'Orthopedic Surgery', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619967882', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000049', 'FON000049', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'E', 'Nolan', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '14861 Southwest Fwy Ste 302', 'Sugar Land', 'Harris', 'TX', '77081', '2813401234', NULL, '14861 Southwest Fwy Ste 302', 'Sugar Land', 'Harris', 'TX', '77081', '2813401234', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629092994', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.612, -95.6085, NULL, NULL),
('760363583', 'FON000050', 'FON000050', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'E', 'Nolan', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '6550 Mapleridge Ste 108', 'Houston', 'Harris', 'TX', '77081', '7136610066', NULL, '6550 Mapleridge Ste 108', 'Houston', 'Harris', 'TX', '77081', '7136610066', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629092994', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.71, -95.4742, NULL, NULL),
('760363583', 'FON000051', 'FON000051', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'E', 'Nolan', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '720 Ave F North Ste 5', 'Bay City', 'Matagorda', 'TX', '77414', '2813401234', NULL, '720 Ave F North Ste 5', 'Bay City', 'Matagorda', 'TX', '77414', '2813401234', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629092994', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.0108, -95.9737, NULL, NULL),
('760363583', 'FON000048', 'FON000048', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'E', 'Nolan', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629092994', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000052', 'FON000052', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Steven', 'M', 'Hammerman', 'MD', 'Emergency Medicine', 'Emergency Medicine', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', '', '', NULL, 'HCFA|UB|', '1649268236', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000054', 'FON000054', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'M', 'Bloome', 'MD', 'Orthopedic Surgery', 'Foot and Ankle Surgery', '', NULL, 'O', '14861 Southwest Fwy Ste C 302', 'Sugar Land', 'Fort Bend', 'TX', '77478', '7137992300', NULL, '14861 Southwest Fwy Ste C 302', 'Sugar Land', 'Fort Bend', 'TX', '77478', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649372962', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.612, -95.6085, NULL, NULL),
('760363583', 'FON000053', 'FON000053', 'TXHOUSTD', 'Fondren Orthopedic Group', 'David', 'M', 'Bloome', 'MD', 'Orthopedic Surgery', 'Foot and Ankle Surgery', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649372962', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000056', 'FON000056', 'TXHOUSTD', 'Fondren Orthopedic Group', 'J', 'Michael', 'Bennett', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', NULL, '4690 Sweetwater Blvd Ste 240', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137774785', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', 'HCFA|UB|', '1699741520', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.584, -95.6309, NULL, NULL),
('760363583', 'FON000055', 'FON000055', 'TXHOUSTD', 'Fondren Orthopedic Group', 'J', 'Michael', 'Bennett', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', 'HCFA|UB|', '1699741520', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000058', 'FON000058', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Razvan', 'G', 'Scobercea', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700043783', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000057', 'FON000057', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Razvan', 'G', 'Scobercea', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700043783', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000059', 'FON000059', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Thomas', 'L', 'Mehlhoff', 'MD', 'Orthopedic Surgery', 'Hand Surgeon', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720076151', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000060', 'FON000060', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Joseph', 'J', 'Gugenheim', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedic', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730177320', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000061', 'FON000061', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Nicole', 'A', 'Wunderlich', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1811261514', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000063', 'FON000063', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barry', 'D', 'Boone', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821081498', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('760363583', 'FON000062', 'FON000062', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barry', 'D', 'Boone', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821081498', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000065', 'FON000065', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Phillip', 'G', 'Daley', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821086406', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('760363583', 'FON000064', 'FON000064', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Phillip', 'G', 'Daley', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821086406', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000066', 'FON000066', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Gary', 'M', 'Gartsman', 'MD', 'Orthopedic Surgery', 'Shoulder Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821086414', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000067', 'FON000067', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Richard', 'J', 'Kearns', 'MD', 'Orthopedic Surgery', 'Joint Implant Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831187236', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000068', 'FON000068', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Nizar', 'A', 'Moughrabi', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '          ', 'FONDREN', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831466820', 0, 'N', 0, '2014-02-14', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000121', 'FON000121', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barry', '', 'Raborn', 'LPO', 'Durable Medical Equipment', '', '', NULL, 'O', '2525 W Bellfort Ste 150', 'Houston', 'Harris', 'TX', '77054', '7133499335', NULL, '2525 W Bellfort Ste 150', 'Houston', 'Harris', 'TX', '77054', '7133499335', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1851377626', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.6729, -95.4186, NULL, NULL),
('760363583', 'FON000120', 'FON000120', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barry', '', 'Raborn', 'LPO', 'Durable Medical Equipment', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1851377626', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000069', 'FON000069', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Gregory', 'W', 'Stocks', 'MD', 'Orthopedic Surgery', 'Joint Implant Surgery', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861480238', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000070', 'FON000070', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Mark', 'R', 'Brinker', 'MD', 'Orthopedic Surgery', 'Trauma-Acute and Reconstructive', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861480386', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000071', 'FON000071', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Eugene', 'C', 'Lou', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '915 Gessner Ste 470', 'Houston', 'Harris', 'TX', '77024', '7137227454', NULL, '915 Gessner Ste 470', 'Houston', 'Harris', 'TX', '77024', '7137227454', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881682201', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760363583', 'FON000072', 'FON000072', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Gary', 'T', 'Brock', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedics', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891783304', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000073', 'FON000073', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Scott', 'R', 'Stanislaw', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912903238', 0, 'N', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000087', 'FON000087', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Jermaine', '', 'McNeal', 'CST', 'Orthopedic Surgery', '', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1922063767', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('760363583', 'FON000074', 'FON000074', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Barrett', 'S', 'Brown', 'MD', 'Orthopedic Surgery', 'General Orthopedics', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952470262', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760363583', 'FON000114', 'FON000114', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Dasia', '', 'Hernandez', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', NULL, '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1962645622', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'FON000115', 'FON000115', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Dasia', '', 'Hernandez', 'PT-A', 'Physical Therapy', '', '', NULL, 'O', '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', NULL, '601 Rockmead Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1962645622', 0, 'Y', 0, '2013-09-09', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('760363583', 'FON000113', 'FON000113', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Dasia', '', 'Hernandez', 'PT-A', 'Physical Therapy', '', '', NULL, 'B', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1962645622', 0, 'Y', 0, '2013-09-09', NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'FON000075', 'FON000075', 'TXHOUSTD', 'Fondren Orthopedic Group', 'Idris', 'S', 'Gharbaoui', 'MD', 'Orthopedic Surgery', 'Hand Surgeon', '', NULL, 'O', '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, '7401 S Main', 'Houston', 'Harris', 'TX', '77030', '7137992300', '', 'FONDREN', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Texas Orthopedic Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992731392', 0, 'N', 0, '2013-09-09', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('462733616', 'W12037820', 'W12037820', 'UTDT01', 'Creek Road Dental', 'Amy', 'D', 'Florance', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'DEN|', '1669599015', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('204840137', 'W12037822', 'W12037822', 'UTDT01', 'Advanced Family Dental', 'Brian', '', 'Glazier', 'DDS', 'Dentist', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', NULL, '1760 N Main St Ste 103', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1033430111', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('208389141', 'W12037824', 'W12037824', 'UTDT01', 'Crawford Leishman Dental Group', 'Blake', '', 'Gutierrez', 'DDS', 'Dentist', '', '', NULL, 'O', '265 W Center St', 'Orem', 'Utah', 'UT', '84057', '8012255888', NULL, '265 W Center St', 'Orem', 'Utah', 'UT', '84057', '8012255888', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'DEN|', '1043585730', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('462733613', 'W12037825', 'W12037825', 'UTDT01', 'Creek Road Dental', 'Brian', '', 'Homer', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1881696904', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037827', 'W12037827', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Corissa', 'J', 'Elgar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1306162458', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037828', 'W12037828', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Corissa', 'J', 'Elgar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1306162458', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037829', 'W12037829', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Corissa', 'J', 'Elgar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1306162458', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'W12037831', 'W12037831', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kim', 'M', 'Harmon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932188299', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'W12037833', 'W12037833', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kim', 'M', 'Harmon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932188299', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037832', 'W12037832', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kim', 'M', 'Harmon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932188299', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037835', 'W12037835', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Grace', 'H', 'Wang', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1043324247', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037837', 'W12037837', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Grace', 'H', 'Wang', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1043324247', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037836', 'W12037836', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Grace', 'H', 'Wang', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1043324247', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, 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
