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
('363330928', 'EDMPMG030', 'EDMPMG030', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Matthew', '', 'Jordan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952302101', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('362709982', 'EDMPMG387', 'EDMPMG387', 'ILCHIGSTD', 'Resurrection Behavior Health', 'Iyad', '', 'Alkhouri', 'MD', 'Psychiatry', '', '', NULL, 'O', '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '8474933600', NULL, '1325 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '8474933600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952328940', 0, 'Y', 0, '2013-06-04', NULL, NULL, 41.7856, -88.3289, NULL, NULL),
('362709982', 'EDMPMG388', 'EDMPMG388', 'ILCHIGSTD', 'Resurrection Behavior Health', 'Iyad', '', 'Alkhouri', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8474933600', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8474933600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952328940', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG152', 'EDMPMG152', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Jeffrey', '', 'Olson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4905 Old Orchard Ctr Ste 634', 'Skokie', 'Cook', 'IL', '60077', '8476795120', NULL, '4905 Old Orchard Ctr Ste 634', 'Skokie', 'Cook', 'IL', '60077', '8476795120', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1952374795', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.0614, -87.7475, NULL, NULL),
('363330928', 'EDMPMG505', 'EDMPMG505', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Jeffrey', '', 'Olson', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737690575', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737690575', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1952374795', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG307', 'EDMPMG307', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Nitesh', NULL, 'Thakker', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952480295', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG306', 'EDMPMG306', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Nitesh', NULL, 'Thakker', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952480295', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363330928', 'EDMPMG535', 'EDMPMG535', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Elenita', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', NULL, '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1962514984', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9241, -87.7596, NULL, NULL),
('363330928', 'EDMPMG538', 'EDMPMG538', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Elenita', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1962514984', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG106', 'EDMPMG106', 'ILCHIGSTD', 'RMG Lincoln Prk Medical Associates', 'Robert', NULL, 'Hargan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 2110', 'Chicago', 'Cook', 'IL', '60657', '7734727412', NULL, '2800 N Sheridan Rd Ste 2110', 'Chicago', 'Cook', 'IL', '60657', '7734727412', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1962591404', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG558', 'EDMPMG558', 'ILCHIGSTD', 'RMG Lincoln Prk Medical Associates', 'Robert', NULL, 'Hargan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734727412', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734727412', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1962591404', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG179', 'EDMPMG179', 'ILCHIGSTD', 'Drs Farby Levin and Associates', 'Gerald', NULL, 'Farby', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7739613200', NULL, '3500 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7739613200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1972504454', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9903, -87.7164, NULL, NULL),
('363330928', 'EDMPMG180', 'EDMPMG180', 'ILCHIGSTD', 'Drs Farby Levin and Associates', 'Gerald', NULL, 'Farby', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7739613200', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7739613200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1972504454', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG447', 'EDMPMG447', 'ILCHIGSTD', 'RMG Evanston Internal Medicine', 'Thomas', NULL, 'Campbell', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473166600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473166600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972506665', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG024', 'EDMPMG024', 'ILCHIGSTD', 'RMG Evanston Internal Medicine', 'Thomas', NULL, 'Campbell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St East Tower Ste 451', 'Evanston', 'Cook', 'IL', '60202', '8473166600', NULL, '800 Austin St East Tower Ste 451', 'Evanston', 'Cook', 'IL', '60202', '8473166600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972506665', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('870299862', 'W40006975', 'W40006975', 'UTMH1', 'LDS Family Services', 'Christopher', 'J', 'Bouwhuis', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619053949', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.072, -111.981, NULL, NULL),
('364314354', 'EDMPMG130', 'EDMPMG130', 'ILCHIGSTD', 'PMG Joliet Pediatrics', 'Gilda', '', 'Alcala', 'MD', 'Pediatrics', '', '', NULL, 'O', '301 N Springfield Ave Ste 4', 'Joliet', 'Will', 'IL', '60435', '8157250001', '8157254579', '301 N Springfield Ave Ste 4', 'Joliet', 'Will', 'IL', '60435', '8157250001', '8157254579', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1972591188', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG035', 'EDMPMG035', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Andrew', NULL, 'Riskin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '3127702418', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982878138', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG198', 'EDMPMG198', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Andrew', NULL, 'Riskin', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982878138', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG542', 'EDMPMG542', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Gina', '', 'Wehrmann', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1992729263', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG023', 'EDMPMG023', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Gina', '', 'Wehrmann', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '800 Austin St East Tower Ste 354', 'Evanston', 'Cook', 'IL', '60202', '8474916890', NULL, '800 Austin St East Tower Ste 354', 'Evanston', 'Cook', 'IL', '60202', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1992729263', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG267', 'EDMPMG267', 'ILCHIGSTD', 'PMG Joliet Behavioral Health', 'Paul', '', 'Hannah', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1992920169', 0, 'Y', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG266', 'EDMPMG266', 'ILCHIGSTD', 'PMG Joliet Behavioral Health', 'Paul', '', 'Hannah', 'MD', 'Psychiatry', '', '', NULL, 'O', '333 Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1992920169', 0, 'Y', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG302', 'EDMPMG302', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Rahul', '', 'Agarwal', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992930374', 0, 'Y', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG301', 'EDMPMG301', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Rahul', '', 'Agarwal', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992930374', 0, 'Y', 0, '2013-10-16', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('820200895', 'W12027022', 'W12027022', 'IDBOISTD', 'Saint Alphonsus  Medical Group Comprehensive Pain and Spine', 'Nicole', 'M', 'Amideo', 'PA-C', 'Pain Management', 'Physician Assistant', '', NULL, 'O', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083673319', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083673319', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-22', 0, 0, 0, '', '', '', '', 'HCFA|', '1700813714', 0, 'N', 0, '2013-03-08', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W12027023', 'W12027023', 'IDBOISTD', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Rebekah', 'E', 'Guy', 'MD', 'Pain Management', '', '', NULL, 'O', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-08', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154542355', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W12027024', 'W12027024', 'IDBOISTD', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Daniel', 'R', 'Marsh', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-07', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356377535', 0, 'N', 0, '2013-12-26', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12027025', 'W12027025', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Norman "John"', '', 'East', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518005701', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12027026', 'W12027026', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Norman "John"', '', 'East', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518005701', 0, 'Y', 0, '2013-07-31', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'W12027027', 'W12027027', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Norman "John"', '', 'East', 'MD', 'Pulmonary', NULL, NULL, NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518005701', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('363819436', 'W12027606', 'W12027606', 'ILCHIGSTD', 'Cardiac Surgery Associates', '', '', 'Cardiac Surgery Associates', '', 'Cardiology', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043269160', 0, 'Y', 0, '2014-02-25', NULL, NULL, 41.8082, -88.0496, NULL, NULL),
('362784592', 'W12028325', 'W12028325', 'ILCHIGSTD', 'Consultants in Neurology', 'Neil', '', 'Allen', 'MD', 'Neurology', '', '', NULL, 'O', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1255325023', 0, 'N', 0, '2013-01-11', NULL, NULL, 42.1524, -87.8039, NULL, NULL),
('760548150', 'W12027028', 'W12027028', 'TXHOUSTD', 'Bay Area Gastroenterology', '', '', 'Bay Area Gastroenterology', '', 'Gastroenterology', '', '', NULL, 'O', '1015 Medical Center Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', '1015 Medical Center Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1629142211', 0, 'Y', 0, '2013-09-27', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
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('741759758', 'W12027056', 'W12027056', 'TXHOUSTD', 'Bay Area Obstetrics and Gynecology', 'Michael', 'A', 'Petitt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17 Professional Park Dr', 'Webster', 'Harris', 'TX', '77598', '2813329511', '2813326685', '17 Professional Park Dr', 'Webster', 'Harris', 'TX', '77598', '2813329511', '2813326685', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356303564', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.5455, -95.1293, NULL, NULL),
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('820200895', 'W12027158', 'W12027158', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Nampa ', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('201019831', 'W12027173', 'W12027173', 'TXHOUSTD', '20/20 Eye Clinic and Optical', 'Edward', 'K', 'Chan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4675 Hwy 6 S Ste B', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812776100', '2812776106', '4675 Hwy 6 S Ste B', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812776100', '2812776106', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1699097741', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5809, -95.5833, NULL, NULL),
('201019831', 'W12027172', 'W12027172', 'TXHOUSTD', '20/20 Eye Clinic and Optical', 'Edward', 'K', 'Chan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7737 Southwest Fwy Ste 850', 'Houston', 'Harris', 'TX', '77074', '7132712271', '7132712734', '7737 Southwest Fwy Ste 850', 'Houston', 'Harris', 'TX', '77074', '7132712271', '7132712734', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1699097741', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.6951, -95.523, NULL, NULL),
('752384311', 'W12027174', 'W12027174', 'TXDALSTD', 'Dallas Family Medicine  ', 'Paul', 'S', 'Worrell', 'MD', 'Family Practice', '', '', NULL, 'O', '8668 Skillman St', 'Dallas', 'Dallas', 'TX', '75243', '2143494909', '2143494973', '8668 Skillman St', 'Dallas', 'Dallas', 'TX', '75243', '2143494909', '2143494973', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|', '1720195779', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('760506276', 'W12027178', 'W12027178', 'TXHOUSTD', 'Northeast OB-GYN Associates ', 'Julie', 'A', 'Bernell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '19701 Kingwood Dr Bldg 5', 'Kingwood', 'Harris', 'TX', '77339', '2813194111', '2813194623', '19701 Kingwood Dr Bldg 5', 'Kingwood', 'Harris', 'TX', '77339', '2813194111', '2813194623', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184627341', 0, 'N', 0, '2012-12-20', NULL, NULL, 30.0461, -95.1898, NULL, NULL),
('760506276', 'W12027180', 'W12027180', 'TXHOUSTD', 'Northeast OB-GYN Associates ', 'Christopher', '', 'Glenn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '19701 Kingwood Dr Bldg 5', 'Kingwood', 'Harris', 'TX', '77339', '2813194111', '2813194623', '19701 Kingwood Dr Bldg 5', 'Kingwood', 'Harris', 'TX', '77339', '2813194111', '2813194623', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992786149', 0, 'N', 0, '2012-12-20', NULL, NULL, 30.0461, -95.1898, NULL, NULL),
('650930853', 'W12027182', 'W12027182', 'TXHOUSTD', 'Foot and Ankle Associates', 'Marco', 'A', 'Vargas', 'MD', 'Podiatry', '', '', NULL, 'O', '117 Hwy 90 A E', 'Richmond', 'Fort Bend', 'TX', '77469', '2813428700', '8325324118', '117 Hwy 90 A E', 'Richmond', 'Fort Bend', 'TX', '77469', '2813428700', '8325324118', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760582647', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.585, -95.7555, NULL, NULL),
('650930853', 'W12027181', 'W12027181', 'TXHOUSTD', 'Foot and Ankle Associates', 'Marco', 'A', 'Vargas', 'MD', 'Podiatry', '', '', NULL, 'O', '17510 W Grand Pwy S Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130090', '2817544688', '17510 W Grand Pwy S Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130090', '2817544688', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760582647', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.5639, -95.688, NULL, NULL),
('760403765', 'W12027183', 'W12027183', 'TXHOUSTD', 'Willits, Verne', 'Verne', 'L', 'Willits', 'MD', 'Internal Medicine', '', '', NULL, 'O', '15035 E Fwy', 'Channelview', 'Harris', 'TX', '77530', '2814523983', '2814525168', '15035 E Fwy', 'Channelview', 'Harris', 'TX', '77530', '2814523983', '2814525168', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841204864', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.7732, -95.146, NULL, NULL),
('841617523', 'W12027184', 'W12027184', 'NM01', 'Northside Family Medicine', 'Vivian', 'B', 'Giudice', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1174617542', 0, 'N', 0, '2013-02-06', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('263160344', 'W12027185', 'W12027185', 'TXHOUSTD', 'Champions Pediatric Associates', 'Aisha', 'J', 'Ahmed', 'MD', 'Pediatrics', '', '', NULL, 'O', '18607 Kuykendahl Rd', 'Spring', 'Harris', 'TX', '77379', '2813701122', '2813701139', '18607 Kuykendahl Rd', 'Spring', 'Harris', 'TX', '77379', '2813701122', '2813701139', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-28', 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1023201118', 0, 'N', 0, '2014-05-02', NULL, NULL, 30.0406, -95.4887, NULL, NULL),
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('263160344', 'W12027189', 'W12027189', 'TXHOUSTD', 'Champions Pediatric Associates', 'Shams', 'S', 'Nandwani', 'MD', 'Pediatrics', '', '', NULL, 'O', '25201 Kuykendahl Rd Ste 650', 'Tomball', 'Harris', 'TX', '77375', '2813701122', '2813701139', '25201 Kuykendahl Rd Ste 650', 'Tomball', 'Harris', 'TX', '77375', '2813701122', '2813701139', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1134121551', 0, 'N', 0, '2013-01-08', NULL, NULL, 30.123, -95.5541, NULL, NULL),
('263160344', 'W12027190', 'W12027190', 'TXHOUSTD', 'Champions Pediatric Associates', 'Karla', '', 'Rangel', 'NP', 'Pediatrics', '', '', NULL, 'O', '18607 Kuykendahl Rd', 'Spring', 'Harris', 'TX', '77379', '2813701122', '2813701139', '18607 Kuykendahl Rd', 'Spring', 'Harris', 'TX', '77379', '2813701122', '2813701139', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699028670', 0, 'Y', 0, '2013-03-27', NULL, NULL, 30.0406, -95.4887, NULL, NULL),
('263160344', 'W12027191', 'W12027191', 'TXHOUSTD', 'Champions Pediatric Associates', 'Karla', '', 'Rangel', 'NP', 'Pediatrics', '', '', NULL, 'O', '25201 Kuykendahl Rd Ste 650', 'Tomball', 'Harris', 'TX', '77375', '2813701122', '2813701139', '25201 Kuykendahl Rd Ste 650', 'Tomball', 'Harris', 'TX', '77375', '2813701122', '2813701139', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699028670', 0, 'Y', 0, '2013-01-08', NULL, NULL, 30.123, -95.5541, NULL, NULL),
('201196128', 'W12027192', 'W12027192', 'TXHOUSTD', 'Sugar Land Medical', 'Rueywen', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'O', '16659 Southwest Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', '16659 SW Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548257884', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('201196128', 'W12027193', 'W12027193', 'TXHOUSTD', 'Sugar Land Medical', 'Paul', '', 'Tse', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16659 Southwest Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', '16659 SW Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1629279153', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('760642971', 'W12027197', 'W12027197', 'TXHOUSTD', 'Lee R Colosimo MD', 'Lee', 'R', 'Colosimo', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '19411 McKay Dr Ste 250', 'Humble', 'Harris', 'TX', '77338', '2815403838', '2815406773', '19411 McKay Dr Ste 250', 'Humble', 'Harris', 'TX', '77338', '2815403838', '2815406773', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851393888', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0016, -95.2753, NULL, NULL),
