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
('205805198', 'ELCUC0061', 'ELCUC0061', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508055278', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0018', 'ELCUC0018', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '6360 W Sam Houston Pkwy N Ste 200', 'Houston', 'Harris', 'TX', '77041', '8669446046', '7138960702', '6360 W Sam Houston Pkwy N Ste 200', 'Houston', 'Harris', 'TX', '77041', '8669446046', '7138960702', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508055278', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.8606, -95.5627, NULL, NULL),
('205805198', 'ELCUC0072', 'ELCUC0072', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619156106', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0029', 'ELCUC0029', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '3453 N Hwy 35 Ste 110', 'San Antonio', 'Bexar', 'TX', '78219', '8669446046', '2102269656', '3453 N Hwy 35 Ste 110', 'San Antonio', 'Bexar', 'TX', '78219', '8669446046', '2102269656', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619156106', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.4472, -98.4303, NULL, NULL),
('205805198', 'ELCUC0034', 'ELCUC0034', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '8755 S Harlem Ave', 'Bridgeview', 'Cook', 'IL', '60455', '8669446046', '7084302372', '8755 S Harlem Ave', 'Bridgeview', 'Cook', 'IL', '60455', '8669446046', '7084302372', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659560282', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.7317, -87.799, NULL, NULL),
('205805198', 'ELCUC0077', 'ELCUC0077', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659560282', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0043', 'ELCUC0043', 'ILCHIGSTD', 'Concentra Immediate Care', NULL, NULL, 'Concentra Immediate Care', NULL, 'Urgent Care', '', '', NULL, 'O', '545 Plainfield Rd Ste B', 'Willowbrook', 'Dupage', 'IL', '60527', '8669446046', '6309861096', '545 Plainfield Rd Ste B', 'Willowbrook', 'Dupage', 'IL', '60527', '8669446046', '6309861096', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659661783', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0086', 'ELCUC0086', 'ILCHIGSTD', 'Concentra Immediate Care', NULL, NULL, 'Concentra Immediate Care', NULL, 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659661783', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0008', 'ELCUC0008', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '2500 W Fwy I 30 Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76102', '8669446046', '8178828707', '2500 W Fwy I 30 Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76102', '8669446046', '8178828707', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700075439', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8272, -97.3854, NULL, NULL),
('205805198', 'ELCUC0051', 'ELCUC0051', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700075439', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0060', 'ELCUC0060', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710176482', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0017', 'ELCUC0017', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '401 Greens Rd', 'Houston', 'Harris', 'TX', '77060', '8669446046', '2818730660', '401 Greens Rd', 'Houston', 'Harris', 'TX', '77060', '8669446046', '2818730660', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710176482', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.9488, -95.4145, NULL, NULL),
('205805198', 'ELCUC0025', 'ELCUC0025', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1300 N Central Expwy', 'Plano', 'Collin', 'TX', '75074', '8669446046', '9728817666', '1300 N Central Expwy', 'Plano', 'Collin', 'TX', '75074', '8669446046', '9728817666', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760769616', 0, 'N', 0, '2013-11-27', NULL, NULL, 33.0174, -96.7078, NULL, NULL),
('205805198', 'ELCUC0068', 'ELCUC0068', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760769616', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0023', 'ELCUC0023', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '5910 N MacArthur Blvd Ste 133', 'Irving', 'Dallas', 'TX', '75039', '8669446046', '9724384647', '5910 N MacArthur Blvd Ste 133', 'Irving', 'Dallas', 'TX', '75039', '8669446046', '9724384647', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790085355', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8929, -96.9605, NULL, NULL),
('205805198', 'ELCUC0066', 'ELCUC0066', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790085355', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0038', 'ELCUC0038', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '900 E 103rd St', 'Chicago', 'Cook', 'IL', '60628', '8669446046', '7734682975', '900 E 103rd St', 'Chicago', 'Cook', 'IL', '60628', '8669446046', '7734682975', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790974368', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.7101, -87.5984, NULL, NULL),
('205805198', 'ELCUC0081', 'ELCUC0081', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790974368', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0004', 'ELCUC0004', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1345 Valwood Pkwy Ste 306', 'Carrollton', 'Dallas', 'TX', '75006', '8669446046', '9724846785', '1345 Valwood Pkwy Ste 306', 'Carrollton', 'Dallas', 'TX', '75006', '8669446046', '9724846785', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821287525', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.939, -96.9137, NULL, NULL),
('205805198', 'ELCUC0047', 'ELCUC0047', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821287525', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0037', 'ELCUC0037', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '3145 Ashland Ave Ste 110', 'Chicago', 'Cook', 'IL', '60608', '8669446046', '7732545518', '3145 Ashland Ave Ste 110', 'Chicago', 'Cook', 'IL', '60608', '8669446046', '7732545518', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831388404', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.8372, -87.6639, NULL, NULL),
('205805198', 'ELCUC0080', 'ELCUC0080', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831388404', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0035', 'ELCUC0035', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '1030 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60642', '8669446046', '3122431698', '1030 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60642', '8669446046', '3122431698', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902098742', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.8963, -87.6538, NULL, NULL),
('205805198', 'ELCUC0078', 'ELCUC0078', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902098742', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0032', 'ELCUC0032', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '4000 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '8669446046', '6308515008', '4000 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '8669446046', '6308515008', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-08-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912196536', 0, 'N', 0, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0075', 'ELCUC0075', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912196536', 0, 'Y', 0, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0007', 'ELCUC0007', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '5520 W Moreland Ste 200', 'Dallas', 'Dallas', 'TX', '75237', '8669446046', '2144678192', '5520 W Moreland Ste 200', 'Dallas', 'Dallas', 'TX', '75237', '8669446046', '2144678192', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922297639', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.7985, -96.7739, NULL, NULL),
('205805198', 'ELCUC0050', 'ELCUC0050', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922297639', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0042', 'ELCUC0042', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '544 W Dundee Rd', 'Wheeling', 'Cook', 'IL', '60090', '8669446046', '8474196982', '544 W Dundee Rd', 'Wheeling', 'Cook', 'IL', '60090', '8669446046', '8474196982', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942489422', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.1393, -87.9297, NULL, NULL),
('205805198', 'ELCUC0085', 'ELCUC0085', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942489422', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0058', 'ELCUC0058', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942492590', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0015', 'ELCUC0015', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '12345 Katy Fwy', 'Houston', 'Harris', 'TX', '77079', '8669446046', '2816796510', '12345 Katy Fwy', 'Houston', 'Harris', 'TX', '77079', '8669446046', '2816796510', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942492590', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.7838, -95.6054, NULL, NULL),
