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
('262072378', 'W12033995', 'W12033995', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Scott', 'S', 'Rees', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952427031', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12033996', 'W12033996', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Scott', 'S', 'Rees', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952427031', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033997', 'W12033997', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Stephen', 'M', 'Rees', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1689750838', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12033998', 'W12033998', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Stephen', 'M', 'Rees', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1689750838', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12033999', 'W12033999', 'UT01', 'Southern Utah Womens Health Center', 'Jeffrey', 'G', 'Rogers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588664312', 0, 'N', 0, '2013-07-10', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('262072378', 'W12034000', 'W12034000', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Sue', '', 'Schlegelmilch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W  ', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366580714', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12034001', 'W12034001', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Sue', '', 'Schlegelmilch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014045588', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014045588', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', '2014-03-06', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366580714', 0, 'N', 0, '2014-03-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12034002', 'W12034002', 'UT01', 'Southern Utah Womens Health Center', 'Pamela', 'J', 'Sorensen', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992972616', 0, 'N', 0, '2013-07-10', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('262072378', 'W12034003', 'W12034003', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jefforey', 'R', 'Thorpe', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225153828', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('262072378', 'W12034004', 'W12034004', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jefforey', 'R', 'Thorpe', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225153828', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('262072378', 'W12034005', 'W12034005', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('611681251', 'W12034006', 'W12034006', 'ID01', 'Epic Psychological Services', 'Jon', 'E', 'Ashton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', 'IDMH13PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336361336', 0, 'N', 0, '2013-09-18', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('043698413', 'W12034007', 'W12034007', 'ID01', 'Scott P Hoopes MD & Associates', 'Gladys', 'J', 'Gonzales', 'PA', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588850812', 0, 'N', 0, '2013-07-25', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('043698413', 'W12034008', 'W12034008', 'SACN', 'Scott P Hoopes MD & Associates', 'Gladys', 'J', 'Gonzales', 'PA', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588850812', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('043698413', 'W12034009', 'W12034009', 'ID01', 'Scott P Hoopes MD & Associates', 'Scott', 'P', 'Hoopes', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1255368635', 0, 'N', 0, '2013-07-25', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('611681251', 'W12034011', 'W12034011', 'ID01', 'Epic Psychological Services', 'Ryan', 'J', 'Hulbert', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', 'IDMH13PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053689356', 0, 'N', 0, '2013-07-25', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('043698413', 'W12034010', 'W12034010', 'SACN', 'Scott P Hoopes MD & Associates', 'Scott', 'P', 'Hoopes', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1255368635', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('501523991', 'W12034012', 'W12034012', 'ID01', '', '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', '          ', 'IDMH13MA', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619051463', 0, 'N', 0, '2013-11-26', NULL, NULL, 43.6384, -116.278, NULL, NULL),
('501523991', 'W12034013', 'W12034013', 'SACN', '', 'Rand', 'G', 'Martel', 'LCPC LMFT', 'Mental Health', 'Marriage & Family Therapy', 'Counseling', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MA', '', '', '0.00', '15.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619051463', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('501523991', 'W12034014', 'W12034014', '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', '          ', 'IDMH13MA', '', '', '0.00', '15.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619051463', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('043698413', 'W12034015', 'W12034015', 'ID01', 'Scott P Hoopes MD & Associates', 'Joycelyn', 'J', 'Reiland', 'NP', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225101975', 0, 'N', 0, '2013-07-25', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('043698413', 'W12034016', 'W12034016', 'SACN', 'Scott P Hoopes MD & Associates', 'Joycelyn', 'J', 'Reiland', 'NP', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMH13MD', '', '', '0.00', '15.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225101975', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('270725506', 'W12034033', 'W12034033', 'UTMH1', '', 'Amy', 'L', 'Fehlberg', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1750 Sun Peak Dr Ste 175', 'Park City', 'Summit', 'UT', '84098', '8012637100', NULL, '1750 Sun Peak Dr Ste 175', 'Park City', 'Summit', 'UT', '84098', '8012637100', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619108057', 0, 'N', 0, '2013-06-05', NULL, NULL, 40.6924, -111.545, NULL, NULL),
('270725506', 'W12034034', 'W12034034', 'UTMH1', '', 'Amy', 'L', 'Fehlberg', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '4359010759', NULL, '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '4359010759', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 6, '2013-06-01', '2014-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619108057', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('462488167', 'W12034035', 'W12034035', 'TXHOUSTD', 'Gary A DeBakey MD', 'Gary', '', 'DeBakey', 'MD', 'Gynecology', '', '', NULL, 'B', 'Po Box 12298', 'Belfast', 'Waldo', 'ME', '04915', '2813511195', '2813510519', 'Po Box 12298', 'Belfast', 'Waldo', 'ME', '04915', '2813511195', '2813510519', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1770663254', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12034042', 'W12034042', 'ILCHIGSTD', 'Provena Service Corporation', 'Valbona', '', 'Behaj', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407011588', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12034041', 'W12034041', 'ILCHIGSTD', 'Provena Service Corporation', 'Valbona', '', 'Behaj', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 W Ct St', 'Kankakee', 'Kankakee', 'IL', '60901', '          ', NULL, '500 W Ct St', 'Kankakee', 'Kankakee', 'IL', '60901', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407011588', 0, 'N', 0, '2013-07-31', NULL, NULL, 41.1211, -87.8718, NULL, NULL),