('201196128', 'W12027198', 'W12027198', 'TXHOUSTD', 'Sugar Land Medical', 'Wen LI', '', 'Chang', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16659 Southwest Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', '16659 SW Fwy Ste 401', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812652225', '2812651556', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356385249', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('134342845', 'W12027199', 'W12027199', 'TXHOUSTD', 'Allencherril, Paul', 'Paul', 'J', 'Allencherril', 'MD', 'Internal Medicine', '', '', NULL, 'O', '15035 E Fwy', 'Channelview', 'Harris', 'TX', '77530', '2814523983', '2814525168', '15035 E Fwy', 'Channelview', 'Harris', 'TX', '77530', '2814523983', '2814525168', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437173168', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.7732, -95.146, NULL, NULL),
('760550011', 'W12027201', 'W12027201', 'TXHOUSTD', 'Jia John MD', 'John', 'Z', 'Jia', 'MD', 'Pediatrics', '', '', NULL, 'O', '5201 Hwy 6 Ste 500', 'Missouri City', 'Fort Bend', 'TX', '77459', '2812084600', '2812084608', '5201 Hwy 6 Ste 500', 'Missouri City', 'Fort Bend', 'TX', '77459', '2812084600', '2812084608', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467435016', 0, 'N', 0, '2013-06-04', NULL, NULL, 29.5757, -95.5757, NULL, NULL),
('760550011', 'W12027200', 'W12027200', 'TXHOUSTD', 'Jia John MD', 'John', 'Z', 'Jia', 'MD', 'Pediatrics', '', '', NULL, 'O', '9110 Bellaire Blvd Ste C', 'Houston', 'Harris', 'TX', '77036', '7132726366', '7132726336', '9110 Bellaire Blvd Ste C', 'Houston', 'Harris', 'TX', '77036', '7132726366', '7132726336', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467435016', 0, 'N', 0, '2013-06-04', NULL, NULL, 29.705, -95.5442, NULL, NULL),
('760534474', 'W12027202', 'W12027202', 'TXHOUSTD', 'Peggy Wongsa MD', 'Peggy', '', 'Wongsa', 'MD', 'Pediatrics', '', '', NULL, 'O', '11302 Fallbrook Dr Ste 305', 'Houston', 'Harris', 'TX', '77065', '2818971122', '2818970777', '11302 Fallbrook Dr Ste 305', 'Houston', 'Harris', 'TX', '77065', '2818971122', '2818970777', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1699743674', 0, 'N', 0, '2013-10-11', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('200830401', 'W12027203', 'W12027203', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', '', '', 'Ear Nose and Throat Associates of Texas', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093839342', 0, 'Y', 0, '2013-07-03', NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('200830401', 'W12027205', 'W12027205', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', '', '', 'Ear Nose and Throat Associates of Texas', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093839342', 0, 'Y', 0, '2013-07-03', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('200830401', 'W12027204', 'W12027204', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', '', '', 'Ear Nose and Throat Associates of Texas', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6717 W Eldorado Pkwy Ste 140', 'McKinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', '6717 W Eldorado Pkwy Ste 140', 'McKinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093839342', 0, 'Y', 0, '2013-07-03', NULL, NULL, 33.1741, -96.7048, NULL, NULL),
('200830401', 'W12027209', 'W12027209', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Neelesh', 'H', 'Mehendale', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '6717 W Eldorado Pkwy Ste 140', 'McKinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', '6717 W Eldorado Pkwy Ste 140', 'Mckinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1235134271', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.1741, -96.7048, NULL, NULL),
('200830401', 'W12027207', 'W12027207', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Neelesh', 'H', 'Mehendale', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1235134271', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('200830401', 'W12027208', 'W12027208', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Neelesh', 'H', 'Mehendale', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1235134271', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('200830401', 'W12027211', 'W12027211', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Chad', 'M', 'McDuffie', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1851341085', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('200830401', 'W12027212', 'W12027212', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Chad', 'M', 'McDuffie', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1851341085', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('200830401', 'W12027213', 'W12027213', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Chad', 'M', 'McDuffie', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '6717 W Eldorado Pkwy Ste 140', 'McKinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', '6717 W Eldorado Pkwy Ste 140', 'Mckinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1851341085', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.1741, -96.7048, NULL, NULL),
('200830401', 'W12027215', 'W12027215', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Dale', 'R', 'Ehmer Jr', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1710030473', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('200830401', 'W12027216', 'W12027216', 'TXDALSTD', 'Ear Nose and Throat Associates of Texas', 'Dale', 'R', 'Ehmer Jr', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', 'ENTofTX', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1710030473', 0, 'N', 0, '2012-12-19', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
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('621801973', 'W12027232', 'W12027232', 'UT01', 'Hyperbaric & Wound Care Center', 'Horace', 'P', 'Guerra', 'MD', 'Family Practice', '', '', NULL, 'O', '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', '8018077904', '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', '8018077904', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-15', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376643296', 0, 'N', 0, '2012-12-17', NULL, NULL, 41.0892, -111.997, 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
('000000PPA', 'W12027194', 'W12027194', 'ILCHIGSTD', 'Provena Physicians Alliance', '', '', 'Provena Physicians Alliance', '', 'Clinics', '', '', NULL, 'O', '19065 Hickory Creek Dr Ste 300', 'Mokena', 'Will', 'IL', '60448', '8157417378', '8157417143', '19065 Hickory Creek Dr Ste 300', 'Mokena', 'Will', 'IL', '60448', '8157417378', '8157417143', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010020', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('000000PPA', 'W12027195', 'W12027195', 'ILCHIGSTD', 'Provena Physicians Alliance', '', '', 'Provena Physicians Alliance', '', 'Clinics', '', '', NULL, 'M', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417378', '8157417143', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417378', '8157417143', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010020', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('000009967', 'W12027241', 'W12027241', 'TXHOUSTD', 'HCA TX', '', '', 'HCA TX', '', 'Clinics', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010022', 0, 'Y', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12025662', 'W12025662', 'UT01', 'Ashley Regional Medical Center', 'Nolan', 'R', 'Brooksby', 'DO', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '150 W 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357893342', '          ', '150 W 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357893342', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1912949603', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.4571, -109.531, NULL, NULL),
('942938348', 'W40006811', 'W40006811', 'UTMH1', 'Valley Mental Health  Inc', 'KIMBERLY', NULL, 'KETTLE', '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|', '1871573634', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('510560819', 'W12023598', 'W12023598', 'UT01', '', 'Michael', 'L', 'Nelson', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017943856', NULL, 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017943856', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710909122', 0, 'Y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40017425', 'W40017425', 'UTMH1', ' Valley Mental Health Inc', 'Bryan D', NULL, 'Nestripke', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHPHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689784688', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820392395', 'SACN00629', 'SACN00629', 'SACN', NULL, 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', NULL, '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'n', 0, '2013-10-30', NULL, NULL, 43.6238, -116.273, NULL, NULL),
('820471484', 'SACN00630', 'SACN00630', 'SACN', 'Kuna Family Medical Clinic', 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'n', 0, '2013-10-30', NULL, NULL, 43.4909, -116.415, NULL, NULL),
('611684739', 'ELHCA0155', 'ELHCA0155', 'TXHOUSTD', 'Conroe Physician Associates', 'James', 'D', 'Pickett', 'MD', 'Cardiology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003904962', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0156', 'ELHCA0156', 'TXHOUSTD', 'Conroe Physician Associates', 'James', 'D', 'Pickett', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003904962', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003838', 'W12003838', 'UTIHC02', 'Physical Therapy', 'Lindsay', 'A', 'Newlin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 4400', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-22', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609193390', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003839', 'W12003839', 'UTIHC03', 'Physical Therapy', 'Lindsay', 'A', 'Newlin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 4400', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-22', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609193390', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820471484', 'SACN00631', 'SACN00631', 'SACN', 'Kuna Family Medical Clinic', 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870436102', 'W12002069', 'W12002069', 'UTDT01', '', 'David', '', 'Nance', 'DMD', 'Dentist', '', '', NULL, 'O', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014891000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-03-01', NULL, NULL, 0, NULL, '', '', '', '', 'DEN|', '0001000007', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('204157017', 'SACN00361', 'SACN00361', 'SACN', 'Jensen Eye Associates', 'Emily ', 'J', 'Naugle', 'OD', 'Optometry', '', '', NULL, 'O', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '2084674450', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '2084674450', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1639331069', 0, 'N', 0, '2014-03-14', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('205934739', 'SACN00317', 'SACN00317', 'SACN', 'Family Medicine Health Center', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'n', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA0175', 'ELHCA0175', 'TXHOUSTD', 'Conroe Physician Associates', 'Timothy', '', 'Reynolds', 'MD', 'Cardiology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1033403530', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0176', 'ELHCA0176', 'TXHOUSTD', 'Conroe Physician Assoc ', 'Timothy', '', 'Reynolds', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', NULL, NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1033403530', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00315', 'SACN00315', 'SACN', 'Family Medicine Health Center', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'n', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006743', 'W40006743', 'UTMH1', 'Valley Mental Health  Inc', 'SUSAN T', NULL, 'MILLER', 'APRN', 'Mental Health', '', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528045457', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'SACN00716', 'SACN00716', 'SACN', 'Treasure Valley Hearing and Balance Clinic', 'Melvin', '', 'Miller', 'AUD', 'Audiology', '', '', NULL, 'O', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', '1084 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083770019', '2083770313', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1164655262', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W40016146', 'W40016146', 'UTMH1', 'Northeastern Counseling Center', 'Melody', 'A', 'Miller', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508949785', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W40016142', 'W40016142', 'UTMH1', 'Northeastern Counseling Center', 'Melody', 'A', 'Miller', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508949785', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.292, -109.993, NULL, NULL),
('820477852', 'SACN00770', 'SACN00770', 'SACN', 'Saint Alphonsus Medical Group McMillan', 'Katherine', 'E', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'o', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225066707', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6481, -116.335, NULL, NULL),
('820200895', 'SACN00769', 'SACN00769', 'SACN', 'Saint Alphonsus Medical Group McMillan', 'Katherine', 'E', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225066707', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6481, -116.335, NULL, NULL),
('264260933', 'ELHCA0125', 'ELHCA0125', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Jonna', NULL, 'Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1508859802', 0, 'N', 0, '2014-01-14', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('264260933', 'ELHCA0126', 'ELHCA0126', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Jonna', NULL, 'Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1508859802', 0, 'Y', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('273225359', 'ELHCA0124', 'ELHCA0124', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Jessica', NULL, 'Miller', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', NULL, NULL, 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '', '', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104172907', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('273225359', 'ELHCA0123', 'ELHCA0123', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Jessica', NULL, 'Miller', 'NP', 'Family Practice', '', '', NULL, 'O', '1108 S Gulf Fwy Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', '1108 S Gulf Fwy Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104172907', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.495, -95.1088, NULL, NULL),
('942938348', 'W40006921', 'W40006921', 'UTMH1', 'Valley Mental Health  Inc', 'ARTHUR', NULL, 'MILLER', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659342921', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008475', 'W12008475', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12010642', 'W12010642', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('611684739', 'ELHCA0021', 'ELHCA0021', 'TXHOUSTD', 'Conroe Physician Associates', 'George', NULL, 'Boyle', 'MD', 'Cardiology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205850286', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0022', 'ELHCA0022', 'TXHOUSTD', 'Conroe Physician Associates', 'George', NULL, 'Boyle', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205850286', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12007558', 'W12007558', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-03', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('870373083', 'W12018860', 'W12018860', 'UT01', 'Heart and Lung Institute of Utah Inc', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870373083', 'W12007559', 'W12007559', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-03', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12013603', 'W12013603', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', NULL, 0, NULL, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('942938348', 'W40004220', 'W40004220', 'UTMH1', 'Valley Mental Health  Inc', 'Lydia', '', 'Midgley', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730382847', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('272783644', 'W40022453', 'W40022453', 'UTMH1', 'Helping Hands Counseling ', 'Lydia', '', 'Midgley', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '11075 S State St Ste 30', 'Sandy', 'Salt Lake', 'UT', '84070', '8017555531', NULL, '11075 S State St Ste 30', 'Sandy', 'Salt Lake', 'UT', '84070', '8017555531', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730382847', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.5502, -111.891, NULL, NULL),
('942938348', 'W40006920', 'W40006920', 'UTMH1', 'Valley Mental Health  Inc', 'RICHARD', NULL, 'MICKELSEN', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740250372', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('760545192', 'W12030007', 'W12030007', 'TXHOUSTD', 'Houston Methodist Sugar Land Hospital', '', '', 'Houston Methodist Sugar Land Hospital', '', 'Hospital', '', '', NULL, 'B', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', 'PO Box 4755', 'Houston', 'Harris', 'TX', '77210', '8774933228', '8326675903', '', '', 'METHOUST1', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497871628', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('263091562', 'ELHCA0122', 'ELHCA0122', 'TXHOUSTD', 'Mainland Primary Care Physicians ', 'Dorothy ', NULL, 'Merritt', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405470      ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 405470      ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881698579', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA0019', 'ELHCA0019', 'TXHOUSTD', 'Conroe Physician Associates', 'Laura', '', 'Bonds', 'MD', 'Neurology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295919116', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0020', 'ELHCA0020', 'TXHOUSTD', 'Conroe Physician Associates', 'Laura', '', 'Bonds', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295919116', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263091562', 'ELHCA0121', 'ELHCA0121', 'TXHOUSTD', 'Mainland Primary Care Physicians ', 'Dorothy ', NULL, 'Merritt', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6807 Emmett F Lowry Expwy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', '6807 Emmett F Lowry Expwy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881698579', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.3953, -94.9874, NULL, NULL),