('205805198', 'ELCUC0024', 'ELCUC0024', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '4928 Samuell Blvd', 'Mesquite', 'Dallas', 'TX', '75149', '8669446046', '2143282884', '4928 Samuell Blvd', 'Mesquite', 'Dallas', 'TX', '75149', '8669446046', '2143282884', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972792554', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0067', 'ELCUC0067', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972792554', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0056', 'ELCUC0056', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992994644', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0013', 'ELCUC0013', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1000 N Post Oak Bldg G Ste G 100', 'Houston', 'Harris', 'TX', '77055', '8669446046', '7136865127', '1000 N Post Oak Bldg G Ste G 100', 'Houston', 'Harris', 'TX', '77055', '8669446046', '7136865127', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992994644', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028836', 'W12028836', 'TXHOUSTD', 'San Jacinto Family Practice', 'Jennifer', '', 'Mahand', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508093733', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028837', 'W12028837', 'TXHOUSTD', 'San Jacinto Family Practice', 'Jennifer', '', 'Mahand', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508093733', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028839', 'W12028839', 'TXHOUSTD', 'San Jacinto Family Practice', 'Lakshmi', '', 'Puppala', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477755510', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028840', 'W12028840', 'TXHOUSTD', 'San Jacinto Family Practice', 'Lakshmi', '', 'Puppala', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477755510', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028842', 'W12028842', 'TXHOUSTD', 'San Jacinto Family Practice', 'Hubert', '', 'Williston', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902888381', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028843', 'W12028843', 'TXHOUSTD', 'San Jacinto Family Practice', 'Hubert', '', 'Williston', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902888381', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028846', 'W12028846', 'TXHOUSTD', 'San Jacinto Family Practice', 'Quynh-Uyen Thi', '', 'Bui', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699702837', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028845', 'W12028845', 'TXHOUSTD', 'San Jacinto Family Practice', 'Quynh-Uyen Thi', '', 'Bui', 'MD', 'Hospitalist', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699702837', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028848', 'W12028848', 'TXHOUSTD', 'San Jacinto Family Practice', 'Hamidreza', '', 'Iranmanesh', 'MD', 'Urgent Care', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1710189097', 0, 'N', 0, '2014-05-02', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028849', 'W12028849', 'TXHOUSTD', 'San Jacinto Family Practice', 'Hamidreza', '', 'Iranmanesh', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1710189097', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028851', 'W12028851', 'TXHOUSTD', 'San Jacinto Family Practice', 'Corentine', '', 'Kwende', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386854834', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028852', 'W12028852', 'TXHOUSTD', 'San Jacinto Family Practice', 'Corentine', '', 'Kwende', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386854834', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028854', 'W12028854', 'TXHOUSTD', 'San Jacinto Family Practice', 'Rosemary', '', 'Obudulu', 'MD', 'Hospitalist', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740215029', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028855', 'W12028855', 'TXHOUSTD', 'San Jacinto Family Practice', 'Rosemary', '', 'Obudulu', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', '2013-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740215029', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028857', 'W12028857', 'TXHOUSTD', 'San Jacinto Family Practice', 'Farouk', '', 'Barbandi', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700861887', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028858', 'W12028858', 'TXHOUSTD', 'San Jacinto Family Practice', 'Farouk', '', 'Barbandi', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700861887', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028860', 'W12028860', 'TXHOUSTD', 'San Jacinto Family Practice', 'Sarma', '', 'Challa', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699776286', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028861', 'W12028861', 'TXHOUSTD', 'San Jacinto Family Practice', 'Sarma', '', 'Challa', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699776286', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028863', 'W12028863', 'TXHOUSTD', 'San Jacinto Family Practice', 'Fayez', '', 'Hadidi', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851472716', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028864', 'W12028864', 'TXHOUSTD', 'San Jacinto Family Practice', 'Fayez', '', 'Hadidi', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851472716', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028866', 'W12028866', 'TXHOUSTD', 'San Jacinto Family Practice', 'Christopher', 'D', 'Hays', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982647327', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028867', 'W12028867', 'TXHOUSTD', 'San Jacinto Family Practice', 'Christopher', 'D', 'Hays', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982647327', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028869', 'W12028869', 'TXHOUSTD', 'San Jacinto Family Practice', 'Edward', '', 'Leahey', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770584690', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028870', 'W12028870', 'TXHOUSTD', 'San Jacinto Family Practice', 'Edward', '', 'Leahey', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770584690', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028872', 'W12028872', 'TXHOUSTD', 'San Jacinto Family Practice', 'Malladi', '', 'Reddy', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, '', '', 'HCFA|UB|', '1730102062', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028873', 'W12028873', 'TXHOUSTD', 'San Jacinto Family Practice', 'Malladi', '', 'Reddy', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, '', '', 'HCFA|UB|', '1730102062', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028875', 'W12028875', 'TXHOUSTD', 'San Jacinto Family Practice', 'Fernando', '', 'Sarti', 'MD', 'Radiology', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346395282', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028876', 'W12028876', 'TXHOUSTD', 'San Jacinto Family Practice', 'Fernando', '', 'Sarti', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346395282', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028878', 'W12028878', 'TXHOUSTD', '', 'Rashid', 'M', 'Siddiqi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-03-20', 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023077161', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028879', 'W12028879', 'TXHOUSTD', '', 'Rashid', 'M', 'Siddiqi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023077161', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('455118509', 'W12028880', 'W12028880', 'ID01', 'Spaulding Counesling Services', 'Roy', 'C', 'Spaulding', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088871911', '2088958049', '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088871911', '2088958049', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2013-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366692790', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12028881', 'W12028881', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', '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, '2012-12-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12028882', 'W12028882', 'ID02', 'Family Medicine Health Center', 'Nikole', 'A', 'Shepherdson', '', '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, '2012-12-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760610950', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W12028886', 'W12028886', 'ID02', 'Family Medicine Health Center', 'Brandon', 'G', 'Isaacs', 'DO', '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, '2012-12-26', '2013-05-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1801833645', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12028894', 'W12028894', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Gayle', '', 'Stewart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255300331', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12028895', 'W12028895', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Gayle', '', 'Stewart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255300331', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('000009770', 'W12028893', 'W12028893', 'UT01', 'St Marks Senior Health Center', '', '', 'HCA', '', 'Clinics', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-02-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009770', 0, 'Y', 0, '2014-02-18', NULL, NULL, 40.6871, -111.858, NULL, NULL),
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('621801973', 'W12028897', 'W12028897', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Stephen', 'D', 'Lash', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB', '1447228572', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
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('352332742', 'W12028908', 'W12028908', 'ID01', 'Healthy Habits Wellness Clinic', 'Kenneth', '', 'Gough', 'DC', 'Chiropractic', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 6, '2013-02-15', '2013-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285966598', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('262786698', 'W12028909', 'W12028909', 'WY01', 'High Mountain Fitness Physical Therapy', 'Kathy', 'L', 'Scott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073823753', 0, 'N', 0, '2013-06-17', NULL, NULL, 42.8347, -108.739, NULL, NULL),
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('752797257', 'W12028916', 'W12028916', 'TXDALSTD', 'Texas Lung Center', '', '', 'Texas Lung Center PA', '', 'Pulmonary', '', '', NULL, 'O', '3600 Gaston Ave Ste 806', 'Dallas', 'Dallas', 'TX', '75246', '2148248521', '2148241988', '3600 Gaston Ave Ste 806', 'Dallas', 'Dallas', 'TX', '75246', '2148248521', '2148241988', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881788990', 0, 'Y', 0, '2013-01-22', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