('364088232', 'W12037839', 'W12037839', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Natalie', 'K', 'Roche', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1710906235', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037840', 'W12037840', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Natalie', 'K', 'Roche', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1710906235', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037843', 'W12037843', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Carolyn', 'N', 'Mills', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1548354731', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'W12037844', 'W12037844', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Carolyn', 'N', 'Mills', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1548354731', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037845', 'W12037845', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Carolyn', 'N', 'Mills', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1548354731', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037847', 'W12037847', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'C', 'Simkins', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1184860595', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037849', 'W12037849', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'C', 'Simkins', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1184860595', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037848', 'W12037848', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kelly', 'C', 'Simkins', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1184860595', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'W12037851', 'W12037851', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Edward', 'M', 'Newman', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1053304741', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037852', 'W12037852', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Edward', 'M', 'Newman', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1053304741', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037854', 'W12037854', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shelly', 'M', 'Sinatra', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1467666453', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037855', 'W12037855', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shelly', 'M', 'Sinatra', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1467666453', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037857', 'W12037857', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'H', 'Kobak', 'MD', 'Urogynecology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1023007887', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037859', 'W12037859', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'H', 'Kobak', 'MD', 'Urogynecology', '', '', NULL, 'O', '1801 W Taylor St Ste 4C', 'Chicago', 'Cook', 'IL', '60612', '3124137500', '3124138331', '1801 W Taylor St Ste 4C', 'Chicago', 'Cook', 'IL', '60612', '3124137500', '3124138331', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1023007887', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.8692, -87.6714, NULL, NULL),
('364088232', 'W12037858', 'W12037858', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'H', 'Kobak', 'MD', 'Urogynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1023007887', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037861', 'W12037861', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Eleanor', 'T', 'Ross', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786605', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786605', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801054549', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'W12037862', 'W12037862', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Eleanor', 'T', 'Ross', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '4440 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7086845580', '7086844068', '4440 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7086845580', '7086844068', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801054549', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.7203, -87.7327, NULL, NULL),
('364088232', 'W12037863', 'W12037863', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Eleanor', 'T', 'Ross', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 92710', 'Chicago', 'Cook', 'IL', '60675', '8473905900', '0000000000', 'PO Box 92710', 'Chicago', 'Cook', 'IL', '60675', '8473905900', '0000000000', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801054549', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037864', 'W12037864', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Eleanor', 'T', 'Ross', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801054549', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037869', 'W12037869', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mark', 'P', 'Kruszewski', 'NP', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1255625281', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037866', 'W12037866', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mark', 'P', 'Kruszewski', 'NP', 'Pediatrics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1255625281', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037871', 'W12037871', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bridget', 'M', 'Sweeney', 'MD', 'Pediatrics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932339132', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037873', 'W12037873', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bridget', 'M', 'Sweeney', 'MD', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932339132', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037872', 'W12037872', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bridget', 'M', 'Sweeney', 'MD', 'Pediatrics', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-01-01', 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1932339132', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.8072, -88.3523, NULL, NULL),
('364088232', 'W12037875', 'W12037875', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sarah', 'E', 'Smith', 'MD', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275796260', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037877', 'W12037877', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sarah', 'E', 'Smith', 'MD', 'Pediatrics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275796260', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037876', 'W12037876', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sarah', 'E', 'Smith', 'MD', 'Pediatrics', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275796260', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'W12037879', 'W12037879', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Maria', '', 'Holgado-Cocjin', 'MD', 'Pediatrics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164407508', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('364088232', 'W12037881', 'W12037881', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Maria', '', 'Holgado-Cocjin', 'MD', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164407508', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037880', 'W12037880', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Maria', '', 'Holgado-Cocjin', 'MD', 'Pediatrics', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164407508', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.805, -88.352, NULL, NULL),
('390816848', 'W12037883', 'W12037883', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Josh', '', 'Thomas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184883597', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037885', 'W12037885', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Josh', '', 'Thomas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184883597', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037884', 'W12037884', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Josh', '', 'Thomas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8115344479', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8115344479', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184883597', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037887', 'W12037887', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Diane', '', 'Donais', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1427095033', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037889', 'W12037889', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Diane', '', 'Donais', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1427095033', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037888', 'W12037888', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Diane', '', 'Donais', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1427095033', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037891', 'W12037891', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Gilbert', '', 'Cua', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1336193507', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037892', 'W12037892', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Gilbert', '', 'Cua', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1336193507', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037893', 'W12037893', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Gilbert', '', 'Cua', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1336193507', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037895', 'W12037895', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Paula', '', 'French', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992751002', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037896', 'W12037896', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Paula', '', 'French', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992751002', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037897', 'W12037897', 'ILCHIGSTD', 'Mercy McHenry Immediate Care', 'Paula', '', 'French', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992751002', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037900', 'W12037900', 'ILCHIGSTD', 'Mercy McHenry Immediate Care', 'Amy', '', 'Michalak', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1437196698', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037899', 'W12037899', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Amy', '', 'Michalak', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1437196698', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037901', 'W12037901', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Amy', '', 'Michalak', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1437196698', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037903', 'W12037903', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Linda', '', 'Glenn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1417104159', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037905', 'W12037905', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Linda', '', 'Glenn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1417104159', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037904', 'W12037904', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Linda', '', 'Glenn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1417104159', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037907', 'W12037907', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Marie', 'Joy', 'Wolff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1467684613', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037908', 'W12037908', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Marie', 'Joy', 'Wolff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1467684613', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037909', 'W12037909', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Marie', 'Joy', 'Wolff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1467684613', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037913', 'W12037913', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Jessica', '', 'Wagner', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518298058', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037915', 'W12037915', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Jessica', '', 'Wagner', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518298058', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037914', 'W12037914', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Jessica', '', 'Wagner', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518298058', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037917', 'W12037917', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Eric', '', 'Miranda', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1730336332', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037918', 'W12037918', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Eric', '', 'Miranda', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1730336332', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037916', 'W12037916', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Eric', '', 'Miranda', 'PT', 'Physical Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1730336332', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('390816848', 'W12037919', 'W12037919', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Nancy', '', 'Barnes', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184871634', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12037921', 'W12037921', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Nancy', '', 'Barnes', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184871634', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('390816848', 'W12037920', 'W12037920', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Nancy', '', 'Barnes', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184871634', 0, 'N', 0, '2013-09-09', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('459918138', 'W12037922', 'W12037922', 'ID01', '', 'Misty', 'L', 'Wall', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '849 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83646', '2082979495', '2089399009', '849 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83646', '2082979495', '2089399009', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2013-09-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912136466', 0, 'N', 0, '2013-09-30', NULL, NULL, 43.6194, -116.384, NULL, NULL),