('942938348', 'W40006829', 'W40006829', 'UTMH1', 'Valley Mental Health  Inc', 'PATRICIA L', NULL, 'MERKLEY', '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|', '1659340164', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('263094218', 'ELHCA0118', 'ELHCA0118', 'TXHOUSTD', 'Medrano, Juan', 'Juan', 'C', 'Medrano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405712      ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405712      ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1063515161', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263094218', 'ELHCA0117', 'ELHCA0117', 'TXHOUSTD', 'Medrano, Juan', 'Juan', 'C', 'Medrano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 800', 'Houston', 'Harris', 'TX', '77054', '7137971100', '7137979757', '7400 Fannin St Ste 800', 'Houston', 'Harris', 'TX', '77054', '7137971100', '7137979757', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1063515161', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('263091124', 'ELHCA0116', 'ELHCA0116', 'TXHOUSTD', 'Complete Womens Care Center', 'Kathleen', NULL, 'Mechler', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1093018244', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0115', 'ELHCA0115', 'TXHOUSTD', 'Complete Womens Care Center', 'Kathleen', NULL, 'Mechler', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1093018244', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('611684739', 'ELHCA0093', 'ELHCA0093', 'TXHOUSTD', 'Conroe Physician Associates', 'Alexander', NULL, 'Klein ', 'MD', 'Gynecology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336236207', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0094', 'ELHCA0094', 'TXHOUSTD', 'Conroe Physician Assoc ', 'Alexander', NULL, 'Klein ', 'MD', 'Gynecology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', NULL, NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336236207', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006919', 'W40006919', 'UTMH1', 'Valley Mental Health  Inc', 'Michael', 'O', 'Measom', '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, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1861479701', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870470032', 'W40005424', 'W40005424', 'UTMH1', NULL, 'Michael', 'O', 'Measom', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', NULL, 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', '', 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1861479701', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA0211', 'ELHCA0211', 'TXHOUSTD', 'Conroe Physician Assoc ', 'Lindsay', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366485369', 0, 'Y', 0, '2014-06-11', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0212', 'ELHCA0212', 'TXHOUSTD', 'Conroe Physician Assoc ', 'Lindsay', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366485369', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006828', 'W40006828', 'UTMH1', 'Valley Mental Health  Inc', 'TYLEAN A', NULL, 'MCTURK', '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|', '1861470320', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870470032', 'W40005423', 'W40005423', 'UTMH1', 'A/D Psychotherapy  & Clinical', 'Michael', 'O', 'Measom', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', NULL, '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', '', 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1861479701', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.5975, -111.872, NULL, NULL),
('611684739', 'ELHCA0141', 'ELHCA0141', 'TXHOUSTD', 'Conroe Physician Associates', 'James', 'P', 'ONeal', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376527218', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0142', 'ELHCA0142', 'TXHOUSTD', 'Conroe Physician Associates', 'James', 'P', 'ONeal', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376527218', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'SACN00370', 'SACN00370', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL);
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('826041596', 'SACN00368', 'SACN00368', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', NULL, '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'SACN00367', 'SACN00367', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', NULL, '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('611684739', 'ELHCA0007', 'ELHCA0007', 'TXHOUSTD', 'Conroe Physician Associates', 'Jason Scott', '', 'Ashford', 'MD', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407050347', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
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('826041596', 'SACN00366', 'SACN00366', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA0201', 'ELHCA0201', 'TXHOUSTD', 'Conroe Physician Associates', 'Kyle', '', 'Scarborough', 'MD', 'Family Practice', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-05-01', 0, 0, 0, 'Conroe Regional Medical Center', '', '', '', 'HCFA|UB|', '1417045303', 0, 'N', 0, '2014-06-11', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0202', 'ELHCA0202', 'TXHOUSTD', 'Conroe Physician Assoc ', 'Kyle', '', 'Scarborough', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-05-01', 0, 0, 0, 'Conroe Regional Medical Center', '', '', '', 'HCFA|UB|', '1417045303', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'SACN00363', 'SACN00363', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653651', NULL, '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653651', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('826041596', 'SACN00364', 'SACN00364', 'SACN', 'Gem State Radiology LLP dba Advanced Vein Therapy', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089470100', '2086396625', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089470100', '2086396625', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'SACN00362', 'SACN00362', 'SACN', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('942854057', 'W12002303', 'W12002303', 'UTIHCPHY', 'Bountiful KidsCare', 'Gary', 'J', 'McFadden', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1669495420', 0, 'Y', 0, '2013-02-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('454855728', 'W12019200', 'W12019200', 'UT01', 'Obstetrix Medical Group of Utah', 'Sterling', 'W', 'McColgin', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1760513204', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('942854057', 'W12003820', 'W12003820', 'UTIHC04', 'Physical Therapy', 'W Luke', '', 'McCausland', 'PT', 'Physical Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-20', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972824548', 0, 'N', 0, '2013-02-28', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12003819', 'W12003819', 'UTIHC03', 'Physical Therapy', 'W Luke', '', 'McCausland', 'PT', 'Physical Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-20', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972824548', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0113', 'ELHCA0113', 'TXHOUSTD', 'McBride, James', 'James', NULL, 'McBride', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7580 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137979171', '7137970493', '7580 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137979171', '7137970493', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1164485009', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6931, -95.401, NULL, NULL),
('263091124', 'ELHCA0114', 'ELHCA0114', 'TXHOUSTD', 'McBride, James', 'James', NULL, 'McBride', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1164485009', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006825', 'W40006825', 'UTMH1', 'Valley Mental Health  Inc', 'Bill', '', 'Mastson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578549127', 0, 'Y', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('263091124', 'ELHCA0111', 'ELHCA0111', 'TXHOUSTD', 'Complete Womens Care Center', 'Shauna', '', 'Mason', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1760756100', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('611684739', 'ELHCA0075', 'ELHCA0075', 'TXHOUSTD', 'Conroe Physician Associates', 'Blair', NULL, 'Jordan', 'MD', 'General Surgery', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1457448490', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0076', 'ELHCA0076', 'TXHOUSTD', 'Conroe Physician Associates', 'Blair', NULL, 'Jordan', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1457448490', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('501523991', 'SACN01217', 'SACN01217', 'SACN', '', 'Rand', 'G', 'Martel', 'LCPC LMFT', 'Mental Health', 'Marriage & Family Therapy', 'Counseling', NULL, 'O', '7745 W Long Dr', 'Boise', 'Ada', 'ID', '83704', '2083273533', NULL, '7745 W Long Dr', 'Boise', 'Ada', 'ID', '83704', '2083273533', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619051463', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006917', 'W40006917', 'UTMH1', 'Valley Mental Health  Inc', 'Ludmil', 'K', 'Manov', '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, '', '', '', '', 'HCFA|UB|', '1629098108', 0, 'Y', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA0109', 'ELHCA0109', 'TXHOUSTD', 'Maniscalco, Stephen', 'Stephen', '', 'Maniscalco', 'MD', 'Cardiothoracic Surgery', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891716403', 0, 'N', 0, '2013-12-18', NULL, NULL, 30.2849, -95.466, NULL, NULL),
('381966107', 'W12024890', 'W12024890', 'ID02', 'DaVita Nampa Dialysis Center', 'Michael', 'C', 'Mallea', 'MD', 'Nephrology', '', '', NULL, 'O', '846 Park Centre Way', 'Nampa', 'Canyon', 'ID', '83651', '2083673370', '2083673332', '846 Park Centre Way  ', 'Nampa', 'Canyon', 'ID', '83651', '2083673370', '2083673332', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043235377', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'ELHCA0108', 'ELHCA0108', 'TXHOUSTD', 'Critical Care Pediatrics of Houston', 'Gautam', '', 'Malkani', 'MD', 'Hospitalist', 'Pediatric Critical Care Hospitalist', '', NULL, 'B', 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538113733', 0, 'Y', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'ELHCA0107', 'ELHCA0107', 'TXHOUSTD', 'Critical Care Pediatrics of Houston', 'Gautam', '', 'Malkani', 'MD', 'Hospitalist', 'Pediatric Critical Care Hospitalist', '', NULL, 'O', '500 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', '500 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538113733', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5411, -95.1263, NULL, NULL),
('942938348', 'W40006823', 'W40006823', 'UTMH1', 'Valley Mental Health  Inc', 'HOLLY', NULL, 'MAJOR-YEH', '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|', '1578540407', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('271712522', 'ELHCA0106', 'ELHCA0106', 'TXHOUSTD', 'Plus Care', 'Murtaza', '', 'Mahesri', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741115', 'Atlanta', 'Fulton', 'GA', '30374', NULL, NULL, 'PO Box 741115', 'Atlanta', 'Fulton', 'GA', '30374', '', '', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437253739', 0, 'Y', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40016889', 'W40016889', 'IDBOISTD', 'Primary Health Medical Group', 'Jenna', 'L', 'Maffey', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084666567', '2083451261', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084666567', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467787598', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40016888', 'W40016888', 'IDBOISTD', 'Primary Health Medical Group', 'Jenna', 'L', 'Maffey', 'PA', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2083451261', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467787598', 0, 'Y', 0, '2014-04-29', NULL, NULL, 43.5963, -116.59, NULL, NULL),
('201657769', 'ELHCA0143', 'ELHCA0143', 'TXHOUSTD', 'General and CardioVascular Surgeons of Conroe', 'Lori', '', 'Parker', 'PA', 'Cardiothoracic Surgery', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 300', 'Conroe', 'Montgomery', 'TX', '77304', '9365395000', '9365395027', '500 Medical Ctr Blvd Ste 300', 'Conroe', 'Montgomery', 'TX', '77304', '9365395000', '9365395027', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548273543', 0, 'Y', 0, '2013-05-01', NULL, NULL, 30.2831, -95.4693, NULL, NULL),
('201657769', 'ELHCA0144', 'ELHCA0144', 'TXHOUSTD', 'General and CardioVascular Surgeons of Conroe', 'Lori', '', 'Parker', 'PA', 'Cardiothoracic Surgery', '', '', NULL, 'B', 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548273543', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12024306', 'W12024306', 'UTMH1', 'The Counseling Center', 'Hilary', 'C', 'Madsen', 'LCSW', 'Mental Health', '', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528214327', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12024307', 'W12024307', 'UTMH1', 'The Counseling Center', 'Hilary', 'C', 'Madsen', 'LCSW', 'Mental Health', '', '', NULL, 'O', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528214327', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0104', 'ELHCA0104', 'TXHOUSTD', 'Womans OB-GYN Specialists', 'Maurizio', '', 'Maccato', 'MD', 'Obstetrics and Gynecology', 'Infectious Disease', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1369746830', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0103', 'ELHCA0103', 'TXHOUSTD', 'Womans OB-GYN Specialists', 'Maurizio', '', 'Maccato', 'MD', 'Obstetrics and Gynecology', 'Infectious Disease', '', NULL, 'O', '7900 Fannin St Ste 2650', 'Houston', 'Harris', 'TX', '77054', '7137971119', '7137969747', '7900 Fannin St Ste 2650', 'Houston', 'Harris', 'TX', '77054', '7137971119', '7137969747', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1369746830', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('611684739', 'ELHCA0133', 'ELHCA0133', 'TXHOUSTD', 'Conroe Physician Associates', 'Francis', 'J', 'Morrison', 'MD', 'Family Practice', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1578651402', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0134', 'ELHCA0134', 'TXHOUSTD', 'Conroe Physician Associates', 'Francis', 'J', 'Morrison', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1578651402', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40013462', 'W40013462', 'IDBOISTD', 'Primary Health Medical Group', 'Robert', 'A', 'Lyons', 'MD', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1699712034', 0, 'N', 0, '2013-03-01', NULL, NULL, 43.5903, -116.294, NULL, NULL),
('621801973', 'W12004513', 'W12004513', 'UT01', 'Davis Orthopedics', 'Matthew', 'H', 'Lyman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851307706', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('200954473', 'SACN00687', 'SACN00687', 'SACN', 'Winding Creek Medical Arts', 'Marion', 'L', 'Luque', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1139 E Winding Creek Dr', 'Eagle', 'Ada', 'ID', '83616', '2089388887', '2089388897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1124088331', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004511', 'W12004511', 'UT01', 'Davis Orthopedics', 'Matthew', 'H', 'Lyman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017733900', NULL, '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017733900', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851307706', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40017443', 'W40017443', 'UTMH1', ' Valley Mental Health Inc', 'Andrea', '', 'Lunt', '', 'Mental Health', '', '', 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, '', '', '', '', 'HCFA|UB|', '1588899074', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006822', 'W40006822', 'UTMH1', 'Valley Mental Health  Inc', 'RICKIE', 'B', 'LUNDSTROM', '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|', '1942271028', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40022492', 'W40022492', 'IDBOISTD', 'Primary Health Medical Group-Overland', 'Joseph', '', 'Luna', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568680197', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA0147', 'ELHCA0147', 'TXHOUSTD', 'Conroe Physician Associates', 'Patricia', NULL, 'Patrinely', 'DO', 'Family Practice', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1619957636', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA0148', 'ELHCA0148', 'TXHOUSTD', 'Conroe Physician Associates', 'Patricia', NULL, 'Patrinely', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1619957636', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40022493', 'W40022493', 'IDBOISTD', 'Primary Health Medical Group-Overland', 'Joseph', '', 'Luna', 'PA', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', NULL, '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568680197', 0, 'N', 0, '2013-11-25', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('870395551', 'W12001282', 'W12001282', 'ID02', '', 'James', 'S', 'Luckock', 'DC', 'Chiropractic', '', '', NULL, 'O', '105 Filer Rd', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087330522', '2087330522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-04-10', '2010-10-31', NULL, 0, 1, '', '', '', '', 'HCFA|UB|DEN|', '1932251899', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006888', 'W40006888', 'UTMH1', 'Valley Mental Health  Inc', 'KRISTINE LOUISE', '', 'LUBLIN', 'LPC', 'Mental Health', 'Counseling', '', 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, '', '', '', '', 'HCFA|UB|', '1942280557', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202622667', 'ELHCA0102', 'ELHCA0102', 'TXHOUSTD', 'Santa Fe Family Health Ctr', 'Nancy', NULL, 'Lounds', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205901204', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('202622667', 'ELHCA0101', 'ELHCA0101', 'TXHOUSTD', 'Santa Fe Family Health Ctr', 'Nancy', NULL, 'Lounds', 'PA', 'Family Practice', '', '', NULL, 'O', '4225 FM 646                                      Ste 100', 'Santa Fe', 'Galveston', 'TX', '77510', '4099272040', '4099272060', '4225 FM 646                                      Ste 100', 'Santa Fe', 'Galveston', 'TX', '77510', '4099272040', '4099272060', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205901204', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.3804, -95.0896, NULL, NULL),
('202630141', 'W40013461', 'W40013461', 'IDBOISTD', 'Primary Health Medical Group', 'Timothy', '', 'Loewenstein', 'PA', 'Family Practice', '', '', NULL, 'O', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376597377', 0, 'Y', 0, '2013-07-11', NULL, NULL, 43.6166, -116.356, NULL, NULL),
('820455201', 'SACN00557', 'SACN00557', 'SACN', '', 'John', 'M', 'Livingston', 'MD', 'General Surgery', '', '', NULL, 'O', '8756 W Emerald Ste 136', 'Boise', 'Ada', 'ID', '83706', '2088533051', '2088533053', '8756 W Emerald Ste 136', 'Boise', 'Ada', 'ID', '83706', '2088533051', '2088533053', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2013-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1013064641', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('820455201', 'SACN00556', 'SACN00556', 'SACN', '', 'John', 'M', 'Livingston', 'MD', 'General Surgery', '', '', NULL, 'B', '1475 Tyrell', 'Boise', 'Ada', 'ID', '83706', '2083239130', '2083239070', '1475 Tyrell', 'Boise', 'Ada', 'ID', '83706', '2083239130', '2083239070', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2013-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1013064641', 0, 'Y', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('352332742', 'W12001568', 'W12001568', 'ID01', 'Healthy Habits Wellness Clinic', 'Cory', '', 'Lindstrom', 'DC', 'Chiropractic', '', '', NULL, 'O', '14 S Baltic Place', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-10-01', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1265677587', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6045, -116.38, NULL, NULL),