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('752797257', 'W12028920', 'W12028920', 'TXDALSTD', 'Texas Lung Center', 'Robert', 'D', 'Black', 'MD', 'Pulmonary', 'Critical Care', '', NULL, 'O', '3600 Gaston Ave Ste 806', 'Dallas', 'Dallas', 'TX', '75246', '2148248521', '2148241988', '3600 Gaston Ave Ste 806', 'Dallas', 'Dallas', 'TX', '75246', '2148248521', '2148241988', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1902808827', 0, 'N', 0, '2013-01-23', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
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('562289768', 'W12028928', 'W12028928', 'TXHOUSTD', 'Northwest Med Care', 'Yamini', 'B', 'Naygandhi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '21216 NW Fwy Ste 360', 'Cypress', 'Harris', 'TX', '77429', '2818902121', '2818905677', '21216 NW Fwy Ste 360', 'Cypress', 'Harris', 'TX', '77429', '2818902121', '2818905677', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841256898', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.9265, -95.635, 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
('760458614', 'W12028929', 'W12028929', 'TXHOUSTD', 'Clincia Hispana I', 'Oscar', 'L', 'De Valle', 'MD', 'Family Practice', '', '', NULL, 'O', '9740 Jones Rd Ste 240', 'Houston', 'Harris', 'TX', '77065', '2818978142', '2814698094', '9740 Jones Rd Ste 240', 'Houston', 'Harris', 'TX', '77065', '2818978142', '2814698094', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-02', '2013-05-19', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669415196', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('741802430', 'W12028931', 'W12028931', 'TXBEAUSTD', 'Antonio Remirez MD', 'Antonio', '', 'Remirez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4222 College St', 'Beaumont', 'Jefferson', 'TX', '77707', '4098423711', '4098422878', '4222 College St', 'Beaumont', 'Jefferson', 'TX', '77707', '4098423711', '4098422878', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1649256827', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0682, -94.1388, NULL, NULL),
('455038181', 'W12028932', 'W12028932', 'TXHOUSTD', 'Conroe Family Doctor', 'Trang', 'D', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 300', 'Conroe', 'Montgomery', 'TX', '77304', '9364412012', '9364944012', '508 Medical Ctr Blvd Ste 300', 'Conroe', 'Montgomery', 'TX', '77304', '9364412012', '9364944012', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1588752414', 0, 'N', 0, '2013-05-31', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('141883875', 'W12028933', 'W12028933', 'TXSATSTD', 'River Valley Pediatrics', 'Ivonne', 'M', 'Sahagun Carreon', 'MD', 'Pediatrics', '', '', NULL, 'O', '1500 E Court St Ste 300', 'Seguin', 'Guadalupe', 'TX', '78155', '8303797334', '8303039945', '1500 E Court St Ste 300', 'Seguin', 'Guadalupe', 'TX', '78155', '8303797334', '8303039945', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346329661', 0, 'N', 0, '2013-01-30', NULL, NULL, 29.5692, -97.9393, NULL, NULL),
('752632114', 'W12028937', 'W12028937', 'TXDALSTD', 'Wise County Medical & Surgical Association', '', '', 'Wise County Medical and Surgical Association', '', 'Clinics', '', '', NULL, 'O', '1001 Eagle Dr', 'Decatur', 'Wise', 'TX', '76234', '9406277443', NULL, '1001 Eagle Dr', 'Decatur', 'Wise', 'TX', '76234', '9406277443', '          ', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010041', 0, 'Y', 0, '2013-01-28', NULL, NULL, 33.2186, -97.5972, NULL, NULL),
('752632114', 'W12028938', 'W12028938', 'TXDALSTD', 'Wise County Medical & Surgical Association', '', '', 'Wise County Medical and Surgical Association', '', 'Clinics', '', '', NULL, 'O', '1306 13th St', 'Bridgeport', 'Wise', 'TX', '76426', '9406835287', NULL, '1306 13th St', 'Bridgeport', 'Wise', 'TX', '76426', '9406835287', '          ', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010041', 0, 'Y', 0, '2013-01-28', NULL, NULL, 33.2105, -97.7545, NULL, NULL),
('752632114', 'W12028939', 'W12028939', 'TXDALSTD', 'Wise County Medical & Surgical Association', '', '', 'Wise County Medical and Surgical Association', '', 'Clinics', '', '', NULL, 'O', '217 W Belknap', 'Jacksboro', 'Jack', 'TX', '76458', '9405675521', NULL, '217 W Belknap', 'Jacksboro', 'Jack', 'TX', '76458', '9405675521', '          ', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010041', 0, 'Y', 0, '2013-01-28', NULL, NULL, 33.2182, -98.1604, NULL, NULL),
('752632114', 'W12028941', 'W12028941', 'TXDALSTD', 'Wise County Medical & Surgical Association', 'Jeff', 'B', 'Alling', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '1001 Eagle Dr', 'Decatur', 'Wise', 'TX', '76234', '9406277443', NULL, '1001 Eagle Dr', 'Decatur', 'Wise', 'TX', '76234', '9406277443', '          ', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477558245', 0, 'N', 0, '2013-01-29', NULL, NULL, 33.2186, -97.5972, NULL, NULL),
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('752536818', 'W12030872', 'W12030872', 'TXDALSTD', 'Health Texas Provider Network', 'Jeffrey', '', 'Zsohar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2835 Grand Ave', 'Dallas', 'Dallas', 'TX', '75215', '2148238710', '2148213282', '2835 Grand Ave', 'Dallas', 'Dallas', 'TX', '75215', '2148238710', '2148213282', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063494839', 0, 'Y', 0, '2013-09-24', NULL, NULL, 32.7723, -96.7708, NULL, NULL),
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('942938348', 'W40006798', 'W40006798', 'UTMH1', 'Valley Mental Health  Inc', 'STEVEN', NULL, 'HOLLANDER', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558331934', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006914', 'W40006914', 'UTMH1', 'Valley Mental Health  Inc', 'Jamal', '', 'Hejazi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558332437', 0, 'Y', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN00159', 'SACN00159', 'SACN', 'Saint Alphonsus Employee Assistance Program', 'Patricia', '', 'Heeb', 'LCSW', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'o', '6140 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673300', NULL, '6140 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673300', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1043352743', 0, 'n', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
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('272713767', 'TX0107229', 'TX0107229', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Karin', 'N', 'Hawkins', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144356619', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('264557232', 'W12029029', 'W12029029', 'WY01', 'Platte River Family Practice', '', '', 'Platte River Family Practice', '', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942443536', 0, 'Y', 0, '2013-06-17', NULL, NULL, 42.8501, -106.3, NULL, NULL),
('264557232', 'W12029030', 'W12029030', 'WYT2', 'Platte River Family Practice', '', '', 'Platte River Family Practice', '', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942443536', 0, 'Y', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('800864010', 'W12028890', 'W12028890', 'UT01', 'St Marks Senior Health Center', '', '', 'HCA', '', 'Clinics', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009770', 0, 'Y', 0, '2013-11-14', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12028891', 'W12028891', 'UT01', 'St Marks Interventional Pain Clinic', '', '', 'HCA', '', 'Clinics', '', '', NULL, 'O', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009770', 0, 'Y', 0, '2013-11-14', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('800864010', 'W12028892', 'W12028892', 'UT01', 'St Marks Senior Health Center', '', '', 'HCA', '', 'Clinics', '', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009770', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029031', 'W12029031', 'UT01', 'St Marks Senior Health Center', 'Florentino', '', 'Abueg', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1649372558', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029032', 'W12029032', 'UT01', 'St Marks Senior Health Center', 'Florentino', '', 'Abueg', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1649372558', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029033', 'W12029033', 'UT01', 'St Marks Senior Health Center', 'Alexander', '', 'Del Castillo', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1881705168', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029034', 'W12029034', 'UT01', 'St Marks Senior Health Center', 'Alexander', '', 'Del Castillo', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1881705168', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029035', 'W12029035', 'UT01', 'St Marks Senior Health Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1629145123', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029036', 'W12029036', 'UT01', 'St Marks Senior Health Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1629145123', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029037', 'W12029037', 'UT01', 'St Marks Senior Health Center', 'Cynthia', '', 'Lawlor', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1396999868', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029038', 'W12029038', 'UT01', 'St Marks Senior Health Center', 'Cynthia', '', 'Lawlor', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1396999868', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029039', 'W12029039', 'UT01', 'St Marks Senior Health Center', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029040', 'W12029040', 'UT01', 'St Marks Senior Health Center', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029041', 'W12029041', 'UT01', 'St Marks Senior Health Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1487744553', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('800864010', 'W12029042', 'W12029042', 'UT01', 'St Marks Senior Health Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1487744553', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029043', 'W12029043', 'UT01', 'St Marks Interventional Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'O', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('800864010', 'W12029044', 'W12029044', 'UT01', 'St Marks Interventional Pain Clinicr', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '8664016413', 'PO Box 742382', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '8664016413', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12029045', 'W12029045', 'UT01', 'St Marks Interventional Pain Clinic', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', '1250 E 3900 S Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '8776423374', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB', '1790794063', 0, 'N', 0, '2013-10-08', NULL, NULL, 40.6871, -111.856, NULL, NULL),