('204043287', 'W12037923', 'W12037923', 'NM01', 'ABQ Health Partners', 'Teresa', '', 'Balcomb', 'MD', 'Orthopedic Surgery/Hand', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245311034', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12037924', 'W12037924', 'NM01', 'ABQ Health Partners', 'Galina', '', 'Batygina', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962525550', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12037925', 'W12037925', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('204043287', 'W12037926', 'W12037926', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', '0314-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('204043287', 'W12037927', 'W12037927', 'NM01', 'ABQ Health Partners', 'Alice', '', 'Harsh', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639104755', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('204043287', 'W12037928', 'W12037928', 'NM01', 'ABQ Health Partners', 'Teresa', '', 'Marroquin-Elizondo', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457384018', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('204043287', 'W12037929', 'W12037929', 'NM01', 'ABQ Health Partners', 'Kenna', '', 'Larsen', 'MD', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-30', '2014-07-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1073723375', 0, 'N', 0, '2014-07-14', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12037933', 'W12037933', 'NM01', 'ABQ Health Partners', 'Allison', '', 'Richards', 'DO', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052623774', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891700365', 0, 'N', 0, '2013-09-10', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('870617336', 'W12037935', 'W12037935', 'UTDT01', 'Monarch Dental', 'Angelica', '', 'McHugh', 'DDS', 'Dentist', '', '', NULL, 'O', '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', NULL, '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1720182314', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870645970', 'W12037938', 'W12037938', 'UTDT01', 'Meyer Family Dental', 'Louis', '', 'Meyer', 'DDS', 'Dentist', '', '', NULL, 'O', '4645 Midland Dr Ste 1', 'Ogden', 'Weber', 'UT', '84401', '8017315600', NULL, '4645 Midland Dr Ste 1', 'Ogden', 'Weber', 'UT', '84401', '8017315600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1447337910', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870645970', 'W12037937', 'W12037937', 'UTDT01', 'Meyer Family Dental', 'Louis', '', 'Meyer', 'DDS', 'Dentist', '', '', NULL, 'O', '4645 Midland Dr Ste 1', 'Ogden', 'Weber', 'UT', '84401', '8017315600', NULL, '4645 Midland Dr Ste 1', 'Ogden', 'Weber', 'UT', '84401', '8017315600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2030-01-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'DEN', '1447337910', 0, 'N', 1, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870623840', 'W12037940', 'W12037940', 'UTDT01', 'Mark T Miller Dental', 'Mark', 'T', 'Miller', 'DDS', 'Dentist', '', '', NULL, 'O', '307 N 300 W Ste 304', 'Kaysville', 'Davis', 'UT', '84037', '8015444003', NULL, '307 N 300 W Ste 304', 'Kaysville', 'Davis', 'UT', '84037', '8015444003', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1427209329', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('105529963', 'W12037944', 'W12037944', 'UTDT01', 'W Henry Pond', 'Henry', '', 'Pond', 'DMD', 'Dentist', '', '', NULL, 'O', '688 E Vine St Ste 16', 'Murray', 'Salt Lake', 'UT', '84107', '8012628728', NULL, '688 E Vine St Ste 16', 'Murray', 'Salt Lake', 'UT', '84107', '8012628728', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1174688378', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('010959908', 'W12037942', 'W12037942', 'UTDT01', 'Payson Family Dental', 'Ritchie', '', 'Pelton', 'DMD', 'Dentist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1619315454', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12037945', 'W12037945', 'UTDT01', 'The Center of Dental Professionals', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478018', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478018', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870627380', 'W12037946', 'W12037946', 'UTDT01', 'Koelliker Endodontics', 'Christopher', '', 'Sadler', 'DDS', 'Endodontist', '', '', NULL, 'O', '6364 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', NULL, '6364 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1073777611', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('710938777', 'W12037948', 'W12037948', 'UTDT01', 'Lakeview Dental', 'Daniel', '', 'Snedaker', 'DDS', 'Dentist', '', '', NULL, 'O', '3626 W 5600 S Ste D', 'Rush Valley', 'Tooele', 'UT', '84069', '8019852273', NULL, '3626 W 5600 S Ste D', 'Rush Valley', 'Tooele', 'UT', '84069', '8019852273', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1134564388', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('263716255', 'W12037949', 'W12037949', 'UTDT01', 'Lakeview Dental', 'Daniel', '', 'Snedaker', 'DDS', 'Dentist', '', '', NULL, 'O', '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252275', NULL, '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252275', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1134564388', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('520217559', 'W12037951', 'W12037951', 'UTDT01', 'Rock Canyon Dentistry', 'Zachary', '', 'Taylor', 'DDS', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013736362', NULL, '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013736362', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1407118490', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('562747001', 'W12037954', 'W12037954', 'UTDT01', 'Rock Canyon Dentistry', 'Eric', '', 'Tidwell', 'DDS', 'Dentist', '', '', NULL, 'O', '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013736362', NULL, '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013736362', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1932131562', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870374545', 'W12037956', 'W12037956', 'UTDT01', '', 'Spencer', '', 'Wade', 'DDS', 'Dentist', '', '', NULL, 'O', '5139 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017737762', NULL, '5139 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017737762', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1487893988', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('470897660', 'W12037958', 'W12037958', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Adam', 'A', 'Nelson', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902239478', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('470897660', 'W12037957', 'W12037957', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Adam', 'A', 'Nelson', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902239478', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('760564520', 'W12037959', 'W12037959', 'TXHOUSTD', 'Shreekant N Patolia', 'Shreekant', 'N', 'Patolia', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1315 St Joseph Pkwy Ste 1200', 'Houston', 'Harris', 'TX', '77002', '7137568707', '7137568353', '1315 St Joseph Pkwy Ste 1200', 'Houston', 'Harris', 'TX', '77002', '7137568707', '7137568353', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689692477', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7486, -95.3675, NULL, NULL),
('470897660', 'W12037961', 'W12037961', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Pamela', 'J', 'Cronin', 'AUD', 'Audiology', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639109481', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('470897660', 'W12037964', 'W12037964', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Brian', 'R', 'Peterson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316978687', 0, 'N', 0, '2013-10-02', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('470897660', 'W12037965', 'W12037965', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Brian', 'R', 'Peterson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316978687', 0, 'N', 0, '2013-10-02', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('470897660', 'W12037966', 'W12037966', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Vance', 'K', 'Gunnell', 'AUD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205272291', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('470897660', 'W12037968', 'W12037968', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Jennifer', 'H', 'Johnson', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225288376', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('470897660', 'W12037967', 'W12037967', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Jennifer', 'H', 'Johnson', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225288376', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('364088232', 'W12035647', 'W12035647', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Abby', 'E', 'Ludwig', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912348855', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8633, -88.269, 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
('364088232', 'W12035646', 'W12035646', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Abby', 'E', 'Ludwig', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912348855', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('850275777', 'W12037135', 'W12037135', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5057974503', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5057974503', '', '', '', '0.00', '0.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12037979', 'W12037979', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('850275777', 'W12037980', 'W12037980', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd Nw', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd Nw', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12037981', 'W12037981', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12037982', 'W12037982', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12037983', 'W12037983', 'NM01', 'Southwest Medical Associates', 'Lowry', 'O', 'Simpson', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548365893', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('204043287', 'W12037985', 'W12037985', 'NM01', 'ABQ Health Partners', 'Patrick', '', 'Chan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052623937', '5052627147', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052623937', '5052627147', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942477971', 0, 'N', 0, '2013-09-11', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('760520222', 'W12037987', 'W12037987', 'TXHOUSTD', '', 'James', '', 'Albright', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '11777 FM 1960 W', 'Houston', 'Harris', 'TX', '77065', '7137962001', '7137969172', '11777 FM 1960 W', 'Houston', 'Harris', 'TX', '77065', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1548255805', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.9254, -95.5973, NULL, NULL),
('760520222', 'W12037986', 'W12037986', 'TXHOUSTD', '', 'James', '', 'Albright', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1548255805', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('760520222', 'W12037988', 'W12037988', 'TXHOUSTD', 'James Albright MD', 'James', '', 'Albright', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1548255805', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('470897660', 'W12037963', 'W12037963', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Ryan', '', 'Gilbert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497930234', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('470897660', 'W12037962', 'W12037962', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Ryan', '', 'Gilbert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '8015668330', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497930234', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870450251', 'W12037992', 'W12037992', 'UT01', 'The Eye Institute of Utah', 'Charles', 'H', 'Weber', 'MD', 'Ophthalmology', '', '', NULL, 'O', '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012662283', '8012686151', '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012662283', '8012686151', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1942447016', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.6871, -111.87, NULL, NULL),
('753071148', 'W12037993', 'W12037993', 'TXHOUSTD', 'Lois Y Chu', 'Lois', 'Y', 'Chu', 'DC', 'Family Practice', '', '', NULL, 'O', '2714 W Lake Houston Pkwy Ste 100', 'Kingwood', 'Harris', 'TX', '77345', '2813608898', '2813609968', '2714 W Lake Houston Pkwy Ste 100', 'Kingwood', 'Harris', 'TX', '77345', '2813608898', '2813609968', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861594392', 0, 'N', 0, '2013-09-27', NULL, NULL, 30.0467, -95.1822, NULL, NULL),