('942938348', 'W40017446', 'W40017446', 'UTMH1', ' Valley Mental Health Inc', 'Marilyn', NULL, 'Little', 'APRN/NP', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467606228', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('611684739', 'ELHCA0120', 'ELHCA0120', 'TXHOUSTD', 'Conroe Physician Associates', 'Amy', NULL, 'Mellonig', 'AuD', 'Audiology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649442690', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('870635889', 'W12004727', 'W12004727', 'UT01', 'Grantsville Medical Center', 'Benjamin', 'J', 'Krogh', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, NULL, 0, NULL, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013003540', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12004728', 'W12004728', 'UT01', 'Grantsville Medical Center', 'Benjamin', 'J', 'Krogh', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, NULL, 0, NULL, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013003540', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.5996, -112.426, NULL, NULL);
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('942938348', 'W40006813', 'W40006813', 'UTMH1', 'Valley Mental Health  Inc', 'ELAINE', NULL, 'KNUDSEN', '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|', '1881629681', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W40013460', 'W40013460', 'IDBOISTD', 'Primary Health Medical Group', 'Robert', '', 'Klomp', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '100 E Idaho Ste 401', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', '100 E Idaho Ste 401', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952351710', 0, 'N', 0, '2013-07-11', NULL, NULL, 43.6122, -116.195, NULL, NULL),
('942938348', 'W40024041', 'W40024041', 'UTMH1', 'Valley Mental Health  Inc', 'Gary', 'J', 'Klein', '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|', '1861613853', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('362985395', 'ELPPA0005', 'ELPPA0005', 'ILCHIGSTD', 'Advanced Urology Associates', 'Thomas', 'E', 'Burns', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003896903', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('364314354', 'ELPPA0007', 'ELPPA0007', 'ILCHIGSTD', 'Provena Medical Group - Lemont', 'Iulia', '', 'Enacopol', 'MD', 'Internal Medicine', '', '', NULL, 'O', '15947 127th St Ste B', 'Lemont', 'Cook', 'IL', '60439', '6302436300', '6302436336', '15947 127th St Ste B', 'Lemont', 'Cook', 'IL', '60439', '6302436300', '6302436336', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1003899741', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6565, -88.0052, NULL, NULL),
('364314354', 'ELPPA0008', 'ELPPA0008', 'ILCHIGSTD', 'Provena Medical Group - Lemont', 'Iulia', '', 'Enacopol', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'Provena Service Corporation 25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '6302436300', '6302436336', 'Provena Service Corporation 25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '6302436300', '6302436336', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1003899741', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'ELPPA0010', 'ELPPA0010', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Neelima', 'D', 'Kabre', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '15 Salt Creek Ln  Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '8157251355', '8157259861', '15 Salt Creek Ln  Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', '2013-07-25', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1023096294', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'ELPPA0009', 'ELPPA0009', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Neelima', 'D', 'Kabre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2614 Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', '2013-01-01', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1023096294', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.5212, -88.1479, NULL, NULL),
('362985395', 'ELPPA0011', 'ELPPA0011', 'ILCHIGSTD', 'Advanced Urology Associates', 'Gregory', 'A', 'Lewis', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1023098910', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('362643663', 'ELPPA0015', 'ELPPA0015', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'Joseph', 'J', 'Natarelli', 'DO', 'Pathology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157257080', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157257080', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043208317', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362643663', 'ELPPA0016', 'ELPPA0016', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'Joseph', 'J', 'Natarelli', 'DO', 'Pathology', '', '', NULL, 'B', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157257080', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157257080', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043208317', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0017', 'ELPPA0017', 'ILCHIGSTD', 'EMP of Will County', 'Matthew', '', 'Nitsche', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043210446', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363966193', 'ELPPA0019', 'ELPPA0019', 'ILCHIGSTD', 'Jercinovic Pediatrics', 'Bruno', 'J', 'Jercinovic', 'MD', 'Pediatrics', '', '', NULL, 'O', '611 W Jefferson St', 'Shorewood', 'Will', 'IL', '60404', '8157291144', '8157292587', '611 W Jefferson St', 'Shorewood', 'Will', 'IL', '60404', '8157291144', '8157292587', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043273915', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5215, -88.2033, NULL, NULL),
('362711176', 'ELPPA0021', 'ELPPA0021', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Shilpa', '', 'Thakkar', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043278070', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0022', 'ELPPA0022', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Shilpa', '', 'Thakkar', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043278070', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362830077', 'ELPPA0023', 'ELPPA0023', 'ILCHIGSTD', 'Premier Dermatology', 'Lalitha', '', 'Reddy', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1053306597', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('364030589', 'ELPPA0025', 'ELPPA0025', 'ILCHIGSTD', 'Fine Skin', 'Seema', 'Sahia', 'Sheth', 'MD', 'Dermatology', '', '', NULL, 'O', '2202 Essington Rd Ste 101', 'Joliet', 'Will', 'IL', '60435', '8156765310', '8157251321', '2202 Essington Rd Ste 101', 'Joliet', 'Will', 'IL', '60435', '8156765310', '8157251321', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-03', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1053519595', 0, 'N', 0, '2014-05-29', NULL, NULL, 41.561, -88.1615, NULL, NULL),
('271846104', 'ELPPA0029', 'ELPPA0029', 'ILCHIGSTD', 'Jill Patterson MD', 'Jill', 'A', 'Patterson', 'MD', 'Family Practice', '', '', NULL, 'O', '11148 Front St', 'Mokena', 'Will', 'IL', '60448', '7084785763', '7084788763', '11148 Front St', 'Mokena', 'Will', 'IL', '60448', '7084785763', '7084788763', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1083642557', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5308, -87.8883, 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
('362711176', 'ELPPA0031', 'ELPPA0031', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Syung', 'H', 'Paik', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083671226', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0032', 'ELPPA0032', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Syung', 'H', 'Paik', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083671226', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364121175', 'ELPPA0033', 'ELPPA0033', 'ILCHIGSTD', 'ENT Surgical Consultants  ', 'Ankit', '', 'Patel', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2201 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157251191', '8157252048', '2201 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157251191', '8157252048', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1083697692', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5296, -88.1347, NULL, NULL),
('364195126', 'ELPPA0035', 'ELPPA0035', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Marquess', 'T', 'Wilson', 'MD', 'Neurology', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093963670', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0036', 'ELPPA0036', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Marquess', 'T', 'Wilson', 'MD', 'Neurology', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093963670', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('362711176', 'ELPPA0037', 'ELPPA0037', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Yun', 'P', 'Kipnis', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157254709', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093968257', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0038', 'ELPPA0038', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Yun', 'P', 'Kipnis', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157259160', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157259160', '8157254709', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093968257', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('383701260', 'ELPPA0039', 'ELPPA0039', 'ILCHIGSTD', 'Kidney Care Center', 'Amit', 'B', 'Jamnadas', 'MD', 'Nephrology', '', '', NULL, 'O', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157416832', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157416832', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104072305', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5369, -88.148, NULL, NULL),
('383701260', 'ELPPA0040', 'ELPPA0040', 'ILCHIGSTD', 'Kidney Care Center', 'Amit', 'B', 'Jamnadas', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', '8157416832', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', '8157416832', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104072305', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0042', 'ELPPA0042', 'ILCHIGSTD', '', 'Sudarsana', '', 'Chakrabarti', 'MD', 'Internal Medicine', '', '', NULL, 'B', '310 N Hammes  Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes  Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104096940', 0, 'Y', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0041', 'ELPPA0041', 'ILCHIGSTD', '', 'Sudarsana', '', 'Chakrabarti', 'MD', 'Internal Medicine', '', '', NULL, 'O', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104096940', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5284, -88.1313, NULL, NULL),
('200160739', 'ELPPA0043', 'ELPPA0043', 'ILCHIGSTD', 'Mokena Family Physicians  ', 'Joseph', '', 'Prieboy', 'DO', 'Family Practice', '', '', NULL, 'O', '11243 La Porte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', '11243 La Porte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1104841204', 0, 'N', 0, '2013-03-25', NULL, NULL, 41.5267, -87.8908, NULL, NULL),
('200160739', 'ELPPA0044', 'ELPPA0044', 'ILCHIGSTD', 'Mokena Family Physicians  ', 'Joseph', '', 'Prieboy', 'DO', 'Family Practice', '', '', NULL, 'B', '11243 LaPorte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', '11243 LaPorte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1104841204', 0, 'Y', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('061818027', 'ELPPA0045', 'ELPPA0045', 'ILCHIGSTD', 'Suburban Gynecology', 'Nahla', '', 'Merhi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 375', 'New Lenox', 'Will', 'IL', '60451', '8157178727', '8157178722', '1890 Silver Cross Blvd Ste 375', 'New Lenox', 'Will', 'IL', '60451', '8157178727', '8157178722', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104928498', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('061818027', 'ELPPA0046', 'ELPPA0046', 'ILCHIGSTD', 'Suburban Gynecology', 'Nahla', '', 'Merhi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO BOX 2069', 'Joliet', 'Will', 'IL', '60435', '8157178727', '8157178722', 'PO BOX 2069', 'Joliet', 'Will', 'IL', '60435', '8157178727', '8157178722', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104928498', 0, 'Y', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364373383', 'ELPPA0047', 'ELPPA0047', 'ILCHIGSTD', 'Angela Intili MD', 'Angela', '', 'Intili', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1415 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157292084', NULL, '1415 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157292084', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114080033', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.5481, -88.161, NULL, NULL),
('364373383', 'ELPPA0048', 'ELPPA0048', 'ILCHIGSTD', 'Angela Intili MD', 'Angela', '', 'Intili', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '250 E Maple', 'New Lenox', 'Will', 'IL', '60451', '8157292084', NULL, '250 E Maple', 'New Lenox', 'Will', 'IL', '60451', '8157292084', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114080033', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('362553143', 'ELPPA0049', 'ELPPA0049', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Joshua', '', 'Tepper', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417215', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417215', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114183514', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0050', 'ELPPA0050', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Joshua', '', 'Tepper', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417215', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417215', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114183514', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362711176', 'ELPPA0051', 'ELPPA0051', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Ronald', '', 'Hayes', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114985504', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0052', 'ELPPA0052', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Ronald', '', 'Hayes', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114985504', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('262879348', 'ELPPA0053', 'ELPPA0053', 'ILCHIGSTD', 'Holistic Science Pain Clinic', 'Asad', 'A', 'Cheema', 'MD', 'Anesthesiology', '', '', NULL, 'O', '105 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157257200', '8157257258', '105 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157257200', '8157257258', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124073861', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5247, -88.1509, NULL, NULL),
('364308962', 'ELPPA0056', 'ELPPA0056', 'ILCHIGSTD', 'Northeast Endocrinology', 'Veena', '', 'Nadkarni', 'MD', 'Endocrinology', '', '', NULL, 'B', '2221 Weber Rd ', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', '2221 Weber Rd ', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124090931', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364308962', 'ELPPA0055', 'ELPPA0055', 'ILCHIGSTD', 'Northeast Endocrinology', 'Veena', '', 'Nadkarni', 'MD', 'Endocrinology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124090931', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5628, -88.1214, NULL, NULL),
('363852678', 'ELPPA0058', 'ELPPA0058', 'ILCHIGSTD', '', 'Keyur', 'M', 'Chauhan', 'MD', 'Family Practice', '', '', NULL, 'B', '310 N Hammes  Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes  Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124261748', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0057', 'ELPPA0057', 'ILCHIGSTD', '', 'Keyur', 'M', 'Chauhan', 'MD', 'Family Practice', '', '', NULL, 'O', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124261748', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5284, -88.1313, NULL, NULL),
('364115235', 'ELPPA0061', 'ELPPA0061', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Aristides', '', 'DeLaHera', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8159425790', '8159415704', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8159425790', '8159415704', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1134177447', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364115235', 'ELPPA0063', 'ELPPA0063', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Jong Yoon', '', 'Yi', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1134178056', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('363047976', 'ELPPA0065', 'ELPPA0065', 'ILCHIGSTD', 'Kisnor Ajmere, MD', 'Kishor', '', 'Ajmere', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2435 Glenwood', 'Joliet', 'Will', 'IL', '60435', '8157446005', '8157446023', '2435 Glenwood', 'Joliet', 'Will', 'IL', '60435', '8157446005', '8157446023', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144239369', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5295, -88.142, NULL, NULL),
('362553143', 'ELPPA0067', 'ELPPA0067', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'John', '', 'Groch', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417200', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417200', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144379363', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0068', 'ELPPA0068', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'John', '', 'Groch', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417200', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417200', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144379363', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362830077', 'ELPPA0069', 'ELPPA0069', 'ILCHIGSTD', 'Premier Dermatology', 'Gayle', '', 'McCloskey', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1154315760', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('362711176', 'ELPPA0071', 'ELPPA0071', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Steven', '', 'Jiotis', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164470027', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0072', 'ELPPA0072', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Steven', '', 'Jiotis', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164470027', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362985395', 'ELPPA0073', 'ELPPA0073', 'ILCHIGSTD', 'Advanced Urology Associates', 'Sandeep', '', 'Sawhney', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164531034', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('364115235', 'ELPPA0075', 'ELPPA0075', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Colin', 'W', 'Sumida', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854469', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854469', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1174572119', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('453136848', 'ELPPA0079', 'ELPPA0079', 'ILCHIGSTD', 'EMP of Will County', 'Edwin', '', 'Veguilla', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184624553', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0080', 'ELPPA0080', 'ILCHIGSTD', 'EMP of Will County', 'Edwin', '', 'Veguilla', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184624553', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364115235', 'ELPPA0081', 'ELPPA0081', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Govind', '', 'Ramadurai', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157252411', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157252411', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1184673089', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('753091373', 'ELPPA0083', 'ELPPA0083', 'ILCHIGSTD', 'Midwest Rehabilitation Associates', 'Ming', 'L', 'Hung', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '310 N Hammes Ave Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', '310 N Hammes Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194730267', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5276, -88.132, NULL, NULL),