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('870281028', 'W12029140', 'W12029140', 'UT01', 'Central Utah Clinic PC', 'Christine', 'L', 'Jackson', 'MD', 'Family Practice', NULL, NULL, NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1114087996', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029137', 'W12029137', 'UT01', 'Central Utah Clinic PC', 'Christine', 'L', 'Jackson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '65 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4355282130', NULL, '65 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4355282130', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1114087996', 0, 'N', 0, '2013-07-25', NULL, NULL, 39.1567, -111.816, NULL, NULL),
('870625250', 'W12029142', 'W12029142', 'UTMH1', 'Sundance Behavioral Resources ', 'T Michael', '', 'Reid', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '8012659604', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '8012659604', 'MD-3', '', '', '0.00', '35.00', '0.00', 6, '2013-02-01', '2013-02-14', 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053381194', 0, 'N', 0, '2013-02-27', 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
('870618776', 'W12029143', 'W12029143', 'UT01', 'Gamma West Cancer Services', 'Thomas', 'B', 'Skidmore', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1250 E 3900 S Ste B-10', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014568401', '8014568408', '1250 E 3900 S Ste B-10', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014568401', '8014568408', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194905752', 0, 'N', 0, '2013-01-23', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870618776', 'W12029144', 'W12029144', 'UT01', 'Gamma West Cancer Services', 'Thomas', 'B', 'Skidmore', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194905752', 0, 'N', 0, '2013-01-23', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('364195126', 'W12029169', 'W12029169', 'ILCHIGSTD', 'Provena Convenient Care Center- Carpentersville', '', '', 'Provena Convenient Care Center', '', 'Physical Therapy', '', '', NULL, 'O', '2201 Randall Rd', 'Carpentersville', 'Kane', 'IL', '60110', '8478447800', NULL, '2201 Randall Rd', 'Carpentersville', 'Kane', 'IL', '60110', '8478447800', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1336215482', 0, 'Y', 0, '2013-10-15', NULL, NULL, 42.1196, -88.3351, NULL, NULL),
('870618776', 'W12029145', 'W12029145', 'UT01', 'Gamma West Cancer Services', 'Thomas', 'B', 'Skidmore', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8013508400', '8013504021', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8013508400', '8013504021', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194905752', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12029146', 'W12029146', 'UT01', 'Gamma West Cancer Services', 'Brandon', 'J', 'Fisher', 'DO', 'Radiation Oncology', '', '', NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275789026', 0, 'N', 0, '2013-01-24', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'W12029147', 'W12029147', 'UT01', 'Gamma West Cancer Services', 'Brandon', 'J', 'Fisher', 'DO', 'Radiation Oncology', '', '', NULL, 'O', '2132 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8018077777', '8018077778', '2132 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8018077777', '8018077778', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275789026', 0, 'N', 0, '2013-01-24', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12029148', 'W12029148', 'UT01', 'Gamma West Cancer Services', 'Brandon', 'J', 'Fisher', 'DO', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '0000000000', '0000000000', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '0000000000', '0000000000', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275789026', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('262518076', 'W12029149', 'W12029149', 'ID01', 'Green Leaves Counseling', 'Kendal', 'M', 'Tucker', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3709 Locust Grove Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088552295', '0000000000', '3709 Locust Grove Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088552295', '0000000000', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2013-01-02', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285968859', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W12029150', 'W12029150', 'UT01', 'Intermountain Anesthesia', 'Shane', 'E', 'Stockwell', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 393', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', 'PO Box 393', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', '', '', '1000', '41.23', '0.00', '0.00', 6, '2013-02-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1346334018', 0, 'N', 0, '2013-01-29', NULL, NULL, 0, 0, NULL, NULL),
('461415830', 'W12029151', 'W12029151', 'UT01', 'Urgent Health Care PC', 'John', 'A', 'Holley', 'MD', 'Family Practice', '', '', NULL, 'O', '212 N 3rd St Ste B', 'Mccall', 'Valley', 'ID', '83638', '2086341334', '2086340588', '212 N 3rd St Ste B', 'Mccall', 'Valley', 'ID', '83638', '2086341334', '2086340588', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', '2014-06-15', 0, 0, 0, 'Oneida County Hospital', '', '', '', 'HCFA|UB|', '1447258157', 0, 'N', 0, '2014-06-30', NULL, NULL, 44.8991, -116.097, NULL, NULL),
('461415830', 'W12029152', 'W12029152', 'UT01', 'Urgent Health Care PC', 'John', 'A', 'Holley', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2603', 'Mccall', 'Valley', 'ID', '83638', '2086341334', '2086340588', 'PO Box 2603', 'Mccall', 'Valley', 'ID', '83638', '2086341334', '2086340588', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', '2014-06-15', 0, 0, 0, 'Oneida County Hospital', '', '', '', 'HCFA|UB|', '1447258157', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12029155', 'W12029155', 'UT01', 'Lonnie Paulos MD', 'Leon (Lonnie)', 'E', 'Paulos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992700330', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12029154', 'W12029154', 'UT01', 'Lonnie Paulos MD', 'Leon (Lonnie)', 'E', 'Paulos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '324 E 10th Ave Ste 172', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088123', '8014088124', '324 E 10th Ave Ste 172', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088123', '8014088124', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2013-07-07', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992700330', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029157', 'W12029157', 'UT01', 'Central Utah Clinic PC', 'John', 'W', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', '2013-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548321862', 0, 'N', 0, '2014-04-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107226', 'TX0107226', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Karin', 'N', 'Hawkins', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144356619', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('272713767', 'W12007229', 'W12007229', 'TX01', 'Cardiology Clinic of San Antonio', 'Karin', 'N', 'Hawkins', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144356619', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('542087434', 'W12029159', 'W12029159', 'UT01', 'Moab Family Medicine', 'Jonas', 'S', 'Munger', 'MD', 'Family Practice', '', '', NULL, 'O', '476 Williams Way Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4355293112', '476 Williams Wy Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4355293112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1801879721', 0, 'N', 0, '2013-03-15', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('542087434', 'W12029160', 'W12029160', 'UT01', 'Moab Family Medicine', 'Katherine', 'K', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '476 Williams Way Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', '476 Williams Way Ste A', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1669455580', 0, 'N', 0, '2014-06-17', NULL, NULL, 38.5743, -109.561, NULL, NULL),
('742719352', 'W12033639', 'W12033639', 'TXSATSTD', 'Urology of San Antonio', 'Rene', 'A', 'Sepulveda', 'MD', 'Urology', '', '', NULL, 'O', '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', NULL, '134 Menger Springs Ste 1210', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710967732', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0543, -98.7392, NULL, NULL),
('263720511', 'W12029161', 'W12029161', 'UT01', 'Stacy R Smith MD', 'Stacy', 'R', 'Smith', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1548 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', '1548 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-12-26', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1639348899', 0, 'N', 0, '2013-01-23', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('870281028', 'W12029181', 'W12029181', 'UT01', 'Central Utah Clinic PC', 'Todd', 'R', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', NULL, '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396770616', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029182', 'W12029182', 'UT01', 'Central Utah Clinic PC', 'Todd', 'R', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89024', '8002399393', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89024', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396770616', 0, 'N', 0, '2013-04-10', NULL, NULL, 36.8087, -114.115, NULL, NULL),