('753071148', 'W12037994', 'W12037994', 'TXHOUSTD', 'Lois Y Chu', 'Lois', 'Y', 'Chu', 'DC', 'Family Practice', '', '', NULL, 'B', 'PO Box 5356', 'Kingwood', 'Harris', 'TX', '77325', '2813608898', '2813609968', 'PO Box 5356', 'Kingwood', 'Harris', 'TX', '77325', '2813608898', '2813609968', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861594392', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12037995', 'W12037995', 'ILCHIGSTD', '', 'Barry', '', 'Atlas', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732818780', '7732818842', '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732818780', '7732818842', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1073513305', 0, 'N', 0, '2013-09-11', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'W12037996', 'W12037996', 'ILCHIGSTD', '', 'Barry', '', 'Atlas', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1073513305', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12037997', 'W12037997', 'ILCHIGSTD', '', 'Barry', '', 'Atlas', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6374 N Lincoln Ave Ste 312', 'Chicago', 'Cook', 'IL', '60657', '7735887710', '7735618977', '6374 N Lincoln Ave Ste 312', 'Chicago', 'Cook', 'IL', '60657', '7735887710', '7735618977', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1073513305', 0, 'N', 0, '2013-09-11', NULL, NULL, 41.9969, -87.7182, NULL, NULL),
('364286236', 'W12037999', 'W12037999', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Olena', '', 'Gordon', 'MD', 'Ambulatory Surgery Center', '', '', NULL, 'O', '150 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8478133510', '0000000000', '150 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8478133510', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528309705', 0, 'N', 0, '2013-09-30', NULL, NULL, 42.0551, -87.8884, NULL, NULL),
('364286236', 'W12038002', 'W12038002', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Olena', '', 'Gordon', 'MD', 'Ambulatory Surgery Center', '', '', NULL, 'O', '205 S NW Hwy Ste 120', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '0000000000', '205 S NW Hwy Ste 120', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528309705', 0, 'N', 0, '2013-09-30', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('364286236', 'W12038001', 'W12038001', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Olena', '', 'Gordon', 'MD', 'Ambulatory Surgery Center', '', '', NULL, 'O', '4900 N Cumberland Ave', 'Harwood Heights', 'Cook', 'IL', '60706', '7084561600', '0000000000', '4900 N Cumberland Ave', 'Harwood Heights', 'Cook', 'IL', '60706', '7084561600', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528309705', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.9688, -87.8368, NULL, NULL),
('364286236', 'W12038000', 'W12038000', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Olena', '', 'Gordon', 'MD', 'Ambulatory Surgery Center', '', '', NULL, 'O', '7230 W North Ave Ste 106B', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', NULL, '7230 W North Ave Ste 106B', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528309705', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.9089, -87.8062, NULL, NULL),
('364286236', 'W12038003', 'W12038003', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Olena', '', 'Gordon', 'MD', 'Ambulatory Surgery Center', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528309705', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12038005', 'W12038005', 'UT01', 'Wasatch Pediatrics', 'Lacey', '', 'Eden', 'MD', '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, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386972875', 0, 'N', 0, '2013-11-13', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'W12038006', 'W12038006', 'UT01', 'Wasatch Pediatrics', 'Lacey', '', 'Eden', 'MD', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386972875', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12038007', 'W12038007', 'UT01', 'Wasatch Pediatrics', 'Lacey', '', 'Eden', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386972875', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019946', 'W12019946', 'UT01', 'Wasatch Pediatrics', 'Steve', '', 'Ostergaard', 'FNP', 'Pediatrics', '', '', NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932373396', 0, 'N', 0, '2013-09-11', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'W12019948', 'W12019948', 'UT01', 'Wasatch Pediatrics', 'Steve', '', 'Ostergaard', 'FNP', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932373396', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019947', 'W12019947', 'UT01', 'Wasatch Pediatrics', 'Steve', '', 'Ostergaard', 'FNP', '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, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932373396', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019944', 'W12019944', 'UT01', 'Wasatch Pediatrics Inc', 'Teresa', '', 'McNaught', 'NP', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386807790', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019942', 'W12019942', 'UT01', 'Wasatch Pediatrics Inc', 'Teresa', '', 'McNaught', 'NP', 'Pediatrics', '', '', NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386807790', 0, 'N', 0, '2013-09-11', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'W12019943', 'W12019943', 'UT01', 'Wasatch Pediatrics Inc', 'Teresa', '', 'McNaught', '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, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386807790', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12038008', 'W12038008', 'UT01', 'Wasatch Pediatrics', '', '', 'Wasatch Pediatrics', '', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000002084', 0, 'Y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12038010', 'W12038010', 'UT01', 'Wasatch Pediatrics', '', '', 'Wasatch Pediatrics', '', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000002084', 0, 'Y', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12035512', 'W12035512', 'Sinclair', 'St Lukes Clinic Wood River', 'Matthew', '', 'Reeck', 'MD', 'Dermatology', '', '', NULL, 'O', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087252171', '2087252015', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087252171', '2087252015', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-12', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1124022801', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12038011', 'W12038011', 'ID02', 'Family Medicine Health Center', 'Amanda', 'D', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790053338', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12035513', 'W12035513', 'Sinclair', 'St Lukes Clinic Wood River', 'Matthew', '', 'Reeck', 'MD', 'Dermatology', '', '', 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, '2013-09-12', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1124022801', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12038012', 'W12038012', 'ID02', 'Family Medicine Health Center', 'Amanda', 'D', 'King', 'FNP', 'Family Practice', '', '', NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '0000000000', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '0000000000', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790053338', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12038013', 'W12038013', 'ID02', 'Family Medicine Health Center', 'Amanda', 'D', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '2275 S Eagle Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2275 S Eagle Rd Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790053338', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12038014', 'W12038014', 'ID02', 'Family Medicine Health Center', 'Amanda', 'D', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790053338', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12038015', 'W12038015', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Robert', 'G', 'Jakubowski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10307 State Hwy 151', 'San Antonio', 'Bexar', 'TX', '78251', '2102374983', '2105811471', '10307 State Hwy 151', 'San Antonio', 'Bexar', 'TX', '78251', '2102374983', '2105811471', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-09-23', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1786654475', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.4538, -98.6825, NULL, NULL),
('202148889', 'W12038016', 'W12038016', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Robert', 'G', 'Jakubowski', 'MD', 'Internal Medicine', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-09-23', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1786654475', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12038017', 'W12038017', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Robert', 'G', 'Jakubowski', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-09-23', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1786654475', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12038018', 'W12038018', 'ILCHIGSTD', 'Presence Healthcare Services', 'Omair', '', 'Sheikh', 'MD', 'Neurology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-29', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1780830711', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12038019', 'W12038019', 'ILCHIGSTD', 'Presence Healthcare Services', 'Omair', '', 'Sheikh', 'MD', 'Neurology', '', '', NULL, 'O', '800 Austin St Ste 363 East Tower', 'Evanston', 'Cook', 'IL', '60202', '8473167055', '8473162692', '800 Austin St Ste 363 East Tower', 'Evanston', 'Cook', 'IL', '60202', '8473167055', '8473162692', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-29', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1780830711', 0, 'N', 0, '2013-09-11', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('870299862', 'W12038020', 'W12038020', 'UTMH1', 'LDS Family Services', 'Marilyn', '', 'Stephens-Burton', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013160860', 0, 'N', 0, '2013-09-11', NULL, NULL, 41.072, -111.981, NULL, NULL),
('742964747', 'W12038021', 'W12038021', 'TX01', '', 'Johnnie', 'M', 'Staggs', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3030 Nacogdoches', 'San Antonio', 'Bexar', 'TX', '78217', '2108269599', NULL, '3030 Nacogdoches', 'San Antonio', 'Bexar', 'TX', '78217', '2108269599', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407931124', 0, 'N', 0, '2013-09-30', NULL, NULL, 29.5259, -98.44, NULL, NULL),
('621801973', 'W12038024', 'W12038024', 'UT01', 'Physician Group of Utah', 'Elizabeth', '', 'Kunzer', '', 'Physical Therapy', '', '', 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, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1013142009', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12038022', 'W12038022', 'UT01', 'Salt Lake Regional Physical Therapy', 'Elizabeth', '', 'Kunzer', '', 'Physical Therapy', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504593', '8013504483', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504593', '8013504483', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', '2014-04-30', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1013142009', 0, 'N', 0, '2013-09-30', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12038023', 'W12038023', 'UT01', 'Eccles Health Wellness and Athletic Center', 'Elizabeth', '', 'Kunzer', '', 'Physical Therapy', '', '', NULL, 'O', '1840 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8018323671', '8013504483', '1840 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8018323671', '8013504483', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013142009', 0, 'N', 0, '2013-09-30', NULL, NULL, 40.7304, -111.854, NULL, NULL),
('460483581', 'W12038025', 'W12038025', 'ILCHIGSTD', 'Presence Home Health', '', '', 'Presence Hospice Elgin', '', 'Hospice', NULL, NULL, NULL, 'B', '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', NULL, '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033168430', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('460483581', 'W12038028', 'W12038028', 'ILCHIGSTD', 'Presence Home Care Kankakee', '', '', 'Presence Home Care Kankakee', '', 'Home Health Agency', '', '', NULL, 'O', '179 E Bethel Dr', 'Bourbonnais', 'Kankakee', 'IL', '60914', '0000000000', NULL, '179 E Bethel Dr', 'Bourbonnais', 'Kankakee', 'IL', '60914', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134178338', 0, 'Y', 0, '2013-09-11', NULL, NULL, 41.1695, -87.8713, NULL, NULL),
('460483581', 'W12038027', 'W12038027', 'ILCHIGSTD', 'Presence Home Health', '', '', 'Presence Home Care Kankakee', '', 'Home Health Agency', '', '', NULL, 'B', '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', NULL, '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134178338', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('460483581', 'W12038031', 'W12038031', 'ILCHIGSTD', 'Presence Home Care Urbana', '', '', 'Presence Home Care Urbana', '', 'Home Health Agency', '', '', NULL, 'O', '1501 Interstate Pkwy', 'Champaign', 'Champaign', 'IL', '61821', '0000000000', NULL, '1501 Interstate Pkwy', 'Champaign', 'Champaign', 'IL', '61821', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659320869', 0, 'Y', 0, '2013-09-11', NULL, NULL, 40.1488, -88.2717, NULL, NULL),
('460483581', 'W12038030', 'W12038030', 'ILCHIGSTD', 'Presence Home Health', '', '', 'Presence Home Care Urbana', '', 'Home Health Agency', '', '', NULL, 'B', '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', NULL, '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659320869', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('460483581', 'W12038034', 'W12038034', 'ILCHIGSTD', 'Presence Home Care Urbana', '', '', 'Presence Hospice Urbana', '', 'Hospice', '', '', NULL, 'O', '1501 Interstate Pkwy', 'Champaign', 'Champaign', 'IL', '61821', '0000000000', NULL, '1501 Interstate Pkwy', 'Champaign', 'Champaign', 'IL', '61821', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407893282', 0, 'N', 0, '2013-10-15', NULL, NULL, 40.1488, -88.2717, NULL, NULL),