('453136848', 'ELPPA0085', 'ELPPA0085', 'ILCHIGSTD', 'EMP of Will County', 'Scott', '', 'Hines', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194799486', 0, 'Y', 0, '2013-08-21', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('453136848', 'ELPPA0086', 'ELPPA0086', 'ILCHIGSTD', 'EMP of Will County', 'Scott', '', 'Hines', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194799486', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('363792031', 'ELPPA0087', 'ELPPA0087', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Jose', '', 'Bolanos', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1205818622', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('362643663', 'ELPPA0089', 'ELPPA0089', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'James', 'L', 'Urban', 'MD', 'Pathology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157737037', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157737037', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205829140', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362643663', 'ELPPA0090', 'ELPPA0090', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'James', 'L', 'Urban', 'MD', 'Pathology', '', '', NULL, 'B', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157737037', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157737037', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205829140', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0091', 'ELPPA0091', 'ILCHIGSTD', 'EMP of Will County', 'Merci', '', 'Madar', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205877008', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0092', 'ELPPA0092', 'ILCHIGSTD', 'EMP of Will County', 'Merci', '', 'Madar', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205877008', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363467108', 'ELPPA0093', 'ELPPA0093', 'ILCHIGSTD', 'Basant Jhawar, MD', 'Basant', 'K', 'Jhawar', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1423 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157418550', '8157412251', '1423 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157418550', '8157412251', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1205878048', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5483, -88.161, NULL, NULL),
('453136848', 'ELPPA0095', 'ELPPA0095', 'ILCHIGSTD', 'EMP of Will County', 'John', '', 'Burger', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205958220', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0096', 'ELPPA0096', 'ILCHIGSTD', 'EMP of Will County', 'John', '', 'Burger', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205958220', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0097', 'ELPPA0097', 'ILCHIGSTD', 'EMP of Will County', 'Andrew', '', 'Wagner', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215154018', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0098', 'ELPPA0098', 'ILCHIGSTD', 'EMP of Will County', 'Andrew', '', 'Wagner', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215154018', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364343160', 'ELPPA0099', 'ELPPA0099', 'ILCHIGSTD', 'Surgical Consultants of Joliet  ', 'Mark', 'V', 'Danielson', 'MD', 'General Surgery', '', '', NULL, 'O', '2 Uno Cir', 'Joliet', 'Will', 'IL', '60435', '8157252277', '8157257870', '2 Uno Cir', 'Joliet', 'Will', 'IL', '60435', '8157252277', '8157257870', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225001068', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5249, -88.1332, NULL, NULL),
('362830077', 'ELPPA0101', 'ELPPA0101', 'ILCHIGSTD', 'Premier Dermatology', 'Matthew', '', 'Kelleher', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1225022882', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('363915732', 'ELPPA0103', 'ELPPA0103', 'ILCHIGSTD', 'Joliet Oncology - Hematology Associates', 'Jason', 'J', 'Suh', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1225024722', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('364115235', 'ELPPA0105', 'ELPPA0105', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Robert', '', 'Elgar', 'DO', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1225087547', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364447206', 'ELPPA0107', 'ELPPA0107', 'ILCHIGSTD', 'Andrea Stampley, MD', 'Andrea', '', 'Stampley', 'MD', 'Pediatrics', '', '', NULL, 'O', '2224 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157251600', '8157250300', '2224 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157251600', '8157250300', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225102148', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('364357727', 'ELPPA0109', 'ELPPA0109', 'ILCHIGSTD', 'Joliet Doctors Clinic', 'Nour', '', 'Kabbani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2450 Glenwood Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157303304', '8157303305', '2450 Glenwood Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157303304', '8157303305', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1235125907', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5295, -88.1423, NULL, NULL),
('362711176', 'ELPPA0111', 'ELPPA0111', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Longcheng', '', 'Su', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235167834', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0112', 'ELPPA0112', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Longcheng', '', 'Su', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157251355', '8157259861', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235167834', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363971104', 'ELPPA0113', 'ELPPA0113', 'ILCHIGSTD', 'Optima Medical', 'Robert', 'W', 'Schubert', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157290129', '8157304732', '1050 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157290129', '8157304732', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245236363', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('363915732', 'ELPPA0115', 'ELPPA0115', 'ILCHIGSTD', 'Joliet Oncology - Hematology Associates', 'Ellen', 'J', 'Gustafson', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1245296896', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('363915732', 'ELPPA0117', 'ELPPA0117', 'ILCHIGSTD', 'Joliet Oncology - Hematology Associates', 'Worood', '', 'Abboud', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1245325018', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('453136848', 'ELPPA0119', 'ELPPA0119', 'ILCHIGSTD', 'EMP of Will County', 'Timothy', '', 'Corvino', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245326156', 0, 'Y', 0, '2014-01-20', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('453136848', 'ELPPA0120', 'ELPPA0120', 'ILCHIGSTD', 'EMP of Will County', 'Timothy', '', 'Corvino', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245326156', 0, 'Y', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0121', 'ELPPA0121', 'ILCHIGSTD', 'EMP of Will County', 'Eunice', '', 'Yoo', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245468123', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0122', 'ELPPA0122', 'ILCHIGSTD', 'EMP of Will County', 'Eunice', '', 'Yoo', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245468123', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('203565031', 'ELPPA0123', 'ELPPA0123', 'ILCHIGSTD', 'MK Orthopaedics Surgery and Rehabilitation', 'Ryan', 'M', 'Pizinger', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '963 129th Infantry Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', '963 129th Infantry Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255438735', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5399, -88.1512, NULL, NULL),
('203565031', 'ELPPA0124', 'ELPPA0124', 'ILCHIGSTD', 'MK Orthopaedics Surgery and Rehabilitation', 'Ryan', 'M', 'Pizinger', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '963 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', '963 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255438735', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0125', 'ELPPA0125', 'ILCHIGSTD', '', 'Andrew', 'Warren', 'Wunderlich', 'MD', 'Internal Medicine', '', '', NULL, 'O', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-12', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275528341', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5284, -88.1313, NULL, NULL),
('364115235', 'ELPPA0127', 'ELPPA0127', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Eugene', '', 'Chiu', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1275582579', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364452578', 'ELPPA0129', 'ELPPA0129', 'ILCHIGSTD', 'Center for Neurological Diseases', 'Mark', 'Loren', 'Fehr', 'MD', 'Neurology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275781338', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5628, -88.1214, NULL, NULL),
('362711176', 'ELPPA0133', 'ELPPA0133', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Dionisio', '', 'Marucut', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285692210', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0134', 'ELPPA0134', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Dionisio', '', 'Marucut', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285692210', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362711176', 'ELPPA0135', 'ELPPA0135', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Mauricio', '', 'Morales', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793479', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0136', 'ELPPA0136', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Mauricio', '', 'Morales', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793479', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364452578', 'ELPPA0137', 'ELPPA0137', 'ILCHIGSTD', 'Center for Neurological Diseases', 'Sreepathy', '', 'Kannan', 'MD', 'Neurology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-01-12', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793529', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5629, -88.1213, NULL, NULL),
('364077453', 'ELPPA0139', 'ELPPA0139', 'ILCHIGSTD', 'Hakim Healthcare', 'Nazeeralla', '', 'Shaik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1325 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157447400', '8157447435', '1325 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157447400', '8157447435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295813996', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.523, -88.1141, NULL, NULL),
('364077453', 'ELPPA0140', 'ELPPA0140', 'ILCHIGSTD', 'Hakim Healthcare', 'Nazeeralla', '', 'Shaik', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2835', 'Chicago', 'Grundy', 'IL', '60474', '8157447400', '8157447435', 'PO Box 2835', 'Chicago', 'Grundy', 'IL', '60474', '8157447400', '8157447435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295813996', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363792031', 'ELPPA0141', 'ELPPA0141', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Deepika', '', 'Buchupalli', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1306000484', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('363792031', 'ELPPA0142', 'ELPPA0142', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Deepika', '', 'Buchupalli', 'MD', 'Infectious Disease', '', '', NULL, 'B', '1301 Copperfield Ave Ste 103', 'Joliet', 'Will', 'IL', '60432', '8157261818', '8157260232', '1301 Copperfield Ave Ste 103', 'Joliet', 'Will', 'IL', '60432', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1306000484', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5366, -88.05, NULL, NULL),
('362553143', 'ELPPA0143', 'ELPPA0143', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Farid', '', 'Shafaie', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '7084713517', '7084440018', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '7084713517', '7084440018', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306891841', 0, 'Y', 0, '2013-04-23', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('362553143', 'ELPPA0144', 'ELPPA0144', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Farid', '', 'Shafaie', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '7084713517', '7084440018', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '7084713517', '7084440018', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306891841', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('363792031', 'ELPPA0145', 'ELPPA0145', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Dan', '', 'Garganera', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1306947536', 0, 'N', 0, '2013-04-30', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('061818027', 'ELPPA0495', 'ELPPA0495', 'ILCHIGSTD', 'Suburban Gynecology', 'Amy', '', 'Abouzied', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 375', 'New Lenox', 'Will', 'IL', '60451', '8157178727', '8157178722', '1890 Silver Cross Blvd Ste 375', 'New Lenox', 'Will', 'IL', '60451', '8157178727', '8157178722', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316079874', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('061818027', 'ELPPA0496', 'ELPPA0496', 'ILCHIGSTD', 'Suburban Gynecology', 'Amy', '', 'Abouzied', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO BOX 2069', 'Joliet', 'Will', 'IL', '60435', '8157178727', '8157178722', 'PO BOX 2069', 'Joliet', 'Will', 'IL', '60435', '8157178727', '8157178722', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316079874', 0, 'Y', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('383701260', 'ELPPA0147', 'ELPPA0147', 'ILCHIGSTD', 'Kidney Care Center', 'Stella', '', 'Awua Larbi', 'MD', 'Nephrology', '', '', NULL, 'O', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157254579', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157254579', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316117443', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5369, -88.148, NULL, NULL),
('364030589', 'ELPPA0149', 'ELPPA0149', 'ILCHIGSTD', 'Fine Skin', 'Renuka', 'H', 'Bhatt', 'MD', 'Dermatology', '', '', NULL, 'O', '2202 Essington Rd ', 'Joliet', 'Will', 'IL', '60435', '8156765310', '8157251321', '2202 Essington Rd ', 'Joliet', 'Will', 'IL', '60435', '8156765310', '8157251321', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1316128861', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.561, -88.1615, NULL, NULL),
('453136848', 'ELPPA0151', 'ELPPA0151', 'ILCHIGSTD', 'EMP of Will County', 'Agnieszka', '', 'Nowak', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316175987', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0152', 'ELPPA0152', 'ILCHIGSTD', 'EMP of Will County', 'Agnieszka', '', 'Nowak', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316175987', 0, 'Y', 0, '2012-12-19', 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
('362711176', 'ELPPA0153', 'ELPPA0153', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Carmen', '', 'Rocco', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316905607', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0154', 'ELPPA0154', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Carmen', '', 'Rocco', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316905607', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0155', 'ELPPA0155', 'ILCHIGSTD', 'EMP of Will County', 'Rajeev', '', 'Sareen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316947468', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0156', 'ELPPA0156', 'ILCHIGSTD', 'EMP of Will County', 'Rajeev', '', 'Sareen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316947468', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0157', 'ELPPA0157', 'ILCHIGSTD', 'EMP of Will County', 'Steven', '', 'Rudis', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316981350', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0158', 'ELPPA0158', 'ILCHIGSTD', 'EMP of Will County', 'Steven', '', 'Rudis', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316981350', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0159', 'ELPPA0159', 'ILCHIGSTD', 'EMP of Will County', 'Joseph', '', 'Betro', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60436', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60436', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326026006', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0160', 'ELPPA0160', 'ILCHIGSTD', 'EMP of Will County', 'Joseph', '', 'Betro', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326026006', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364115235', 'ELPPA0161', 'ELPPA0161', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Abdul', '', 'Sankari', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157233912', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157233912', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1326097239', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364357727', 'ELPPA0163', 'ELPPA0163', 'ILCHIGSTD', 'Joliet Doctors Clinic', 'Wassim', '', 'El Harake', 'MD', 'Endocrinology', '', '', NULL, 'O', '2450 Glenwood Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157303304', '8157303305', '2450 Glenwood Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157303304', '8157303305', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1346236098', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5295, -88.1423, NULL, NULL),