('870281028', 'W12029183', 'W12029183', 'UT01', 'Central Utah Clinic PC', 'Edward', 'J', 'Prince', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', NULL, '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659306975', 0, 'N', 0, '2013-04-10', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('870281028', 'W12029184', 'W12029184', 'UT01', 'Central Utah Clinic PC', 'Edward', 'J', 'Prince', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', NULL, '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659306975', 0, 'N', 0, '2013-04-10', NULL, NULL, 37.0533, -112.532, NULL, NULL),
('870281028', 'W12029185', 'W12029185', 'UT01', 'Central Utah Clinic PC', 'Edward', 'J', 'Prince', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', NULL, '1404 Sun River Pkwy Ste 101', 'Kanab', 'Kane', 'UT', '87490', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659306975', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12029186', 'W12029186', 'UT01', 'Central Utah Clinic PC', 'Edward', 'J', 'Prince', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 N Navajo Dr', 'Page', 'Coconino', 'AZ', '86040', '8002399393', NULL, '501 N Navajo Dr', 'Page', 'Coconino', 'AZ', '86040', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659306975', 0, 'N', 0, '2013-04-10', NULL, NULL, 36.917, -111.463, NULL, NULL),
('870281028', 'W12029187', 'W12029187', 'UT01', 'Central Utah Clinic PC', 'Michael', 'B', 'Anderson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', NULL, '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Kane County Hospital', NULL, NULL, 'HCFA|UB|', '1215964747', 0, 'N', 0, '2013-03-26', NULL, NULL, 37.0959, -113.551, NULL, NULL),
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('270123697', 'W12029344', 'W12029344', 'UT01', 'WorkAbility Centers ', 'Naomi', '', 'Harris', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1689 E 1400 S Ste 120', 'Clearfield', 'Davis', 'UT', '84015', '8015250007', '8015250008', '1689 E 1400 S Ste 120', 'Clearfield', 'Davis', 'UT', '84015', '8015250007', '8015250008', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-01-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891783809', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W12029345', 'W12029345', 'ID01', 'University Health Care Park City Mountain Resort Urgent Care  M-Sun 9am-6pm', '', '', 'University Health Care Park City Mountain Resort Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795256', 0, 'N', 0, '2013-06-12', NULL, NULL, 40.6548, -111.509, NULL, NULL),
('205529469', 'W12029346', 'W12029346', 'ID01', 'University Health Care Park City Mountain Resort Urgent Care', '', '', 'University Health Care Park City Mountain Resort Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', NULL, 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795256', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12029347', 'W12029347', 'ID01', 'University Radiology Associates', '', '', 'University Radiology Associates', 'GROUP', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009332', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('270101195', 'W12029348', 'W12029348', 'ID01', 'U of U Communications & Disorders Speech & Hearing Clinic', '', '', 'U of U Communications & Disorders Speech & Hearing Clinic', 'GROUP', 'Speech Therapy', '', '', NULL, 'O', '417 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015813506', NULL, '417 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015813506', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009219', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.7593, -111.829, NULL, NULL),
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('300655165', 'W12029351', 'W12029351', 'ID01', 'Pediatric Emergency Sedation Services', '', '', 'Pediatric Emergency Sedation Service', 'Group', 'Clinics', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245524651', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
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('300655693', 'W12029353', 'W12029353', 'ID01', 'University of Utah Adult Professional Services', '', '', 'University of Utah Adult Professional Services', 'Group', 'Mental Health', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699074781', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.757, -111.824, NULL, NULL),
('300655693', 'W12029354', 'W12029354', 'ID01', 'University of Utah Adult Professional Services', '', '', 'University of Utah Adult Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699074781', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
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('320186101', 'W12029356', 'W12029356', 'ID01', 'Pediatric Diagnostic Cardiology', NULL, NULL, 'U of U Pediatric Diagnostic Cardiology', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016625400', NULL, '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016625400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710016340', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.5222, -111.981, NULL, NULL),
('320186101', 'W12029357', 'W12029357', 'ID01', 'Pediatric Diagnostic Cardiology', NULL, NULL, 'U of U Pediatric Diagnostic Cardiology', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710016340', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('320325813', 'W12029358', 'W12029358', 'ID01', 'University of Utah Adult Behavioral Health', '', '', 'University of Utah Adult Behavioral Health ', '', 'Mental Health', '', '', NULL, 'O', '650 Komas Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', NULL, '650 Komas Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538451455', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.7553, -111.83, NULL, NULL),
('320325813', 'W12029359', 'W12029359', 'ID01', 'University of Utah Adult Behavioral Health', '', '', 'University of Utah Adult Behavioral Health ', '', 'Mental Health', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538451455', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('320361824', 'W12029360', 'W12029360', 'ID01', 'Internal Med-Interventional Cardiology Department of University of Utah', '', '', 'Internal Med-Interventional Cardiology Department of University of Utah', '', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', NULL, '50 N Medical Dr  ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184979460', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('320361824', 'W12029361', 'W12029361', 'ID01', 'Internal Med-Interventional Cardiology Department of University of Utah', '', '', 'Internal Med-Interventional Cardiology Department of University of Utah', '', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184979460', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('352381020', 'W12029362', 'W12029362', 'ID01', 'Division of Occupational Therapy University of Utah', '', '', 'Division of Occupational Therapy University of Utah', 'Group', 'Clinics', '', '', NULL, 'B', '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', NULL, '520 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700186699', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('352381020', 'W12029363', 'W12029363', 'ID01', 'Division of Occupational Therapy University of Utah', '', '', 'Division of Occupational Therapy University of Utah', 'Group', 'Clinics', '', '', NULL, 'O', '540 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', NULL, '540 Arapeen Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857448', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700186699', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.757, -111.829, NULL, NULL),
('352395602', 'W12029364', 'W12029364', 'ID01', 'University of Utah Pediatric Adolescent Professional Services', '', '', 'University of Utah Pediatric Adolescent Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407155591', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('352395602', 'W12029365', 'W12029365', 'ID01', 'University of Utah Pediatric Adolescent Professional Services', '', '', 'University of Utah Pediatric Adolescent Professional Services', 'Group', 'Mental Health', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407155591', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W12029366', 'W12029366', 'ID01', 'University of Utah Surgical Intensive Care Unit', '', '', 'University of Utah Surgical Intensive Care Unit', 'GROUP', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '0000000000', '50 N Medical Dr   ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '0000000000', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-09-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009323', 0, 'N', 0, '2013-01-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
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('752509430', 'ELFP00024', 'ELFP00024', 'TXDALSTD', 'Fort Worth Pediatrics', 'Julie', 'E', 'Heflin Crawford', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1093773053', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00023', 'ELFP00023', 'TXDALSTD', 'Fort Worth Pediatrics', 'Julie', 'E', 'Heflin Crawford', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1093773053', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00022', 'ELFP00022', 'TXDALSTD', 'Fort Worth Pediatrics', 'J Ben', NULL, 'Worsley', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1114984564', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