('460483581', 'W12038033', 'W12038033', 'ILCHIGSTD', 'Presence Home Health', '', '', 'Presence Hospice Urbana', '', 'Hospice', '', '', NULL, 'B', '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', NULL, '2749 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '0000000000', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407893282', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12038035', 'W12038035', 'NM01', 'Womens Specialists of NM', 'Dena', 'M', 'Knight', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952733909', 0, 'N', 1, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12038038', 'W12038038', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'J', 'Collins', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932390960', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12038036', 'W12038036', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'J', 'Collins', 'MD', 'Family Practice', '', '', NULL, 'B', '624 W Sunset Rd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '2108282532', '624 W Sunset Rd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '2108282532', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', '2014-06-22', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932390960', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12038037', 'W12038037', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'J', 'Collins', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '0000000000', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932390960', 0, 'N', 0, '2013-10-10', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('751856375', 'W12038039', 'W12038039', 'TXDALSTD', 'Healthcare Clinics', 'Angela', 'H', 'Yu', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5315 Ross Ave', 'Dallas', 'Dallas', 'TX', '75206', '2148262151', '2148262196', '5315 Ross Ave', 'Dallas', 'Dallas', 'TX', '75206', '2148262151', '2148262196', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811127459', 0, 'N', 0, '2013-09-11', NULL, NULL, 32.8096, -96.7721, NULL, NULL),
('820492308', 'W12038040', 'W12038040', 'ID02', 'Idaho Gastroenterology Associates', 'Renee', 'M', 'Wilson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St  ', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215019534', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12038041', 'W12038041', 'ID02', 'Idaho Gastroenterology Associates', 'Renee', 'M', 'Wilson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', '425 W Bannock St  ', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215019534', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('208180338', 'W12038042', 'W12038042', 'UT01', '', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', '', '', NULL, 'O', '4460 Highalnd Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016192170', '8015539562', '4460 Highalnd Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016192170', '8015539562', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679590558', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6754, -111.842, NULL, NULL),
('272118774', 'W12038043', 'W12038043', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '5801 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8012611391', '8012772980', '5801 S Fashion Blvd Ste 120', 'Murray', 'Salt Lake', 'UT', '84107', '8012611391', '8012772980', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('463255580', 'W12038044', 'W12038044', 'ID02', 'Idaho Spine and Sports Chiropractic', 'Kendrick', 'L', 'Tweedt', 'DC', 'Chiropractic', '', '', NULL, 'O', '2399 S Orchard St Ste 204', 'Boise', 'Ada', 'ID', '83705', '2083232833', NULL, '2399 S Orchard St Ste 204', 'Boise', 'Ada', 'ID', '83705', '2083232833', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528142007', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12038045', 'W12038045', 'NM01', 'Southwest Medical Associates', 'Teresa', 'J', 'Anderson', 'RD', 'Diabetic Education', '', '', NULL, 'O', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417295916', 0, 'N', 0, '2013-09-25', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12038046', 'W12038046', 'NM01', 'Southwest Medical Associates', 'Janet', 'L', 'Hardt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336191022', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12038047', 'W12038047', 'NM01', 'Southwest Medical Associates', 'Janet', 'L', 'Hardt', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336191022', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('263553949', 'W12038048', 'W12038048', 'TXDALSTD', 'Beltline Foot and Ankle Specialist div of PMPT', 'William', '', 'Arrington', 'DPM', 'Podiatry', '', '', NULL, 'O', '2800 W FM 544 Ste 120', 'Wylie', 'Collin', 'TX', '75098', '9722887441', '9722898025', '2800 W FM 544 Ste 120', 'Wylie', 'Collin', 'TX', '75098', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134213812', 0, 'N', 0, '2014-06-17', NULL, NULL, 33.0111, -96.5833, NULL, NULL),
('202861303', 'W12038049', 'W12038049', 'UT01', 'Mountain View Foot and Ankle Institute', 'David', 'B', 'Glover', 'DPM', 'Podiatry', '', '', NULL, 'O', '6112 S 1550 E Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755683', '8014759499', '6112 S 1550 E Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755683', '8014759499', 'WUOGORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1740371681', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.1523, -111.94, NULL, NULL),
('201417929', 'W12048519', 'W12048519', 'WY01', 'Central Wyoming Neurology', 'Angelo', '', 'Santiago', 'MD ', 'Neurology', '', '', NULL, 'O', '5820 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072349037', '3072349042', '5820 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072349037', '3072349042', '', '', '', '0.00', '15.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1598792483', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('760520222', 'W12037990', 'W12037990', 'TXHOUSTD', '', 'Tiffany', 'P', 'Raynor', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', '6550 Fannin St Ste 2001', 'Houston', 'Harris', 'TX', '77030', '7137962001', '7137969172', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1396812749', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('760520222', 'W12037991', 'W12037991', 'TXHOUSTD', '', 'Tiffany', 'P', 'Raynor', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '915 Gessner Rd Ste 560', 'Houston', 'Harris', 'TX', '77024', '7137220411', '7137227411', '915 Gessner Rd Ste 560', 'Houston', 'Harris', 'TX', '77024', '7137220411', '7137227411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1396812749', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760520222', 'W12037989', 'W12037989', 'TXHOUSTD', '', 'Tiffany', 'P', 'Raynor', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'PO Box 1205', 'Houston', 'Harris', 'TX', '77251', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', '', '', 'HCFA|UB|', '1396812749', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12038050', 'W12038050', 'ID02', 'Foothills Physical Therapy', 'Nicole', '', 'Olsen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844640', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844640', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2013-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740439470', 0, 'N', 0, '2013-11-26', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12038051', 'W12038051', 'ID02', 'Foothills Physical Therapy', 'Nicole', '', 'Olsen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2013-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740439470', 0, 'N', 0, '2013-11-26', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('271918031', 'W12038052', 'W12038052', 'TXHOUSTD', 'Advanced Associates in Dermatology', 'Temitope', '', 'Soares', 'MD', 'Dermatology', '', '', NULL, 'O', '440 Rayford Rd Ste 140', 'Spring', 'Montgomery', 'TX', '77386', '2813858189', '2812035037', '440 Rayford Rd Ste 140', 'Spring', 'Montgomery', 'TX', '77386', '2813858189', '2812035037', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1619950383', 0, 'N', 0, '2013-09-27', NULL, NULL, 30.1271, -95.437, NULL, NULL),
('760020160', 'W12038055', 'W12038055', 'TXHOUSTD', 'Matteethra C Jacob', 'Matteethra', 'C', 'Jacob', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '4006 Inverness', 'Houston', 'Harris', 'TX', '77019', '7137901335', '7137901044', '4006 Inverness', 'Houston', 'Harris', 'TX', '77019', '7137901335', '7137901044', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417020744', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('760020160', 'W12038054', 'W12038054', 'TXHOUSTD', 'Matteethra C Jacob', 'Matteethra', 'C', 'Jacob', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5990 Airline Dr Ste 260', 'Houston', 'Harris', 'TX', '77076', '7136910091', '7136910170', '5990 Airline Dr Ste 260', 'Houston', 'Harris', 'TX', '77076', '7136910091', '7136910170', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417020744', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.8529, -95.3846, NULL, NULL),
('760020160', 'W12038053', 'W12038053', 'TXHOUSTD', 'Matteethra C Jacob', 'Matteethra', 'C', 'Jacob', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8520 Knight Rd', 'Houston', 'Harris', 'TX', '77054', '7137901335', '7137901044', '8520 Knight Rd', 'Houston', 'Harris', 'TX', '77054', '7137901335', '7137901044', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417020744', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.6817, -95.3999, NULL, NULL),
('830261430', 'W12038056', 'W12038056', 'SINCLAIRDEN', '', 'Elise', 'C', 'Hawk', 'DDS', 'Dentist', '', '', NULL, 'O', '1201 S Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072343890', '3074725583', '1201 S Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072343890', '3074725583', '', '', '', '0.00', '7.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1306278197', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12038059', 'W12038059', 'UTIHC04', 'Sanpete Valley Hospital', 'Neil', 'J', 'Carroll', 'MD', 'Urgent Care', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427348507', 0, 'Y', 0, '2013-12-30', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12038063', 'W12038063', 'UTIHC04', 'Primary Childrens Medical Center', 'David', 'G', 'Gamboa', 'MD', 'Pediatric Cardiology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942414875', 0, 'N', 0, '2013-09-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12038065', 'W12038065', 'UTIHC04', 'Bear River Valley Hospital', 'Jonathan', 'M', 'Gardner', '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|', '1154600922', 0, 'N', 0, '2013-12-18', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12038066', 'W12038066', 'UTIHC04', 'Sanpete Valley Hospital', 'Marcus', 'D', 'Harris', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336377472', 0, 'N', 0, '2013-09-12', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12038067', 'W12038067', 'UTIHC04', 'Park City Medical Center', 'Celeste', 'E', 'Raffin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174552863', 0, 'N', 0, '2013-09-12', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12038069', 'W12038069', 'UTIHC04', 'Bear River Valley Hospital', 'Mary-Marie', 'A', 'Sullivan', 'MD', 'Urgent Care', '', '', 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|', '1770872319', 0, 'N', 0, '2013-10-03', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12038068', 'W12038068', 'UTIHC04', 'Primary Childrens Medical Center', 'Holly', 'L', 'Spraker-Perlman', 'MD', 'Pediatric Hematology - Oncology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '0000000000', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '0000000000', '', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235385832', 0, 'N', 0, '2013-09-12', NULL, NULL, 40.7663, -111.837, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12038071', 'W12038071', 'UTIHC04', 'Bear River Valley Hospital', 'Natalie', 'A', 'Trent', '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|', '1467731232', 0, 'N', 0, '2013-12-18', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12038072', 'W12038072', 'UTIHC04', 'Delta Community Medical Center', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12038073', 'W12038073', 'UTIHC04', 'Fillmore Community Medical Center', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12038074', 'W12038074', 'UTIHC04', 'Heber Valley Medical Center', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 1, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12038075', 'W12038075', 'UTIHC04', 'Sanpete Valley Hospital', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12038076', 'W12038076', 'UTIHC04', 'Sevier Valley Medical Center', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12038077', 'W12038077', 'UTIHC04', 'Park City Medical Center', 'Joshua', 'R', 'Silverstein', 'MD', 'Cardiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952587743', 0, 'N', 0, '2013-11-20', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('820200895', 'W12038078', 'W12038078', 'IDBOISTD', 'Saint Alphonsus Medical Group Cherry Lane Family Clinic', 'Autumn', '', 'Freeland', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083675220', '2083675223', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083675220', '2083675223', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1790926210', 