('363265076', 'W12027266', 'W12027266', 'ILCHIGSTD', 'Jerry Bertolini MD', 'Jerry', '', 'Bertolini', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '202 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157414104', '8157414135', '202 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157414104', '8157414135', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1407950116', 0, 'N', 0, '2013-11-15', NULL, NULL, 41.5251, -88.1319, NULL, NULL),
('362710424', 'ELPPA0166', 'ELPPA0166', 'ILCHIGSTD', 'Associated Ophthalmologists', 'David', '', 'Morimoto', 'MD', 'Ophthalmology', '', '', NULL, 'O', '219 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157413220', '8157413814', '219 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157413220', '8157413814', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356305643', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5255, -88.1319, NULL, NULL),
('363822295', 'ELPPA0167', 'ELPPA0167', 'ILCHIGSTD', 'Joliet Womens Health Center', 'Casey', '', 'Moauro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356373120', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.525, -88.1319, NULL, NULL),
('364195126', 'ELPPA0169', 'ELPPA0169', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Mark', '', 'Chwajol', 'MD', 'Neurosurgery', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356575690', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0170', 'ELPPA0170', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Mark', '', 'Chwajol', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356575690', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0171', 'ELPPA0171', 'ILCHIGSTD', 'EMP of Will County', 'Janine', '', 'Andriusus', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356581037', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0172', 'ELPPA0172', 'ILCHIGSTD', 'EMP of Will County', 'Janine', '', 'Andriusus', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356581037', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363822295', 'ELPPA0173', 'ELPPA0173', 'ILCHIGSTD', 'Joliet Womens Health Center', 'Brian', '', 'Egan', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366439226', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.525, -88.1319, NULL, NULL),
('640959744', 'ELPPA0175', 'ELPPA0175', 'ILCHIGSTD', 'Boling Medical  ', 'Suma', 'R', 'Kaki', 'MD', 'Internal Medicine', '', '', NULL, 'O', '899 S Weber Rd Ste G', 'Bolingbrook', 'Will', 'IL', '60490', '6302261800', '6302264226', '899 S Weber Rd Ste G', 'Bolingbrook', 'Will', 'IL', '60490', '6302261800', '6302264226', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366451577', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6723, -88.1255, NULL, NULL),
('362553143', 'ELPPA0177', 'ELPPA0177', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Terry', 'K', 'Kushner', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376641241', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0178', 'ELPPA0178', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Terry', 'K', 'Kushner', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376641241', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362985395', 'ELPPA0179', 'ELPPA0179', 'ILCHIGSTD', 'Advanced Urology Associates', 'Thai', 'T', 'Nguyen', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1386624286', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('364115235', 'ELPPA0181', 'ELPPA0181', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Muawia', '', 'Martini', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1386693703', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0183', 'ELPPA0183', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Sreenivasa', '', 'Dharmavaram', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396703328', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0184', 'ELPPA0184', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Sreenivasa', '', 'Dharmavaram', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396703328', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363915732', 'ELPPA0185', 'ELPPA0185', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Sanjiv', 'S', 'Modi', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1396730909', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('364115235', 'ELPPA0187', 'ELPPA0187', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Parag', '', 'Jain', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1396790911', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362553143', 'ELPPA0189', 'ELPPA0189', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Mickey', 'B', 'Jester', 'DO', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396825238', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0190', 'ELPPA0190', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Mickey', 'B', 'Jester', 'DO', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257133', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257133', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396825238', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0191', 'ELPPA0191', 'ILCHIGSTD', 'EMP of Will County', 'Rebecca', '', 'Weiler', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396911418', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0192', 'ELPPA0192', 'ILCHIGSTD', 'EMP of Will County', 'Rebecca', '', 'Weiler', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396911418', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362553143', 'ELPPA0193', 'ELPPA0193', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Rakesh', '', 'Chaudhari', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417215', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417215', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396938148', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0194', 'ELPPA0194', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Rakesh', '', 'Chaudhari', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417215', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417215', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396938148', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('362643663', 'ELPPA0195', 'ELPPA0195', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'Samir', '', 'Gupta', 'MD', 'Pathology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157257080', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157257080', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407844517', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362643663', 'ELPPA0196', 'ELPPA0196', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'Samir', '', 'Gupta', 'MD', 'Pathology', '', '', NULL, 'B', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157257080', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157257080', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407844517', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0199', 'ELPPA0199', 'ILCHIGSTD', 'EMP of Will County', 'Rhett', '', 'Silver', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417020736', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0200', 'ELPPA0200', 'ILCHIGSTD', 'EMP of Will County', 'Rhett', '', 'Silver', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417020736', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362830077', 'ELPPA0201', 'ELPPA0201', 'ILCHIGSTD', 'Premier Dermatology', 'Anil', '', 'Singal', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1417154006', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('362711176', 'ELPPA0205', 'ELPPA0205', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Maen', '', 'Martini', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427016674', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0206', 'ELPPA0206', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Maen', '', 'Martini', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427016674', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('201675949', 'ELPPA0207', 'ELPPA0207', 'ILCHIGSTD', 'RK Natesh, MD', 'RK', '', 'Natesh', 'MD', 'General Surgery', '', '', NULL, 'O', '1100 Essington Rd Ste 6', 'Joliet', 'Will', 'IL', '60435', '8157252600', '8157252601', '1100 Essington Rd Ste 6', 'Joliet', 'Will', 'IL', '60435', '8157252600', '8157252601', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1427037043', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5416, -88.1608, NULL, NULL),
('364185473', 'ELPPA0209', 'ELPPA0209', 'ILCHIGSTD', 'Digestive Health Associates', 'Richard', 'M', 'Rotnicki', 'DO', 'Gastroenterology', '', '', NULL, 'O', '1100 Houbolt Rd', 'Joliet', 'Will', 'IL', '60431', '8159421550', '8159428419', '1100 Houbolt Rd', 'Joliet', 'Will', 'IL', '60431', '8159421550', '8159428419', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427062850', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5023, -88.1688, NULL, NULL),
('362553143', 'ELPPA0211', 'ELPPA0211', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Andrew', 'J', 'Johanek', 'DO', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '7084713517', '7084440018', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '7084713517', '7084440018', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437187366', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0212', 'ELPPA0212', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Andrew', 'J', 'Johanek', 'DO', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '7084713517', '7084440018', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '7084713517', '7084440018', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437187366', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('753091373', 'ELPPA0213', 'ELPPA0213', 'ILCHIGSTD', 'Midwest Rehabilitation Associates', 'Bernard', 'R', 'Charles', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '310 N Hammes Ave Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', '310 N Hammes Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437309234', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5276, -88.132, NULL, NULL),
('363915732', 'ELPPA0215', 'ELPPA0215', 'ILCHIGSTD', 'Joliet Oncology - Hematology Associates', 'Sarode', 'K', 'Pundaleeka', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8159422791', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8159422791', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1447245071', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('363304094', 'ELPPA0218', 'ELPPA0218', 'ILCHIGSTD', 'Northeast Nephrology Consultants  ', 'Naila', '', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447368949', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5367, -88.1253, NULL, NULL),
('364343160', 'ELPPA0219', 'ELPPA0219', 'ILCHIGSTD', 'Surgical Consultants of Joliet  ', 'Eric', '', 'Bass', 'MD', 'General Surgery', '', '', NULL, 'O', '2 Uno Cir', 'Joliet', 'Will', 'IL', '60435', '8157252277', '8157257870', '2 Uno Cir', 'Joliet', 'Will', 'IL', '60435', '8157252277', '8157257870', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457324824', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5249, -88.1332, NULL, NULL),
('362553143', 'ELPPA0221', 'ELPPA0221', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Edward', 'J', 'Bruno', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457457830', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0222', 'ELPPA0222', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Edward', 'J', 'Bruno', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457457830', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('760555526', 'W12027288', 'W12027288', 'TXHOUSTD', 'Kidney Associates', 'Joey', '', 'Buquing', 'MD', 'Nephrology', '', '', NULL, 'O', '1415 N Loop W Ste 940', 'Houston', 'Harris', 'TX', '77008', '7136910107', '7136910194', '1415 N Loop W Ste 940', 'Houston', 'Harris', 'TX', '77008', '7136910107', '7136910194', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1255335279', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.8123, -95.4253, NULL, NULL),
('760555526', 'W12027275', 'W12027275', 'TXHOUSTD', 'Kidney Associates', 'Han', '', 'Dang', 'MD', 'Nephrology', '', '', NULL, 'O', '6624 Fannin St Ste 1400', 'Houston', 'Harris', 'TX', '77030', '7137955511', '7136910194', '6624 Fannin St Ste 1400', 'Houston', 'Harris', 'TX', '77030', '7137955511', '7136910194', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1811929508', 0, 'N', 0, '2013-01-09', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('363304094', 'ELPPA0224', 'ELPPA0224', 'ILCHIGSTD', 'Northeast Nephrology Consultants  ', 'Theresa', '', 'Kravets', 'MD', 'Nephrology', '', '', NULL, 'O', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, '', '', 'HCFA|UB|', '1467560961', 0, 'N', 0, '2013-05-20', NULL, NULL, 41.5367, -88.1253, NULL, NULL),
('362711176', 'ELPPA0225', 'ELPPA0225', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Woo Chan', '', 'Kim', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477511863', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0226', 'ELPPA0226', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Woo Chan', '', 'Kim', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477511863', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('271643151', 'ELPPA0227', 'ELPPA0227', 'ILCHIGSTD', 'Shorewood Family Medicine', 'Vincent', 'R', 'Benig', 'MD', 'Family Practice', '', '', NULL, 'O', '1144 W Jefferson St Ste 200', 'Shorewood', 'Will', 'IL', '60404', '8157291010', '8885233001', '1144 W Jefferson St Ste 200', 'Shorewood', 'Will', 'IL', '60404', '8157291010', '8885233001', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487609772', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5184, -88.2113, NULL, NULL),
('271643151', 'ELPPA0228', 'ELPPA0228', 'ILCHIGSTD', 'Shorewood Family Medicine', 'Vincent', 'R', 'Benig', 'MD', 'Family Practice', '', '', NULL, 'B', '415 W Golf Rd Ste 16', 'Arlington Heights', 'Cook', 'IL', '60005', '8157291010', '8885233001', '415 W Golf Rd Ste 16', 'Arlington Heights', 'Cook', 'IL', '60005', '8157291010', '8885233001', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487609772', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'ELPPA0229', 'ELPPA0229', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Pelagia', 'E', 'Kouloumberis', 'MD', 'Neurosurgery', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157253503', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157253503', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487804969', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0230', 'ELPPA0230', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Pelagia', 'E', 'Kouloumberis', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157253503', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157253503', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487804969', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('363852831', 'ELPPA0231', 'ELPPA0231', 'ILCHIGSTD', 'Barbara Kijek, MD', 'Barbara', '', 'Kijek', 'MD', 'Pediatrics', '', '', NULL, 'O', '1802 N Division St Ste 303', 'Morris', 'Grundy', 'IL', '60450', '8159420065', '8159421472', '1802 N Division St Ste 303', 'Morris', 'Grundy', 'IL', '60450', '8159420065', '8159421472', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1508822149', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.3795, -88.422, NULL, NULL),
('364115235', 'ELPPA0233', 'ELPPA0233', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Mazen', '', 'Kawji', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854469', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854469', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1518915842', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('383701260', 'ELPPA0235', 'ELPPA0235', 'ILCHIGSTD', 'Kidney Care Center', 'Mohammad', 'S', 'Shafi', 'MD', 'Nephrology', '', '', NULL, 'O', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157416832', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '8157416832', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528052792', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5375, -88.1474, NULL, NULL),
('383701260', 'ELPPA0236', 'ELPPA0236', 'ILCHIGSTD', 'Kidney Care Center', 'Mohammad', 'S', 'Shafi', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', '8157416832', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', '8157416832', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528052792', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0238', 'ELPPA0238', 'ILCHIGSTD', 'Provena Medical Group', 'Patricia', '', 'Panelli', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528068970', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0237', 'ELPPA0237', 'ILCHIGSTD', 'Provena Medical Group', 'Patricia', '', 'Panelli', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528068970', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('203996471', 'ELPPA0239', 'ELPPA0239', 'ILCHIGSTD', 'Allergy and Asthma Associates of Joliet', 'Voraphot', '', 'Sathissarat', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2000 Glenwood Ave Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157411212', '8157410707', '2000 Glenwood Ave Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157411212', '8157410707', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1538156781', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5298, -88.1298, NULL, NULL),
('364115235', 'ELPPA0241', 'ELPPA0241', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Kirkeith', '', 'Lertsburapa', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157252411', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157252411', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1538208004', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('760555526', 'W12027272', 'W12027272', 'TXHOUSTD', 'Kidney Associates', 'Joey', '', 'Buquing', 'MD', 'Nephrology', '', '', NULL, 'O', '6624 Fannin St Ste 1400', 'Houston', 'Harris', 'TX', '77030', '7137955511', '7136910194', '6624 Fannin St Ste 1400', 'Houston', 'Harris', 'TX', '77030', '7137955511', '7136910194', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1255335279', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('362710424', 'ELPPA0244', 'ELPPA0244', 'ILCHIGSTD', 'Associated Ophthalmologists', 'Aras', '', 'Zlioba', 'MD', 'Ophthalmology', '', '', NULL, 'O', '219 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157413220', '8157413814', '219 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157413220', '8157413814', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223233', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5255, -88.1319, NULL, NULL),