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('752509430', 'ELFP00008', 'ELFP00008', 'TXDALSTD', 'Fort Worth Pediatrics', 'Daphne', 'N', 'Shaw', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1144221623', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
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('752509430', 'ELFP00029', 'ELFP00029', 'TXDALSTD', 'Fort Worth Pediatrics', 'Natalia', 'C', 'Hanson', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1174856215', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00003', 'ELFP00003', 'TXDALSTD', 'Fort Worth Pediatrics', 'Robert', 'M', 'Readinger', 'MD', 'Pediatrics', '', '', NULL, 'O', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173351104', '8173389563', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173351104', '8173389563', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1295736254', 0, 'N', 0, '2013-04-04', NULL, NULL, 32.7329, -97.3377, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('752509430', 'ELFP00012', 'ELFP00012', 'TXDALSTD', 'Fort Worth Pediatrics', 'Lisa', 'M', 'Guthrie', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1295792604', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00011', 'ELFP00011', 'TXDALSTD', 'Fort Worth Pediatrics', 'Lisa', 'M', 'Guthrie', 'MD', 'Pediatrics', '', '', NULL, 'O', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1295792604', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6567, -97.4191, NULL, NULL),
('752509430', 'ELFP00001', 'ELFP00001', 'TXDALSTD', 'Fort Worth Pediatrics', 'Ramiro', 'D', 'Cavazos', 'MD', 'Pediatrics', '', '', NULL, 'O', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1427016476', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.7329, -97.3377, NULL, NULL),
('752509430', 'ELFP00002', 'ELFP00002', 'TXDALSTD', 'Fort Worth Pediatrics', 'Ramiro', 'D', 'Cavazos', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1427016476', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00032', 'ELFP00032', 'TXDALSTD', 'Fort Worth Pediatrics', 'James', 'N', 'Murphy', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1487612289', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00031', 'ELFP00031', 'TXDALSTD', 'Fort Worth Pediatrics', 'James', 'N', 'Murphy', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1487612289', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00034', 'ELFP00034', 'TXDALSTD', 'Fort Worth Pediatrics', 'Steven', 'J', 'Senevey', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1518924968', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00033', 'ELFP00033', 'TXDALSTD', 'Fort Worth Pediatrics', 'Steven', 'J', 'Senevey', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1518924968', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00028', 'ELFP00028', 'TXDALSTD', 'Fort Worth Pediatrics', 'James', 'M', 'Friedman', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1528026507', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00027', 'ELFP00027', 'TXDALSTD', 'Fort Worth Pediatrics', 'James', 'M', 'Friedman', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1528026507', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00016', 'ELFP00016', 'TXDALSTD', 'Fort Worth Pediatrics', 'Tamara', 'L', 'Hayward', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1699732016', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00015', 'ELFP00015', 'TXDALSTD', 'Fort Worth Pediatrics', 'Tamara', 'L', 'Hayward', 'MD', 'Pediatrics', '', '', NULL, 'O', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1699732016', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6567, -97.4191, NULL, NULL),
('752509430', 'ELFP00014', 'ELFP00014', 'TXDALSTD', 'Fort Worth Pediatrics', 'Walter', 'H', 'Halpenny', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881652865', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00013', 'ELFP00013', 'TXDALSTD', 'Fort Worth Pediatrics', 'Walter', 'H', 'Halpenny', 'MD', 'Pediatrics', '', '', NULL, 'O', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881652865', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6567, -97.4191, NULL, NULL),
('752509430', 'ELFP00005', 'ELFP00005', 'TXDALSTD', 'Fort Worth Pediatrics', 'Monica', 'M', 'Pradhan', 'MD', 'Pediatrics', '', '', NULL, 'O', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1902048341', 0, 'N', 0, '2013-09-11', NULL, NULL, 32.7329, -97.3377, NULL, NULL),
('752509430', 'ELFP00006', 'ELFP00006', 'TXDALSTD', 'Fort Worth Pediatrics', 'Monica', 'M', 'Pradhan', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1902048341', 0, 'Y', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00009', 'ELFP00009', 'TXDALSTD', 'Fort Worth Pediatrics', 'Mark', 'S', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'O', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1902864887', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.7329, -97.3377, NULL, NULL),
('752509430', 'ELFP00010', 'ELFP00010', 'TXDALSTD', 'Fort Worth Pediatrics', 'Mark', 'S', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1902864887', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00026', 'ELFP00026', 'TXDALSTD', 'Fort Worth Pediatrics', 'A Stanley', NULL, 'Elliott', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962460949', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00025', 'ELFP00025', 'TXDALSTD', 'Fort Worth Pediatrics', 'A Stanley', NULL, 'Elliott', 'MD', 'Pediatrics', '', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962460949', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'ELFP00018', 'ELFP00018', 'TXDALSTD', 'Fort Worth Pediatrics', 'Julee', 'S', 'Morrow', 'MD', 'Pediatrics', '', '', NULL, 'B', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', '3550 Hulen Ste A', 'Fort Worth', 'Tarrant', 'TX', '76107', '8176989196', '8176989160', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1972561850', 0, 'Y', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('752509430', 'ELFP00017', 'ELFP00017', 'TXDALSTD', 'Fort Worth Pediatrics', 'Julee', 'S', 'Morrow', 'MD', 'Pediatrics', '', '', NULL, 'O', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-02-28', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1972561850', 0, 'N', 0, '2013-01-28', NULL, NULL, 32.6567, -97.4191, NULL, NULL),
('200324983', 'W12029505', 'W12029505', 'ID01', 'Idaho Sports Medicine Institute', 'Kristin', 'K', 'Hulquist', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609872241', 0, 'N', 0, '2013-01-28', NULL, NULL, 43.601, -116.196, NULL, NULL),
('200324983', 'W12029506', 'W12029506', 'ID01', 'Idaho Sports Medicine Institute', 'Jay', 'R', 'Armstrong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447256086', 0, 'N', 0, '2013-01-28', NULL, NULL, 43.601, -116.196, NULL, NULL),
('200324983', 'W12029507', 'W12029507', 'ID01', 'Idaho Sports Medicine Institute', 'Linda', '', 'Hammann', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386640928', 0, 'N', 0, '2013-01-28', NULL, NULL, 43.601, -116.196, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('363383867', 'ELCOM1055', 'ELCOM1055', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Lorimer', 'MD', 'General Surgery', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184619900', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1018', 'ELCOM1018', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Lorimer', 'MD', 'General Surgery', '', '', NULL, 'O', '2850 W 95th St Ste 306', 'Evergreen Park', 'Cook', 'IL', '60805', '7084228500', '7084227872', '2850 W 95th St Ste 306', 'Evergreen Park', 'Cook', 'IL', '60805', '7084228500', '7084227872', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184619900', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7218, -87.6941, NULL, NULL),
('363383867', 'ELCOM1046', 'ELCOM1046', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Sujal', '', 'Desai', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1215036330', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1008', 'ELCOM1008', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Sujal', '', 'Desai', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2850 W 95th St Ste 406', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994844', '7084990731', '2850 W 95th St Ste 406', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994844', '7084990731', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1215036330', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1009', 'ELCOM1009', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Sujal', '', 'Desai', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '6700 W 95th St Ste 220', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994844', '7084990731', '6700 W 95th St Ste 220', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994844', '7084990731', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1215036330', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7195, -87.7872, NULL, NULL),
('363383867', 'ELCOM1021', 'ELCOM1021', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Moira', '', 'Mcquillan', 'MD', 'Family Practice', '', '', NULL, 'O', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215120811', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.6934, -87.7009, NULL, NULL),
('363383867', 'ELCOM1058', 'ELCOM1058', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Moira', '', 'Mcquillan', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215120811', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1053', 'ELCOM1053', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Alexis', '', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215999602', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1016', 'ELCOM1016', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Alexis', '', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215999602', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1052', 'ELCOM1052', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Michael', '', 'Hanak', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265609903', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1015', 'ELCOM1015', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Michael', '', 'Hanak', 'MD', 'Family Practice', '', '', NULL, 'O', '5660 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084220120', '7088574721', '5660 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084220120', '7088574721', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265609903', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7198, -87.7618, NULL, NULL),