0, 'N', 0, '2013-09-19', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12038079', 'W12038079', 'IDBOISTD', 'Saint Alphonsus Medical Group Cherry Lane Family Clinic', 'Timothy', 'E', 'McHugh', 'MD', 'Family Practice', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083675220', '2083675223', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083675220', '2083675223', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1831143692', 0, 'N', 0, '2013-09-12', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('260553931', 'W12038081', 'W12038081', 'IDBOISTD', 'Saint Alphonsus Medical Group Vascular Services Boise', 'Wes', 'J', 'Arlein', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1770529240', 0, 'N', 0, '2014-04-28', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('571201170', 'MH0400009', 'MH0400009', 'TXHOUSTD', 'TMH Physician Associates', 'Krista', '', 'Turner', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', '          ', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013947258', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12038082', 'W12038082', 'ID02', 'Intermountain Eye & Laser Centers', 'Lee', '', 'Carter', 'OD', 'Optometry', '', '', NULL, 'O', '251 E Front St Ste 102', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083731216', '251 E Front St Ste 102', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083731216', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-09-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1891789368', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400001', 'MH0400001', 'TXHOUSTD', 'TMH Physician Associates', 'Kimberly', '', 'Byrum', 'FNP', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1003162454', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400002', 'MH0400002', 'TXHOUSTD', 'TMH Physician Associates', 'Sherilyn', '', 'Gordon Burroughs', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003841990', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400003', 'MH0400003', 'TXHOUSTD', 'TMH Physician Associates', 'Earl', '', 'Mangin', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1003874371', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('571201170', 'MH0400004', 'MH0400004', 'TXHOUSTD', 'TMHPO Surgery Department', 'Laurie', 'Jean', 'Punch', 'MD', 'General Surgery', 'Critical Care', NULL, NULL, 'O', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1013042100', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400005', 'MH0400005', 'TXHOUSTD', 'TMHPO Surgery Department', 'Laurie', 'Jean', 'Punch', 'MD', 'General Surgery', 'Critical Care', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1013042100', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400006', 'MH0400006', 'TXHOUSTD', 'TMH Physician Associates', 'Ernst', '', 'Etienne', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071117', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400007', 'MH0400007', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Miclat', 'FNP', 'Family Practice', '', '', NULL, 'O', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1013105733', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
('571201170', 'MH0400008', 'MH0400008', 'TXHOUSTD', 'TMH Physician Associates', 'Krista', '', 'Turner', 'MD', 'Critical Care', '', '', NULL, 'O', '6550 Fannin St Ste 1661A', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013947258', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400010', 'MH0400010', 'TXHOUSTD', 'TMH Physician Associates', 'Saleem', '', 'Zaidi', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134417349', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013947316', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400011', 'MH0400011', 'TXHOUSTD', 'TMH Physician Associates', 'Saleem', '', 'Zaidi', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013947316', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400012', 'MH0400012', 'TXHOUSTD', 'TMH Physician Associates', 'Willa', '', 'Hsueh', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1023036076', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400013', 'MH0400013', 'TXHOUSTD', 'TMH Physician Associates', 'M. Danelle', '', 'McLain', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023048428', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400014', 'MH0400014', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Masud', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023054525', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400015', 'MH0400015', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Masud', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023054525', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400016', 'MH0400016', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Passmore', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1023076205', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('571201170', 'MH0400017', 'MH0400017', 'TXHOUSTD', 'TMH Physician Associates', 'Craig', '', 'Fischer', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906472', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033109475', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400018', 'MH0400018', 'TXHOUSTD', 'TMH Physician Associates', 'Wade', '', 'Fischer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1033116710', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400019', 'MH0400019', 'TXHOUSTD', 'TMH Physician Associates', 'Kadian', '', 'McIntosh', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033298401', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400020', 'MH0400020', 'TXHOUSTD', 'TMH Physician Associates', 'Danielle', '', 'Comeaux', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033300686', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400021', 'MH0400021', 'TXHOUSTD', 'TMH Physician Associates', 'Dalbir', '', 'Purewal', 'MD', 'Family Practice', '', '', NULL, 'O', '16740 Champions Forest Dr', 'Spring', 'Harris', 'TX', '77379', '2813762828', '2813208143', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043241441', 0, 'N', 0, '2013-09-13', NULL, NULL, 30.0122, -95.538, NULL, NULL),
('571201170', 'MH0400022', 'MH0400022', 'TXHOUSTD', 'TMH Physician Associates', 'William', '', 'Bryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043247208', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400023', 'MH0400023', 'TXHOUSTD', 'TMH Physician Associates', 'Vijay', '', 'Jotwani', 'MD', 'Family Practice', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043364839', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7367, -95.4366, NULL, NULL),
('571201170', 'MH0400024', 'MH0400024', 'TXHOUSTD', 'TMH Physician Associates', 'Jose', '', 'Perez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053346379', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400025', 'MH0400025', 'TXHOUSTD', 'TMH Physician Associates', 'Rani', '', 'Nanda', 'DO', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053574913', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400026', 'MH0400026', 'TXHOUSTD', 'TMH Physician Associates', 'Rani', '', 'Nanda', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053574913', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400027', 'MH0400027', 'TXHOUSTD', 'TMH Physician Associates', 'Nicoline', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 130', 'Houston', 'Harris', 'TX', '77070', '8329121188', '2816408806', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1053614636', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400028', 'MH0400028', 'TXHOUSTD', 'TMH Physician Associates', 'Swaminathan', '', 'Iyer', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063493229', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400029', 'MH0400029', 'TXHOUSTD', 'TMH Physician Associates', 'Hosam', '', 'El Sayed', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063598977', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400030', 'MH0400030', 'TXHOUSTD', 'TMH Physician Associates', 'Surya Prakash Deepa', '', 'Bangalore', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134410005', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063671600', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400031', 'MH0400031', 'TXHOUSTD', 'TMH Physician Associates', 'Surya Prakash Deepa', '', 'Bangalore', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063671600', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400032', 'MH0400032', 'TXHOUSTD', 'TMH Physician Associates', 'Heidi', '', 'Matus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063674851', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400033', 'MH0400033', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'DeGarmo', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134416148', '7137906489', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063727485', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400034', 'MH0400034', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'DeGarmo', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063727485', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400035', 'MH0400035', 'TXHOUSTD', 'TMH Physician Associates', 'Mahesh', '', 'Ramchandani', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073513693', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400036', 'MH0400036', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Gaber', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073579835', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400037', 'MH0400037', 'TXHOUSTD', 'TMH Physician Associates', 'Monisha', '', 'Singh', 'MD', 'Hematology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073655965', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400038', 'MH0400038', 'TXHOUSTD', 'TMH Physician Associates', 'Babith', '', 'Mankidy', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1083769194', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400039', 'MH0400039', 'TXHOUSTD', 'TMH Physician Associates', 'Marilyn', '', 'Jose', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083802441', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400040', 'MH0400040', 'TXHOUSTD', 'TMH Physician Associates', 'Layne', '', 'Opersteny', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083942007', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400041', 'MH0400041', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Moseley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093745390', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400042', 'MH0400042', 'TXHOUSTD', 'TMH Physician Associates', 'Sophie', '', 'Fletcher', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1093924714', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400043', 'MH0400043', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Seaberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104009042', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400044', 'MH0400044', 'TXHOUSTD', 'TMH Physician Associates', 'Hue', '', 'Cao', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104046697', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400045', 'MH0400045', 'TXHOUSTD', 'TMH Physician Associates', 'Timothy', '', 'Sitter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813252', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400046', 'MH0400046', 'TXHOUSTD', 'TMH Physician Associates', 'Mirza', '', 'Baig', 'MD', 'Hospitalist', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104846922', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400047', 'MH0400047', 'TXHOUSTD', 'TMH Physician Associates', 'Mirza', '', 'Baig', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104846922', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400048', 'MH0400048', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Key', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1104881010', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400049', 'MH0400049', 'TXHOUSTD', 'TMH Physician Associates', 'Karen', '', 'Hollenberg', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114198173', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400050', 'MH0400050', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Rachel', 'Ann', 'Beauchamp', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'O', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1114241643', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400051', 'MH0400051', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Rachel', 'Ann', 'Beauchamp', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1114241643', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400052', 'MH0400052', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Mahmarian', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114957511', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400053', 'MH0400053', 'TXHOUSTD', 'TMH Physician Associates', 'Dipan', '', 'Shah', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114966470', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400054', 'MH0400054', 'TXHOUSTD', 'TMH Physician Associates', 'Julie', '', 'Hung', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124053863', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400055', 'MH0400055', 'TXHOUSTD', 'TMH Physician Associates', 'Karla', '', 'Kurrelmeyer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124063631', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400056', 'MH0400056', 'TXHOUSTD', 'TMH Physician Associates', 'Bridget', '', 'Fahy', 'MD', 'Oncology', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137926470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124066824', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400057', 