('362711176', 'ELPPA0245', 'ELPPA0245', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Stanley', '', 'Knight', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548228745', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0246', 'ELPPA0246', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Stanley', '', 'Knight', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548228745', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('262039338', 'ELPPA0247', 'ELPPA0247', 'ILCHIGSTD', 'Digestive Health Consultants  ', 'Tamer', '', 'Atassi', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2121 Oneida St Ste 302', 'Joliet', 'Will', 'IL', '60435', '8155824941', '8156305036', '2121 Oneida St Ste 302', 'Joliet', 'Will', 'IL', '60435', '8155824941', '8156305036', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1548276819', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.5249, -88.1327, NULL, NULL),
('262039338', 'ELPPA0248', 'ELPPA0248', 'ILCHIGSTD', 'Digestive Health Consultants  ', 'Tamer', '', 'Atassi', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8155824941', '8156305036', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8155824941', '8156305036', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1548276819', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('362553143', 'ELPPA0249', 'ELPPA0249', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Sasan', '', 'Payvar', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417200', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417200', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548325897', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0250', 'ELPPA0250', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Sasan', '', 'Payvar', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417200', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157417200', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548325897', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0252', 'ELPPA0252', 'ILCHIGSTD', '', 'Timothy', '', 'Doyle', 'DO', 'Family Practice', '', '', NULL, 'B', '310 N Hammes ', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes ', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548376540', 0, 'Y', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('363852678', 'ELPPA0251', 'ELPPA0251', 'ILCHIGSTD', '', 'Timothy', '', 'Doyle', 'DO', 'Family Practice', '', '', NULL, 'O', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '310 N Hammes Ave Ste 101', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548376540', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5284, -88.1313, NULL, NULL),
('364195126', 'ELPPA0253', 'ELPPA0253', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Surendra', 'M', 'Gulati', 'MD', 'Neurology', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558543348', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0254', 'ELPPA0254', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Surendra', 'M', 'Gulati', 'MD', 'Neurology', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558543348', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('364115235', 'ELPPA0255', 'ELPPA0255', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Dennis', 'M', 'Killian', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1568411536', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('943469999', 'ELPPA0257', 'ELPPA0257', 'ILCHIGSTD', 'Alvi Medical Services ', 'Farhana', 'P', 'Alvi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2206 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157251118', '8157251198', '2206 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157251118', '8157251198', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568451276', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5626, -88.1214, NULL, NULL),
('363915732', 'ELPPA0259', 'ELPPA0259', 'ILCHIGSTD', 'Joliet Oncology - Hematology Associates', 'Ali', 'R', 'Lakhani', 'MD', 'Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1568458107', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('201990775', 'ELPPA0263', 'ELPPA0263', 'ILCHIGSTD', 'Haveric Medical ', 'Zlatko', '', 'Haveric', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157737410', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157737410', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568492726', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('201990775', 'ELPPA0264', 'ELPPA0264', 'ILCHIGSTD', 'Haveric Medical ', 'Zlatko', '', 'Haveric', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 621', 'Hinsdale', 'Dupage', 'IL', '60522', '8157257133', '8157737410', 'PO Box 621', 'Hinsdale', 'Dupage', 'IL', '60522', '8157257133', '8157737410', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568492726', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0269', 'ELPPA0269', 'ILCHIGSTD', 'EMP of Will County', 'Lawrence', '', 'Payne', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578647665', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0270', 'ELPPA0270', 'ILCHIGSTD', 'EMP of Will County', 'Lawrence', '', 'Payne', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578647665', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364115235', 'ELPPA0273', 'ELPPA0273', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Ahmad', '', 'Abdul Karim', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157293294', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157293294', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1588721328', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364452578', 'ELPPA0275', 'ELPPA0275', 'ILCHIGSTD', 'Center for Neurological Diseases', 'Sohal', 'K', 'Patel', 'MD', 'Neurology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419719', '8157445137', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588821649', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5628, -88.1214, NULL, NULL),
('453136848', 'ELPPA0279', 'ELPPA0279', 'ILCHIGSTD', 'EMP of Will County', 'Jack', '', 'Wu', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598805483', 0, 'Y', 0, '2014-01-20', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('453136848', 'ELPPA0280', 'ELPPA0280', 'ILCHIGSTD', 'EMP of Will County', 'Jack', '', 'Wu', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598805483', 0, 'Y', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('453136848', 'ELPPA0284', 'ELPPA0284', 'ILCHIGSTD', 'Provena Medical Group', 'Surander', '', 'Singhal', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609876069', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0283', 'ELPPA0283', 'ILCHIGSTD', 'Provena Medical Group', 'Surander', '', 'Singhal', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609876069', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364435643', 'ELPPA0285', 'ELPPA0285', 'ILCHIGSTD', 'Kanchana Esariya Umpai, MD', 'Kanchana', '', 'Esariya Umpai', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1026 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157442556', '8157443554', '1026 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157442556', '8157443554', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1609980549', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.5404, -88.1607, NULL, NULL),
('203565031', 'ELPPA0288', 'ELPPA0288', 'ILCHIGSTD', 'MK Orthopaedics Surgery and Rehabilitation', 'Mukund', '', 'Komanduri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2100 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', '2100 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619904604', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('203565031', 'ELPPA0287', 'ELPPA0287', 'ILCHIGSTD', 'MK Orthopaedics Surgery and Rehabilitation', 'Mukund', '', 'Komanduri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '963 129th Infantry  Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', '963 129th Infantry  Ste 100', 'Joliet', 'Will', 'IL', '60435', '8157416900', '8157416907', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619904604', 0, 'N', 0, '2013-07-08', NULL, NULL, 41.5399, -88.1512, NULL, NULL),
('363822295', 'ELPPA0289', 'ELPPA0289', 'ILCHIGSTD', 'Joliet Womens Health Center', 'Mary', '', 'Fitzgibbon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', '201 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157252699', '8157252120', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629002464', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.525, -88.1319, NULL, NULL),
('364195126', 'ELPPA0291', 'ELPPA0291', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Tamir', '', 'Hersonskey', 'MD', 'Neurosurgery', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629025663', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0292', 'ELPPA0292', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Tamir', '', 'Hersonskey', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629025663', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('202077040', 'ELPPA0293', 'ELPPA0293', 'ILCHIGSTD', 'Pain Centers of Chicago', 'Abed', '', 'Rahman', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157290450', '8157290459', '301 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157290450', '8157290459', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629115258', 0, 'Y', 0, '2013-07-05', NULL, NULL, 41.5272, -88.1346, NULL, NULL),
('202077040', 'ELPPA0294', 'ELPPA0294', 'ILCHIGSTD', 'Pain Centers of Chicago', 'Abed', '', 'Rahman', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 305', 'Bedford Park', 'Cook', 'IL', '60499', '8157290450', '8157290459', 'PO Box 305', 'Bedford Park', 'Cook', 'IL', '60499', '8157290450', '8157290459', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629115258', 0, 'Y', 0, '2013-07-05', NULL, NULL, 0, 0, NULL, NULL),
('362553143', 'ELPPA0295', 'ELPPA0295', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Michael', '', 'Arthofer', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639107428', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0296', 'ELPPA0296', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Michael', '', 'Arthofer', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257133', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257133', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639107428', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362830077', 'ELPPA0297', 'ELPPA0297', 'ILCHIGSTD', 'Premier Dermatology', 'Steven', '', 'Neubauer', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1639164064', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('760555526', 'W12027289', 'W12027289', 'TXHOUSTD', 'Kidney Associates', 'Emil', '', 'Abdulhayoglu', 'MD', 'Nephrology', '', '', NULL, 'O', '1415 N Loop W Ste 940', 'Houston', 'Harris', 'TX', '77008', '7136910107', '7136910194', '1415 N Loop W Ste 940', 'Houston', 'Harris', 'TX', '77008', '7136910107', '7136910194', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801860671', 0, 'N', 0, '2013-05-28', NULL, NULL, 29.8123, -95.4253, NULL, NULL),
('363304094', 'ELPPA0300', 'ELPPA0300', 'ILCHIGSTD', 'Northeast Nephrology Consultants  ', 'Aaron', '', 'Gurfinchel', 'MD', 'Nephrology', '', '', NULL, 'O', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639392939', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5367, -88.1253, NULL, NULL),
('363852828', 'ELPPA0301', 'ELPPA0301', 'ILCHIGSTD', 'Mark Kijek, MD', 'Mark', 'A', 'Kijek', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1802 N Division St Ste 303', 'Morris', 'Grundy', 'IL', '60450', '8159420065', '8159421472', '1802 N Division St Ste 303', 'Morris', 'Grundy', 'IL', '60450', '8159420065', '8159421472', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1659336519', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.3795, -88.422, NULL, NULL),
('455184514', 'ELPPA0303', 'ELPPA0303', 'ILCHIGSTD', 'Precision Surgical Consultants  ', 'Marius', '', 'Katilius', 'MD', 'General Surgery', '', '', NULL, 'O', '300 Barney Dr Ste A', 'Joliet', 'Will', 'IL', '60435', '8157440330', '8157440445', '300 Barney Dr Ste A', 'Joliet', 'Will', 'IL', '60435', '8157440330', '8157440445', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1659346583', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5281, -88.1434, NULL, NULL),
('455184514', 'ELPPA0305', 'ELPPA0305', 'ILCHIGSTD', 'Precision Surgical Consultants  ', 'Jonathan', '', 'Wu', 'MD', 'General Surgery', '', '', NULL, 'O', '300 Barney Dr Ste A', 'Joliet', 'Will', 'IL', '60435', '8157440330', '8157440445', '300 Barney Dr Ste A', 'Joliet', 'Will', 'IL', '60435', '8157440330', '8157440445', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1659347318', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5281, -88.1434, NULL, NULL),
('362553143', 'ELPPA0309', 'ELPPA0309', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Robert', 'E', 'Boyd', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659440774', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362553143', 'ELPPA0310', 'ELPPA0310', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Robert', 'E', 'Boyd', 'MD', 'Radiology', '', '', NULL, 'B', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', '36910 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157259160', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659440774', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364475941', 'ELPPA0311', 'ELPPA0311', 'ILCHIGSTD', 'Srinivas Kota MD', 'Srinivas', '', 'Kota', 'MD', 'Internal Medicine', '', '', NULL, 'O', '726 S Weber Rd', 'Bolingbrook', 'Will', 'IL', '60490', '6303789785', '6303789836', '726 S Weber Rd', 'Bolingbrook', 'Will', 'IL', '60490', '6303789785', '6303789836', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659481562', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('362711176', 'ELPPA0313', 'ELPPA0313', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'George', 'I', 'Macrinici', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659534030', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0314', 'ELPPA0314', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'George', 'I', 'Macrinici', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659534030', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362985395', 'ELPPA0315', 'ELPPA0315', 'ILCHIGSTD', 'Advanced Urology Associates', 'Luke', 'S', 'Cho', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669400933', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('363150764', 'ELPPA0317', 'ELPPA0317', 'ILCHIGSTD', 'Retina Vitreous Associates', 'Christopher', 'D', 'Pelzek', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4930 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084248964', '7084246954', '4930 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7084248964', '7084246954', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669475281', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('300008144', 'ELPPA0319', 'ELPPA0319', 'ILCHIGSTD', 'Mark J Fritz MD', 'Mark', '', 'Fritz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '212 N Larkin Ave', 'Joliet', 'Will', 'IL', '60435', '8157410666', '8157410649', '212 N Larkin Ave', 'Joliet', 'Will', 'IL', '60435', '8157410666', '8157410649', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669509550', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5264, -88.1247, NULL, NULL),
('362830077', 'ELPPA0321', 'ELPPA0321', 'ILCHIGSTD', 'Premier Dermatology', 'Chethana', 'C', 'Gottam', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-06-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669664009', 0, 'N', 0, '2014-05-01', NULL, NULL, 41.5593, -88.1325, NULL, NULL),
('362830077', 'ELPPA0322', 'ELPPA0322', 'ILCHIGSTD', 'Premier Dermatology', 'Chethana', 'C', 'Gottam', 'MD', 'Dermatology', '', '', NULL, 'B', '2400 Glenwood Ave Ste 126', 'Joliet', 'Will', 'IL', '60435', '8157414343', '8157418660', '2400 Glenwood Ave Ste 126', 'Joliet', 'Will', 'IL', '60435', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-06-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669664009', 0, 'Y', 0, '2014-05-01', NULL, NULL, 41.5282, -88.1417, NULL, NULL),
('362711176', 'ELPPA0323', 'ELPPA0323', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Mohammad', '', 'Almachnouk', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679517742', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0324', 'ELPPA0324', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Mohammad', '', 'Almachnouk', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679517742', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('200644558', 'ELPPA0325', 'ELPPA0325', 'ILCHIGSTD', 'Maimoona Aijaz, MD', 'Maimoona', 'Sharif', 'Aijaz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1717 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157448600', '8157448125', '1717 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157448600', '8157448125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1679518518', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5299, -88.123, NULL, NULL),
('362643663', 'ELPPA0327', 'ELPPA0327', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'April', 'Y', 'Platt', 'MD', 'Pathology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157737037', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257222', '8157737037', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679566574', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362643663', 'ELPPA0328', 'ELPPA0328', 'ILCHIGSTD', 'Associate Pathologists of Joliet  ', 'April', 'Y', 'Platt', 'MD', 'Pathology', '', '', NULL, 'B', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157737037', '39784 Treasury Ctr', 'Chicago', 'Cook', 'IL', '60694', '8157257222', '8157737037', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679566574', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('453968029', 'ELPPA0329', 'ELPPA0329', 'ILCHIGSTD', 'Geriatrics Professional Services ', 'Karim', '', 'Tourk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '109 N 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8003534980', NULL, '109 N 129th Infantry Dr', 'Joliet', 'Will', 'IL', '60435', '8003534980', '', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679569347', 0, 'N', 0, '2013-08-26', NULL, NULL, 41.5247, -88.1509, NULL, NULL),
('364115235', 'ELPPA0331', 'ELPPA0331', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Hazem', '', 'Al Muradi', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157413260', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1679896138', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('363966193', 'ELPPA0333', 'ELPPA0333', 'ILCHIGSTD', 'Jercinovic Pediatrics', 'Spomenka', '', 'Jercinovic', 'MD', 'Pediatrics', '', '', NULL, 'O', '611 W Jefferson St', 'Shorewood', 'Will', 'IL', '60404', '8157291144', '8157292587', '611 W Jefferson St', 'Shorewood', 'Will', 'IL', '60404', '8157291144', '8157292587', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689637555', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5215, -88.2033, NULL, NULL),