('363383867', 'ELCOM1060', 'ELCOM1060', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Nimisha', '', 'Patel', 'MD', 'Psychiatry', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1265698914', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1023', 'ELCOM1023', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Nimisha', '', 'Patel', 'MD', 'Psychiatry', '', '', NULL, 'O', '2850 W 95th St Ste 204', 'Evergreen Park', 'Cook', 'IL', '60805', '7084245100', '7084225990', '2850 W 95th St Ste 204', 'Evergreen Park', 'Cook', 'IL', '60805', '7084245100', '7084225990', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1265698914', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1064', 'ELCOM1064', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Jessica', '', 'Sulkowski', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306156500', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1027', 'ELCOM1027', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Jessica', '', 'Sulkowski', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306156500', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1062', 'ELCOM1062', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Prabodh', '', 'Shah', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1316935240', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1025', 'ELCOM1025', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Prabodh', '', 'Shah', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2800 W 95th St Cancer Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082296020', '7082296013', '2800 W 95th St Cancer Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082296020', '7082296013', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1316935240', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1065', 'ELCOM1065', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Nancy', '', 'Taft', 'MD', 'General Surgery', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366496028', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1028', 'ELCOM1028', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Nancy', '', 'Taft', 'MD', 'General Surgery', '', '', NULL, 'O', '2800 W 95th St Comp Breast Hlth Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082294050', '7082294051', '2800 W 95th St Comp Breast Hlth Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082294050', '7082294051', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366496028', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1042', 'ELCOM1042', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Joyce', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376705772', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1005', 'ELCOM1005', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Joyce', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'O', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084220600', '7084224367', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084220600', '7084224367', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376705772', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7491, -87.7442, NULL, NULL),
('363383867', 'ELCOM1040', 'ELCOM1040', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Robert', '', 'Bonaminio', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427001486', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1003', 'ELCOM1003', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Robert', '', 'Bonaminio', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427001486', 0, 'N', 0, '2013-05-01', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1068', 'ELCOM1068', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Timothy', '', 'Wollner', 'DO', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427088061', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1031', 'ELCOM1031', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Timothy', '', 'Wollner', 'DO', 'Family Practice', '', '', NULL, 'O', '2850 W 95th St Ste 102', 'Evergreen Park', 'Cook', 'IL', '60805', '7084259550', '7084257617', '2850 W 95th St Ste 102', 'Evergreen Park', 'Cook', 'IL', '60805', '7084259550', '7084257617', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427088061', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1049', 'ELCOM1049', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Rujata', '', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437180346', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1012', 'ELCOM1012', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Rujata', '', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'O', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437180346', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7215, -87.6421, NULL, NULL),
('363383867', 'ELCOM1037', 'ELCOM1037', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Ryan', 'APRN', 'Family Practice', '', '', NULL, 'O', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447376132', 0, 'Y', 0, '2013-10-07', NULL, NULL, 41.6934, -87.7009, NULL, NULL),
('363383867', 'ELCOM1074', 'ELCOM1074', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Ryan', 'APRN', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447376132', 0, 'Y', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1047', 'ELCOM1047', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Pooja', '', 'Doshi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467608513', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1010', 'ELCOM1010', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Pooja', '', 'Doshi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467608513', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1034', 'ELCOM1034', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Elizabeth', '', 'Cerrentano', 'APRN', 'Family Practice', '', '', NULL, 'O', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467737189', 0, 'Y', 0, '2013-01-30', NULL, NULL, 41.6934, -87.7009, NULL, NULL),
('363383867', 'ELCOM1071', 'ELCOM1071', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Elizabeth', '', 'Cerrentano', 'APRN', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467737189', 0, 'Y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1070', 'ELCOM1070', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Mary', '', 'Burke', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497065312', 0, 'Y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1033', 'ELCOM1033', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Mary', '', 'Burke', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497065312', 0, 'Y', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1057', 'ELCOM1057', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Howard', '', 'Mcnair', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1609808518', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1020', 'ELCOM1020', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Howard', '', 'Mcnair', 'MD', 'Family Practice', '', '', NULL, 'O', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1609808518', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7215, -87.6421, NULL, NULL),
('363383867', 'ELCOM1056', 'ELCOM1056', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Virendra', '', 'Mathur', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1689627010', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1019', 'ELCOM1019', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Virendra', '', 'Mathur', 'MD', 'Internal Medicine', '', '', NULL, 'O', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1689627010', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7215, -87.6421, NULL, NULL),
('363383867', 'ELCOM1061', 'ELCOM1061', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Brady', '', 'Reis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710151675', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1024', 'ELCOM1024', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Brady', '', 'Reis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084220600', '7084224367', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084220600', '7084224367', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710151675', 0, 'N', 0, '2013-10-15', NULL, NULL, 41.7491, -87.7442, NULL, NULL),
('363383867', 'ELCOM1022', 'ELCOM1022', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'James', '', 'Miller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12450 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7084481207', '7084487827', '12450 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7084481207', '7084487827', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710933544', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.6653, -87.7966, NULL, NULL),