'MH0400057', 'TXHOUSTD', 'TMH Physician Associates', 'Debra', '', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134142961', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400058', 'MH0400058', 'TXHOUSTD', 'TMH Physician Associates', 'Lee', '', 'Morris', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134300387', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400059', 'MH0400059', 'TXHOUSTD', 'TMH Physician Associates', 'Christian', '', 'Schupp', 'MD', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144378084', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400060', 'MH0400060', 'TXHOUSTD', 'TMH Physician Associates', 'Erin', '', 'Wickliff', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144406729', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400061', 'MH0400061', 'TXHOUSTD', 'TMH Physician Associates', 'Erin', '', 'Wickliff', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144406729', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400062', 'MH0400062', 'TXHOUSTD', 'TMH Physician Associates', 'Sean', '', 'Townsend', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817970926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144591082', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400063', 'MH0400063', 'TXHOUSTD', 'TMH Physician Associates', 'Sean', '', 'Townsend', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144591082', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400064', 'MH0400064', 'TXHOUSTD', 'TMH Physician Associates', 'Mary', '', 'Ruppe', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154354173', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400065', 'MH0400065', 'TXHOUSTD', 'TMH Physician Associates', 'Thomas', '', 'Baxter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154480689', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400066', 'MH0400066', 'TXHOUSTD', 'TMH Physician Associates', 'Anupam', '', 'Sidhu', 'MD', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154523488', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400067', 'MH0400067', 'TXHOUSTD', 'TMH Physician Associates', 'Su Ming', '', 'Chang', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901 Smith Tower', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164499240', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400068', 'MH0400068', 'TXHOUSTD', 'TMH Physician Associates', 'Tiffani', '', 'Gray', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164756169', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400069', 'MH0400069', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Reardon', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174523229', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400070', 'MH0400070', 'TXHOUSTD', 'TMH Physician Associates', 'Ana', '', 'Roman', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184776882', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400071', 'MH0400071', 'TXHOUSTD', 'TMH Physician Associates', 'Sarah', '', 'Krinock', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1205851896', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400072', 'MH0400072', 'TXHOUSTD', 'TMH Physician Associates', 'Vincent', '', 'Phan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2816904608', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205948296', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400073', 'MH0400073', 'TXHOUSTD', 'TMH Physician Associates', 'Matt', '', 'Khoshnevis', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215032305', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400074', 'MH0400074', 'TXHOUSTD', 'TMH Physician Associates', 'Matt', '', 'Khoshnevis', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215032305', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400075', 'MH0400075', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Janalei', 'Eve', 'Stovall', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'O', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1215281472', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400076', 'MH0400076', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Janalei', 'Eve', 'Stovall', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1215281472', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400077', 'MH0400077', 'TXHOUSTD', 'TMH Physician Associates', 'Tejal', '', 'Patel', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '6445 Main St Ste 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137921642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1215910237', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400078', 'MH0400078', 'TXHOUSTD', 'TMH Physician Associates', 'Heather', '', 'Ashford', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902202', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225105836', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400079', 'MH0400079', 'TXHOUSTD', 'TMH Physician Associates', 'Timothy', '', 'Oppermann', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1225118748', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400080', 'MH0400080', 'TXHOUSTD', 'TMH Physician Associates', 'Alvin', '', 'Goh', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225279169', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400081', 'MH0400081', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad Umair', '', 'Qamar', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235148370', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400082', 'MH0400082', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad Umair', '', 'Qamar', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235148370', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400083', 'MH0400083', 'TXHOUSTD', 'TMH Physician Associates', 'Melanie', '', 'Hafford', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1235339037', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400084', 'MH0400084', 'TXHOUSTD', 'TMH Physician Associates', 'Aaron', '', 'Cohn', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235376682', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('571201170', 'MH0400085', 'MH0400085', 'TXHOUSTD', 'TMH Physician Associates', 'Rafael', '', 'Lugo', 'MD', 'General Surgery', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1245224492', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400086', 'MH0400086', 'TXHOUSTD', 'TMH Physician Associates', 'Joan', '', 'Zampieri', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245329549', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400087', 'MH0400087', 'TXHOUSTD', 'TMH Physician Associates', 'Joan', '', 'Zampieri', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245329549', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400088', 'MH0400088', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Pyle', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4201 Garth Rd Ste 107', 'Baytown', 'Harris', 'TX', '77521', '2814277400', '2814278750', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1255329686', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7677, -94.9775, NULL, NULL),
('571201170', 'MH0400089', 'MH0400089', 'TXHOUSTD', 'TMH Physician Associates', 'Lara', '', 'Colton', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255352365', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400090', 'MH0400090', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Andrea', '', 'McNiel', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255384061', 0, 'Y', 0, '2013-12-02', NULL, NULL, 30.2831, -95.4693, NULL, NULL),
('571201170', 'MH0400092', 'MH0400092', 'TXHOUSTD', 'TMH Physician Associates', 'Andrea', '', 'McNiel', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7134416470', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7134416470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255384061', 0, 'Y', 0, '2013-12-02', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400091', 'MH0400091', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Andrea', '', 'McNiel', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255384061', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400093', 'MH0400093', 'TXHOUSTD', 'TMH Physician Associates', 'Basel', '', 'Ramlawi', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265692479', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400094', 'MH0400094', 'TXHOUSTD', 'TMH Physician Associates', 'Savannah', '', 'Murphy', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137903370', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265757058', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400095', 'MH0400095', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'McCarthy', 'MD', 'Hematology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-10-01', '2014-04-22', 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1275578486', 0, 'N', 0, '2014-04-28', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400096', 'MH0400096', 'TXHOUSTD', 'TMH Physician Associates', 'Ashley', '', 'Drews', 'MD', 'Infectious Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275613515', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400097', 'MH0400097', 'TXHOUSTD', 'TMH Physician Associates', 'Arvind', '', 'Bhimaraj', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275864878', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400098', 'MH0400098', 'TXHOUSTD', 'TMH Physician Associates', 'Susan', '', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902752', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285664581', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400099', 'MH0400099', 'TXHOUSTD', 'TMH Physician Associates', 'Arlene', '', 'De Los Reyes', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285794610', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400100', 'MH0400100', 'TXHOUSTD', 'TMH Physician Associates', 'Ricardo', '', 'Bellera', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Fondren 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285860080', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400101', 'MH0400101', 'TXHOUSTD', 'TMH Physician Associates', 'Ricardo', '', 'Bellera', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285860080', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400102', 'MH0400102', 'TXHOUSTD', 'TMH Physician Associates', 'Johanna', '', 'Clewing', 'MD', 'Hospitalist', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285864884', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400103', 'MH0400103', 'TXHOUSTD', 'TMH Physician Associates', 'Johanna', '', 'Clewing', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285864884', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400104', 'MH0400104', 'TXHOUSTD', 'TMH Physician Associates', 'Dominique', '', 'Ramos', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295030641', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400105', 'MH0400105', 'TXHOUSTD', 'TMH Physician Associates', 'Rose', '', 'Khavari', 'MD', 'Urology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295066397', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400106', 'MH0400106', 'TXHOUSTD', 'TMH Physician Associates', 'Robert', '', 'Ochoa', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295987139', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400107', 'MH0400107', 'TXHOUSTD', 'TMH Physician Associates', 'Robert', '', 'Ochoa', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295987139', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400108', 'MH0400108', 'TXHOUSTD', 'TMH Physician Associates', 'Saverio', '', 'La Francesca', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306000567', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400109', 'MH0400109', 'TXHOUSTD', 'TMH Physician Associates', 'Todd', '', 'Williams', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306117585', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400110', 'MH0400110', 'TXHOUSTD', 'TMH Physician Associates', 'Todd', '', 'Williams', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306117585', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400111', 'MH0400111', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400112', 'MH0400112', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'O', '1327 Lake Pointe Pkwy Ste 425', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2814994490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6061, -95.6214, NULL, NULL),
('571201170', 'MH0400113', 'MH0400113', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '2816904678', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400114', 'MH0400114', 'TXHOUSTD', 'TMH Physician Associates', 'Scott', '', 'Rand', 'MD', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316946452', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400115', 'MH0400115', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Lintner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316982929', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7367, -95.4366, NULL, NULL),