('453136848', 'ELPPA0335', 'ELPPA0335', 'ILCHIGSTD', 'EMP of Will County', 'Daniel', '', 'Magdziarz', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-27', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689674079', 0, 'Y', 0, '2014-03-11', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0336', 'ELPPA0336', 'ILCHIGSTD', 'EMP of Will County', 'Daniel', '', 'Magdziarz', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-27', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689674079', 0, 'Y', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('272959952', 'ELPPA0337', 'ELPPA0337', 'ILCHIGSTD', 'Alan Chen Surgical Associates', 'Alan', '', 'Chen', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '823 129th Infantry Dr Ste 103', 'Joliet', 'Will', 'IL', '60435', '8157299527', '8157299530', '823 129th Infantry Dr Ste 103', 'Joliet', 'Will', 'IL', '60435', '8157299527', '8157299530', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1689878480', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.537, -88.1511, NULL, NULL),
('202077040', 'ELPPA0339', 'ELPPA0339', 'ILCHIGSTD', 'Pain Centers of Chicago', 'Dinesh', '', 'Chinthagada', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699702753', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('202077040', 'ELPPA0340', 'ELPPA0340', 'ILCHIGSTD', 'Pain Centers of Chicago', 'Dinesh', '', 'Chinthagada', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699702753', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364115235', 'ELPPA0341', 'ELPPA0341', 'ILCHIGSTD', 'Heartland Cardiovascular Center', 'Seif', '', 'Martini', 'MD', 'Cardiology', '', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8154854463', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1699724070', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362985395', 'ELPPA0343', 'ELPPA0343', 'ILCHIGSTD', 'Advanced Urology Associates', 'Ernesto', '', 'Tan', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1699882084', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('203872453', 'ELPPA0345', 'ELPPA0345', 'ILCHIGSTD', 'Prairie Rheumatology Associates', 'Anna', 'Adenine', 'Stanislaus', 'MD', 'Rheumatology', '', '', NULL, 'O', '903 129th Infantry Ste 600', 'Joliet', 'Will', 'IL', '60435', '8157447246', '8157447346', '903 129th Infantry Ste 600', 'Joliet', 'Will', 'IL', '60435', '8157447246', '8157447346', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699921353', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('203872453', 'ELPPA0346', 'ELPPA0346', 'ILCHIGSTD', 'Prairie Rheumatology Associates', 'Anna', 'Adenine', 'Stanislaus', 'MD', 'Rheumatology', '', '', NULL, 'B', '903 129th Infantry Dr Ste 600', 'Joliet', 'Will', 'IL', '60435', '8157447246', '8157447346', '903 129th Infantry Dr Ste 600', 'Joliet', 'Will', 'IL', '60435', '8157447246', '8157447346', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699921353', 0, 'Y', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'ELPPA0347', 'ELPPA0347', 'ILCHIGSTD', 'EMP of Will County', 'Rao', '', 'Kilaru', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700886546', 0, 'Y', 0, '2013-09-30', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('453136848', 'ELPPA0348', 'ELPPA0348', 'ILCHIGSTD', 'EMP of Will County', 'Rao', '', 'Kilaru', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700886546', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('363792031', 'ELPPA0351', 'ELPPA0351', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Shashi', '', 'Kathpalia', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1710059027', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('363792031', 'ELPPA0352', 'ELPPA0352', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Shashi', '', 'Kathpalia', 'MD', 'Infectious Disease', '', '', NULL, 'B', '1301 Copperfield Ave Ste 103', 'Joliet', 'Will', 'IL', '60432', '8157261818', '8157260232', '1301 Copperfield Ave Ste 103', 'Joliet', 'Will', 'IL', '60432', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1710059027', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5366, -88.05, NULL, NULL),
('753091373', 'ELPPA0353', 'ELPPA0353', 'ILCHIGSTD', 'Midwest Rehabilitation Associates', 'Michael', 'A', 'Osei', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '310 N Hammes Ave Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', '310 N Hammes Ste 202', 'Joliet', 'Will', 'IL', '60435', '8157412201', '8157412285', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710138599', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5276, -88.132, NULL, NULL),
('450713792', 'ELPPA0356', 'ELPPA0356', 'ILCHIGSTD', 'Dr Lucy Dey Diabetes  Endocrinology and Metabolism Clinic PC', 'Lucy', '', 'Dey', 'MD', 'Endocrinology', '', '', NULL, 'B', '17525 Orland Woods Ln', 'Orland Park ', 'Cook', 'IL', '60467', '8157142240', '8155824145', '17525 Orland Woods Ln', 'Orland Park ', 'Cook', 'IL', '60467', '8157142240', '8155824145', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1710191705', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('450713792', 'ELPPA0355', 'ELPPA0355', 'ILCHIGSTD', 'Dr Lucy Dey Diabetes  Endocrinology and Metabolism Clinic PC', 'Lucy', '', 'Dey', 'MD', 'Endocrinology', '', '', NULL, 'O', '330 N Madison St Ste 303', 'Joliet', 'Will', 'IL', '60435', '8157142240', '8155824145', '330 N Madison St Ste 303', 'Joliet', 'Will', 'IL', '60435', '8157142240', '8155824145', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1710191705', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362711176', 'ELPPA0357', 'ELPPA0357', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Yasser', 'A', 'Hussein', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710967955', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0358', 'ELPPA0358', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Yasser', 'A', 'Hussein', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710967955', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363143695', 'ELPPA0359', 'ELPPA0359', 'ILCHIGSTD', 'Lawrence Sadowski, MD', 'Lawrence', '', 'Sadowski', 'MD', 'Ophthalmology', '', '', NULL, 'O', '202 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157442020', '8157294101', '202 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157442020', '8157294101', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710996715', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5251, -88.1319, NULL, NULL),
('453136848', 'ELPPA0361', 'ELPPA0361', 'ILCHIGSTD', 'EMP of Will County', 'Donald', '', 'Norris', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720169576', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0362', 'ELPPA0362', 'ILCHIGSTD', 'EMP of Will County', 'Donald', '', 'Norris', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720169576', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('383701260', 'ELPPA0363', 'ELPPA0363', 'ILCHIGSTD', 'Kidney Care Center', 'Morufu', '', 'Alausa', 'MD', 'Nephrology', '', '', NULL, 'O', '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', NULL, '812 Campus Dr', 'Joliet', 'Will', 'IL', '60435', '8157416830', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730135955', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5375, -88.1474, NULL, NULL),
('383701260', 'ELPPA0364', 'ELPPA0364', 'ILCHIGSTD', 'Kidney Care Center', 'Morufu', '', 'Alausa', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', NULL, 'PO Box 36', 'Lemont', 'Cook', 'IL', '60439', '8157416830', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730135955', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363792031', 'ELPPA0365', 'ELPPA0365', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Frederick', '', 'Alexander', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1730251042', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('364121175', 'ELPPA0367', 'ELPPA0367', 'ILCHIGSTD', 'ENT Surgical Consultants  ', 'Michael', 'G', 'Gartlan', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2201 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157251191', '8157252048', '2201 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157251191', '8157252048', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1740263664', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5296, -88.1347, NULL, NULL),
('364314354', 'ELPPA0370', 'ELPPA0370', 'ILCHIGSTD', 'Provena Medical Group - New Lenox Geriatic Medicine', 'Neil', '', 'Sharma', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1740587872', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'ELPPA0369', 'ELPPA0369', 'ILCHIGSTD', 'Provena Medical Group - New Lenox Geriatic Medicine', 'Neil', '', 'Sharma', 'MD', 'Family Practice', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', NULL, '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1740587872', 0, 'Y', 0, '2013-04-24', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('364308962', 'ELPPA0371', 'ELPPA0371', 'ILCHIGSTD', 'Northeast Endocrinology', 'Shwetha', '', 'Sunghay', 'MD', 'Endocrinology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157419714', '8157445137', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1750526471', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5628, -88.1214, NULL, NULL),
('453136848', 'ELPPA0375', 'ELPPA0375', 'ILCHIGSTD', 'EMP of Will County', 'Claudine', '', 'Feliciano', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770790032', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0376', 'ELPPA0376', 'ILCHIGSTD', 'EMP of Will County', 'Claudine', '', 'Feliciano', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770790032', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364141833', 'ELPPA0377', 'ELPPA0377', 'ILCHIGSTD', 'Midwest Neurological Associates', 'Grazyna', '', 'Piekos', 'MD', 'Neurology', '', '', NULL, 'O', '1513 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157301200', '8157301066', '1513 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157301200', '8157301066', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780605899', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5496, -88.1611, NULL, NULL),
('364185473', 'ELPPA0379', 'ELPPA0379', 'ILCHIGSTD', 'Digestive Health Associates', 'Bachar', '', 'Hamad', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1100 Houbolt Rd', 'Joliet', 'Will', 'IL', '60431', '8157255950', '8157253666', '1100 Houbolt Rd', 'Joliet', 'Will', 'IL', '60431', '8157255950', '8157253666', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780690040', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5023, -88.1688, NULL, NULL),
('364195126', 'ELPPA0381', 'ELPPA0381', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Qasim', '', 'Bashir', 'MD', 'Neurosurgery', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1780861807', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('364195126', 'ELPPA0382', 'ELPPA0382', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Qasim', '', 'Bashir', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', '75 Remittance Dr Ste 1577', 'Chicago', 'Cook', 'IL', '60675', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1780861807', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('362830077', 'ELPPA0383', 'ELPPA0383', 'ILCHIGSTD', 'Premier Dermatology', 'Cristina', '', 'Camara', 'MD', 'Dermatology', '', '', NULL, 'O', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', '2051 Plainfield Rd', 'Crest Hill', 'Will', 'IL', '60403', '8157414343', '8157418660', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1790779270', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5597, -88.1331, NULL, NULL),
('362704738', 'ELPPA0386', 'ELPPA0386', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Dhananjay', 'D', 'Bendre', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '15 Salt Creek Ln  Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '8157251355', '8157259861', '15 Salt Creek Ln  Ste 119', 'Hinsdale', 'Dupage', 'IL', '60521', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', '2013-08-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790786846', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'ELPPA0385', 'ELPPA0385', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Dhananjay', 'D', 'Bendre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2614 Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', '2614 Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157259861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790786846', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.5212, -88.1479, NULL, NULL),
('453136848', 'ELPPA0387', 'ELPPA0387', 'ILCHIGSTD', 'EMP of Will County', 'Shawn', '', 'Radford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790995934', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0388', 'ELPPA0388', 'ILCHIGSTD', 'EMP of Will County', 'Shawn', '', 'Radford', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790995934', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('200160739', 'ELPPA0389', 'ELPPA0389', 'ILCHIGSTD', 'Mokena Family Physicians  ', 'Lucy', 'R', 'Canaday', 'MD', 'Family Practice', '', '', NULL, 'O', '11243 La Porte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', '11243 La Porte Rd', 'Mokena', 'Will', 'IL', '60448', '7084794681', '7084798516', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1811958028', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5267, -87.8908, NULL, NULL),
('363484044', 'ELPPA0391', 'ELPPA0391', 'ILCHIGSTD', '', 'Suresh', '', 'Bhalla', 'MD', 'Gastroenterology', '', '', NULL, 'O', '201 N Hammes Ave Ste 112', 'Joliet', 'Will', 'IL', '60435', '8157442123', '8157445823', '201 N Hammes Ave Ste 112', 'Joliet', 'Will', 'IL', '60435', '8157442123', '8157445823', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-15', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811995426', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5263, -88.1322, NULL, NULL),
('363792031', 'ELPPA0395', 'ELPPA0395', 'ILCHIGSTD', 'Southwest Infectious Disease', 'Atul', '', 'Gupta', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', '1051 Essington Rd Ste 210', 'Joliet', 'Will', 'IL', '60435', '8157261818', '8157260232', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1821160136', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('362711176', 'ELPPA0397', 'ELPPA0397', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Gintautas', '', 'Ciabilis', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831156033', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0398', 'ELPPA0398', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Gintautas', '', 'Ciabilis', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157254709', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831156033', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('640959744', 'ELPPA0399', 'ELPPA0399', 'ILCHIGSTD', 'Boling Medical  ', 'Ramadevi', '', 'Davarapalli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '899 S Weber Rd Ste G', 'Bolingbrook', 'Will', 'IL', '60490', '6302261800', '6302264226', '899 S Weber Rd Ste G', 'Bolingbrook', 'Will', 'IL', '60490', '6302261800', '6302264226', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831171750', 0, 'Y', 0, '2013-07-15', NULL, NULL, 41.6723, -88.1255, NULL, NULL),
('362553143', 'ELPPA0401', 'ELPPA0401', 'ILCHIGSTD', 'Joliet Radiological Service Corp', 'Brian', '', 'Fagan', 'MD', 'Radiology', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157417591', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831280494', 0, 'Y', 0, '2012-12-26', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('362985395', 'ELPPA0405', 'ELPPA0405', 'ILCHIGSTD', 'Advanced Urology Associates', 'Constance', 'A', 'Marks', 'MD', 'Urology', '', '', NULL, 'O', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', '1541 Riverboat Ctr Dr', 'Joliet', 'Will', 'IL', '60431', '8154094930', '8157267502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1831398445', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.4948, -88.166, NULL, NULL),
('364452578', 'ELPPA0407', 'ELPPA0407', 'ILCHIGSTD', 'Center for Neurological Diseases', 'Nitin', '', 'Nadkarni', 'MD', 'Neurology', '', '', NULL, 'O', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '6304160301', '8157445137', '2222 Weber Rd', 'Crest Hill', 'Will', 'IL', '60403', '6304160301', '8157445137', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', 'Presence Saint Joseph Medical Center', NULL, NULL, 'HCFA|UB|', '1841262961', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5628, -88.1214, NULL, NULL),
('362855470', 'ELPPA0409', 'ELPPA0409', 'ILCHIGSTD', 'Mohammad Toor MD', 'Mohammad', '', 'Toor', 'MD', 'Internal Medicine', 'Cardiology', '', NULL, 'O', '1890 Silver Cross Blvd Ste 320', 'New Lenox', 'Will', 'IL', '60451', '8157228106', '8157178771', '1890 Silver Cross Blvd Ste 320', 'New Lenox', 'Will', 'IL', '60451', '8157228106', '8157178771', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1841289691', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('363304094', 'ELPPA0002', 'ELPPA0002', 'ILCHIGSTD', 'Northeast Nephrology Consultants  ', 'Preeti', 'R', 'Nagarkatte', 'MD', 'Nephrology', '', '', NULL, 'O', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', '815 N Larkin Ave Ste 205', 'Joliet', 'Will', 'IL', '60435', '8157445550', '8157445428', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841308335', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.5367, -88.1253, NULL, NULL),
('453136848', 'ELPPA0411', 'ELPPA0411', 'ILCHIGSTD', 'EMP of Will County', 'Daniel', '', 'Bartgen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841429479', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'ELPPA0412', 'ELPPA0412', 'ILCHIGSTD', 'EMP of Will County', 'Daniel', '', 'Bartgen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', NULL, '4535 Dressler Rd', 'Canton', 'Stark', 'OH', '44718', '8157257133', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841429479', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362711176', 'ELPPA0413', 'ELPPA0413', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Viswanatha', 'B', 'Reddy', 'MD', 'Anesthesiology', '', '', NULL, 'O', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157256331', '301 N Madison St Ste 306', 'Joliet', 'Will', 'IL', '60435', '8157256331', '8157256331', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851328892', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('362711176', 'ELPPA0414', 'ELPPA0414', 'ILCHIGSTD', 'Associated Anesthesiologists of Joliet  ', 'Viswanatha', 'B', 'Reddy', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157256331', 'PO Box 936', 'Bedford Park', 'Cook', 'IL', '60499', '8157256331', '8157256331', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851328892', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL);