('363383867', 'ELCOM1059', 'ELCOM1059', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'James', '', 'Miller', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710933544', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1044', 'ELCOM1044', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Christmas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780637827', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1007', 'ELCOM1007', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Monica', '', 'Christmas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', '2800 W 95th St 3rd Fl Tower', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084994132', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780637827', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1002', 'ELCOM1002', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Priya', '', 'Bhattacharyya', 'MD', 'Family Practice', '', '', NULL, 'O', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', '10961 S Kedzie', 'Chicago', 'Cook', 'IL', '60655', '7732399100', '7732399102', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821289315', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.6934, -87.7009, NULL, NULL),
('363383867', 'ELCOM1039', 'ELCOM1039', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Priya', '', 'Bhattacharyya', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821289315', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1013', 'ELCOM1013', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Florie', '', 'Gonsch', 'DO', 'Internal Medicine', '', '', NULL, 'O', '12450 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7084481207', '7084487827', '12450 S Harlem Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7084481207', '7084487827', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831144476', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.6653, -87.7966, NULL, NULL),
('363383867', 'ELCOM1050', 'ELCOM1050', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Florie', '', 'Gonsch', 'DO', 'Internal Medicine', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831144476', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1054', 'ELCOM1054', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Andrea', 'D', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861487423', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1017', 'ELCOM1017', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Andrea', 'D', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5660 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994100', '7084994132', '5660 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994100', '7084994132', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861487423', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7198, -87.7618, NULL, NULL),
('363383867', 'ELCOM1066', 'ELCOM1066', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Constantina', '', 'Tucker', 'DO', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861515447', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1029', 'ELCOM1029', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Constantina', '', 'Tucker', 'DO', 'Family Practice', '', '', NULL, 'O', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084227100', '7084227364', '4901 W 79th S Ste 10', 'Burbank', 'Cook', 'IL', '60459', '7084227100', '7084227364', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861515447', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7491, -87.7442, NULL, NULL),
('363383867', 'ELCOM1041', 'ELCOM1041', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Melissa', '', 'Chappell', 'MD', 'Psychiatry', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881647576', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1004', 'ELCOM1004', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Melissa', '', 'Chappell', 'MD', 'Psychiatry', '', '', NULL, 'O', '2850 W 95th St Ste 204', 'Evergreen Park', 'Cook', 'IL', '60805', '7084225090', '7084225990', '2850 W 95th St Ste 204', 'Evergreen Park', 'Cook', 'IL', '60805', '7084225090', '7084225990', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881647576', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'ELCOM1072', 'ELCOM1072', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Courtney', '', 'Miller', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912197112', 0, 'Y', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1035', 'ELCOM1035', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Courtney', '', 'Miller', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2800 W 95th St Comp Breast Hlth Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084225505', '2800 W 95th St Comp Breast Hlth Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994100', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912197112', 0, 'Y', 0, '2013-09-05', NULL, NULL, 41.7209, -87.6922, NULL, NULL),
('363383867', 'ELCOM1038', 'ELCOM1038', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Ashlee', '', 'Bergin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430709', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1001', 'ELCOM1001', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Ashlee', '', 'Bergin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430709', 0, 'N', 0, '2013-09-05', NULL, NULL, 41.7218, -87.6941, NULL, NULL),
('363383867', 'ELCOM1043', 'ELCOM1043', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Simona', '', 'Chivu', 'MD', 'Oncology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1942416235', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1006', 'ELCOM1006', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Simona', '', 'Chivu', 'MD', 'Oncology', '', '', NULL, 'O', '2800 W 95th St Cancer Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082296020', '7082296013', '2800 W 95th St Cancer Ctr', 'Evergreen Park', 'Cook', 'IL', '60805', '7082296020', '7082296013', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', NULL, 'HCFA|UB|', '1942416235', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.7209, -87.6932, NULL, NULL),
('363383867', 'ELCOM1073', 'ELCOM1073', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Sandra', '', 'Mulcrone', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952317786', 0, 'Y', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'ELCOM1036', 'ELCOM1036', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Sandra', '', 'Mulcrone', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 103', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952317786', 0, 'Y', 0, '2013-09-11', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('562627035', 'W12029596', 'W12029596', 'UT01', 'UUHC Redstone Center', '', '', 'University of Utah Dept of OBGYN Reproductive Endocrinology', 'GROUP', 'Reproductive Endocrinology', '', '', NULL, 'O', '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009289', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7208, -111.543, NULL, NULL),
('870410144', 'W12029597', 'W12029597', 'UT01', 'UUHC Redstone Center', '', '', 'University of Utah Dept of OB/GYN', 'GROUP', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009285', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.7208, -111.543, NULL, NULL),
('870468377', 'W12029599', 'W12029599', 'UT01', 'UUHC Redstone Center', '', '', 'U-U Dermatology Division', 'GROUP', 'Dermatology', '', '', NULL, 'O', '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009375', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.7208, -111.543, NULL, NULL),
('870616107', 'W12029600', 'W12029600', 'UT01', 'UUHC Redstone Center', '', '', 'U of U Hospitals and Clinics', 'GROUP', 'Family Practice', 'Optometry', 'Internal Medicine', NULL, 'O', '1743 W Redstone Ctr', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr  ', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-01-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009233', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7208, -111.543, NULL, NULL),
('760581778', 'W12029603', 'W12029603', 'TXHOUSTD', 'Pediatric Center', '', '', 'Pediatric Center LTD ', '', 'Pediatrics', '', '', NULL, 'O', '4911 Sand Hill Dr Ste A', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813419696', '2813416218', '4911 Sand Hill Dr Ste A', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813419696', '2813416218', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053492306', 0, 'Y', 0, '2013-06-10', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760581778', 'W12029605', 'W12029605', 'TXHOUSTD', 'Pediatric Center', 'Michael', 'E', 'Bornstein', 'MD', 'Pediatrics', '', '', NULL, 'O', '1300 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813419696', '2813416218', '1300 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813419696', '2813416218', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-02', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB', '1225024326', 0, 'N', 0, '2013-02-07', NULL, NULL, 29.5773, -95.7675, NULL, NULL),
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('836317030', 'W12029628', 'W12029628', 'WY01', 'Wyoming Recovery', '', '', 'Wyoming Recovery LLC', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '231 S Wilson', 'Casper', 'Natrona', 'WY', '82601', '3072653791', '3072654480', '231 S Wilson', 'Casper', 'Natrona', 'WY', '82601', '3072653791', '3072654480', '', '', 'WYRECOVERY', '0.00', '50.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124182100', 0, 'N', 0, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL),
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('454855728', 'W12029630', 'W12029630', 'UT01', 'Ogden Regional Medical Center', 'Joan', '', 'Nold', 'MD', 'Neonatology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014764280', '8014764281', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014764280', '8014764281', '', '', '', '0.00', '20.00', '0.00', 3, '2013-02-01', '2013-01-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1497708481', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('850395469', 'W12029631', 'W12029631', 'NM01', 'Fifty n Fit', 'Paula', 'A', 'Jones Irvin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '11719 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '11719 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '', '', 'NMPT', '0.00', '0.00', '75.00', 3, '2013-03-01', '2013-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033284674', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL);