('571201170', 'MH0400116', 'MH0400116', 'TXHOUSTD', 'TMH Physician Associates', 'Bonnie', '', 'Woeltjen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316983794', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400117', 'MH0400117', 'TXHOUSTD', 'TMH Physician Associates', 'Bonnie', '', 'Woeltjen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134418691', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316983794', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400118', 'MH0400118', 'TXHOUSTD', 'TMH Physician Associates', 'Stephen', '', 'Incavo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137906614', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316989478', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400119', 'MH0400119', 'TXHOUSTD', 'TMH Physician Associates', 'Holly', '', 'Adams', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137906614', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326083817', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400120', 'MH0400120', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Mucha', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326086778', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400121', 'MH0400121', 'TXHOUSTD', 'TMH Physician Associates', 'Sheena', '', 'Stubbers', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336125954', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400122', 'MH0400122', 'TXHOUSTD', 'TMH Physician Associates', 'Eunice', '', 'Ihaza', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336173327', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400123', 'MH0400123', 'TXHOUSTD', 'TMH Physician Associates', 'Jerry', '', 'Estep', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336343847', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400124', 'MH0400124', 'TXHOUSTD', 'TMH Physician Associates', 'Donald', '', 'Dominy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1336370527', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400125', 'MH0400125', 'TXHOUSTD', 'TMH Physician Associates', 'Irum', '', 'Zaheer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1336390707', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400126', 'MH0400126', 'TXHOUSTD', 'TMH Physician Associates', 'Daniel', '', 'Arellano', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346552437', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400127', 'MH0400127', 'TXHOUSTD', 'TMH Physician Associates', 'Jeffrey', '', 'Wood', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356339832', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400128', 'MH0400128', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Nabi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356382816', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400129', 'MH0400129', 'TXHOUSTD', 'TMH Physician Associates', 'Eric', '', 'Peden', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356421770', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400130', 'MH0400130', 'TXHOUSTD', 'TMH Physician Associates', 'Chun', '', 'Lin', 'MD', 'Cardiology', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356532261', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400131', 'MH0400131', 'TXHOUSTD', 'TMH Physician Associates', 'Claire', '', 'Pollard', 'ACNP', 'Family Practice', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1356571764', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400132', 'MH0400132', 'TXHOUSTD', 'TMH Physician Associates', 'Erik', '', 'Suarez', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1356589675', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400133', 'MH0400133', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Soliman', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137906334', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356590970', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400134', 'MH0400134', 'TXHOUSTD', 'TMH Physician Associates', 'Ahmed', '', 'Soliman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356590970', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400135', 'MH0400135', 'TXHOUSTD', 'TMH Physician Associates', 'Patrick', '', 'McCulloch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902058', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366421679', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400136', 'MH0400136', 'TXHOUSTD', 'TMH Physician Associates', 'Ronald', '', 'Mahoney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1366490237', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('571201170', 'MH0400137', 'MH0400137', 'TXHOUSTD', 'TMH Physician Associates', 'Walter', '', 'OHara', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '13300 Hargrave Rd Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817372918', '2817372919', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1376541789', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9687, -95.552, NULL, NULL),
('571201170', 'MH0400138', 'MH0400138', 'TXHOUSTD', 'TMH Physician Associates', 'Hieu', '', 'Ha', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '3100 Timmons Ln Ste 120', 'Houston', 'Harris', 'TX', '77027', '7134413560', '7137902054', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376570671', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7367, -95.4366, NULL, NULL),
('571201170', 'MH0400139', 'MH0400139', 'TXHOUSTD', 'TMH Physician Associates', 'Janet', '', 'Macheledt', 'MD', 'Oncology', '', '', NULL, 'O', '18400 Katy Fwy Ste 520', 'Houston', 'Harris', 'TX', '77094', '8325228521', '8325228524', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1376585281', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('571201170', 'MH0400140', 'MH0400140', 'TXHOUSTD', 'TMH Physician Associates', 'Paula', '', 'Rupert', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137903047', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376622993', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400141', 'MH0400141', 'TXHOUSTD', 'TMH Physician Associates', 'Paula', '', 'Rupert', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376622993', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400142', 'MH0400142', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'Broome', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, '', '', '', '', 'HCFA|UB|', '1376730051', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400143', 'MH0400143', 'TXHOUSTD', 'TMH Physician Associates', 'Eric', '', 'Mueller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376794750', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400144', 'MH0400144', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'OBrien', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376861971', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400145', 'MH0400145', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Baker', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386663268', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400146', 'MH0400146', 'TXHOUSTD', 'TMH Physician Associates', 'Daniela', '', 'Moran', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386711828', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400147', 'MH0400147', 'TXHOUSTD', 'TMH Physician Associates', 'Daniela', '', 'Moran', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386711828', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400148', 'MH0400148', 'TXHOUSTD', 'TMHPO Surgery Department', 'Charles', 'Arthur', 'Hill', 'MD', 'General Surgery', '', NULL, NULL, 'O', '6550 Fannin Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1407039845', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400149', 'MH0400149', 'TXHOUSTD', 'TMHPO Surgery Department', 'Charles', 'Arthur', 'Hill', 'MD', 'General Surgery', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1407039845', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400150', 'MH0400150', 'TXHOUSTD', 'TMH Physician Associates', 'Brian', '', 'Dunkin', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407812670', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400151', 'MH0400151', 'TXHOUSTD', 'TMH Physician Associates', 'Howard', '', 'Monsour', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407853518', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400152', 'MH0400152', 'TXHOUSTD', 'TMH Physician Associates', 'Hemangshu', '', 'Podder', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1407885163', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400153', 'MH0400153', 'TXHOUSTD', 'TMH Physician Associates', 'Sherif', '', 'Nagueh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407891807', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400154', 'MH0400154', 'TXHOUSTD', 'TMH Physician Associates', 'Terry', '', 'McLendon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1407930399', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400155', 'MH0400155', 'TXHOUSTD', 'TMH Physician Associates', 'Harish', '', 'Seethamraju', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1417037847', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400156', 'MH0400156', 'TXHOUSTD', 'TMH Physician Associates', 'Ethan', '', 'Natelson', 'MD', 'Hematology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134415154', '7134412727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417921032', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400157', 'MH0400157', 'TXHOUSTD', 'TMH Physician Associates', 'Hilary', '', 'Beaver', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1417958869', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400158', 'MH0400158', 'TXHOUSTD', 'TMH Physician Associates', 'Shari', '', 'Liberman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427282565', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400159', 'MH0400159', 'TXHOUSTD', 'TMH Physician Associates', 'Kenneth', '', 'Renney', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437147998', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400160', 'MH0400160', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Cortes', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447258959', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400161', 'MH0400161', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Cortes', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447258959', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400162', 'MH0400162', 'TXHOUSTD', 'TMH Physician Associates', 'Melina', '', 'Awar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1447443601', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400163', 'MH0400163', 'TXHOUSTD', 'TMH Physician Associates', 'Miles', '', 'Griffin', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447490289', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400164', 'MH0400164', 'TXHOUSTD', 'TMH Physician Associates', 'Jim', '', 'Nguyen', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447498746', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400165', 'MH0400165', 'TXHOUSTD', 'TMH Physician Associates', 'Anton', '', 'Nielsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1457315632', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400166', 'MH0400166', 'TXHOUSTD', 'TMH Physician Associates', 'Hany', '', 'Samir', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457397978', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400167', 'MH0400167', 'TXHOUSTD', 'TMH Physician Associates', 'Hany', '', 'Samir', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457397978', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400168', 'MH0400168', 'TXHOUSTD', 'TMH Physician Associates', 'Sanjay', '', 'Kunapuli', 'MD', 'Cardiology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902793', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457555021', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400169', 'MH0400169', 'TXHOUSTD', 'TMH Physician Associates', 'Javier', '', 'Lafuente', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137937428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1467481721', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400170', 'MH0400170', 'TXHOUSTD', 'TMH Physician Associates', 'Hung', '', 'Nguyen', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467750026', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400171', 'MH0400171', 'TXHOUSTD', 'TMH Physician Associates', 'Edgard', '', 'Gonzalez Feldman', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', '', '41264.00', '50.00', '0.00', 6, '2013-10-01', '2013-10-01', 0, 41275, 0, '', '', '', '', 'HCFA|UB|', '1477525202', 0, 'N', 0, '2013-11-11', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('571201170', 'MH0400172', 'MH0400172', 'TXHOUSTD', 'TMH Physician Associates', 'Mark', '', 'Davies', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477581619', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400173', 'MH0400173', 'TXHOUSTD', 'TMH Physician Associates', 'Todd', '', 'Worley', 'MD', 'General Surgery', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817378465', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1477789931', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400174', 'MH0400174', 'TXHOUSTD', 'TMH Physician Associates', 'Dena', '', 'Rose', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1477885259', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400175', 'MH0400175', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Coburn', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1487619300', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400176', 'MH0400176', 'TXHOUSTD', 'TMH Physician Associates', 'Shawna', '', 'Blackmon', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487641536', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400177', 'MH0400177', 'TXHOUSTD', 'TMH Physician Associates', 'Asma', '', 'Zainab', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487646253', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400178', 'MH0400178', 'TXHOUSTD', 'TMH Physician Associates', 'Asma', '', 'Zainab', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487646253', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL);