('800307419', 'W12034043', 'W12034043', 'WY01', 'Wyoming Health Medical Group', 'Sarah', 'M', 'Adsit', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', NULL, '419 S Washington St Ste 202A', 'Casper', 'Natrona', 'WY', '82601', '3075770477', '          ', '', '', '', '0.00', '18.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1629301080', 0, 'N', 0, '2013-06-27', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('870286381', 'W12034044', 'W12034044', 'UT01', 'Ogden Clinic', 'Michael', 'T', 'Browne', 'PA', 'Family Practice', '', '', NULL, 'O', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '          ', '8014753701', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '          ', '8014753701', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1043594567', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'W12034045', 'W12034045', 'UT01', 'Ogden Clinic', 'Michael', 'T', 'Browne', 'PA', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '          ', '8014753701', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '          ', '8014753701', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1043594567', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870281028', 'W12034071', 'W12034071', 'UT01', 'Central Utah Clinic PC', '', '', 'Central Utah Clinic PC', 'GROUP', '', '', '', NULL, 'O', '195 W Telegraph', 'Washington', 'Washington', 'UT', '84780', '8013548225', '8014298150', '195 W Telegraph', 'Washington', 'Washington', 'UT', '84780', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2013-10-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005619', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('201180479', 'W12034111', 'W12034111', 'ID01', '', 'Richard', 'A', 'Montgomery', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83704', '2083452212', '2083452282', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83704', '2083452212', '2083452282', 'IDMD', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275567638', 0, 'N', 0, '2013-07-10', NULL, NULL, 43.6239, -116.206, NULL, NULL),
('030463714', 'W12034047', 'W12034047', 'TXHOUSTD', 'Health and Wellness Clinic', 'Ahmad', 'R', 'Al Khush', 'MD', 'Family Practice', '', '', NULL, 'O', '705 S Fry Rd Ste 225', 'Katy', 'Harris', 'TX', '77450', '2814927062', '2814928172', '705 S Fry Rd Ste 225', 'Katy', 'Harris', 'TX', '77450', '2814927062', '2814928172', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821080714', 0, 'N', 0, '2013-06-07', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
('262072378', 'W12034048', 'W12034048', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1578889465', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.2415, -111.667, NULL, NULL),
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('562487247', 'W12034130', 'W12034130', 'TXDALSTD', 'Kavitha Shashikumar MD', 'Kavitha', '', 'Shashikumar', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 16387', 'Fort Worth', 'Tarrant', 'TX', '76162', '8175517712', '8175516262', 'PO Box 16387', 'Fort Worth', 'Tarrant', 'TX', '76162', '8175517712', '8175516262', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1497858435', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('528624487', 'W12034097', 'W12034097', 'UTMH1', '', 'M', 'M', 'Green', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8014768885', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8014768885', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780771147', 0, 'N', 0, '2014-02-27', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('800307419', 'W12034488', 'W12034488', 'WYT1', 'Wyoming Health Medical Group', 'Robert', 'J', 'Griffin', 'PA-C', 'Neurosurgery', '', '', NULL, 'O', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '', '', '', '0.00', '18.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588632236', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('201180479', 'W12034112', 'W12034112', 'SACN', '', 'Richard', 'A', 'Montgomery', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83704', '2083452212', '2083452282', '1423 W Franklin St', 'Boise', 'Ada', 'ID', '83704', '2083452212', '2083452282', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275567638', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12034113', 'W12034113', 'UT01', 'Ogden Clinic- Grand View', '', '', 'Ogden Clinic - Canyon View', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8017799975', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000904878', 0, 'N', 0, '2013-09-19', NULL, NULL, 41.1689, -112.064, NULL, NULL),
('760540476', 'W12035309', 'W12035309', 'TXHOUSTD', 'Oakbend Medical Group', 'Chika', '', 'Odili', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-25', '2014-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104265859', 0, 'N', 0, '2014-02-19', NULL, NULL, 29.5992, -95.6808, NULL, NULL),
('611572907', 'W12034123', 'W12034123', 'UT01', 'MountainStar Medical Group', 'Wyatt', 'J', 'West', 'MD', 'Family Practice', '', '', NULL, 'O', '166 N State St Ste 120', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', '166 N State St Ste 120', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '3.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1730497108', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.039, -111.679, NULL, NULL),
('562487247', 'W12034129', 'W12034129', 'TXDALSTD', 'Kavitha Shashikumar MD', 'Kavitha', '', 'Shashikumar', 'MD', 'Infectious Disease', '', '', NULL, 'O', '11803 S Fwy Ste 104', 'Burleson', 'Johnson', 'TX', '76028', '8175517712', '8175516262', '11803 S Fwy Ste 104', 'Burleson', 'Johnson', 'TX', '76028', '8175517712', '8175516262', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1497858435', 0, 'N', 0, '2013-06-18', NULL, NULL, 32.5865, -97.3191, NULL, NULL),
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('264664897', 'W12034133', 'W12034133', 'UT01', 'Advanced Family Healthcare', 'Bonnie', 'L', 'Wood', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '4358670644', '4358670645', 'PO Box 7944', 'Belfast', 'Waldo', 'ME', '04915', '4358670644', '4358670645', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457610255', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
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('760607742', 'W12034136', 'W12034136', 'TXHOUSTD', 'Capstone Family Practice ', 'Tina', '', 'Corkran', 'MD', 'Family Practice', '', '', NULL, 'O', '13231 Champion Forest Dr Ste 230', 'Houston', 'Harris', 'TX', '77069', '2818667080', '2818667151', '13231 Champion Forest Dr Ste 230', 'Houston', 'Harris', 'TX', '77069', '2818667080', '2818667151', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB', '1972659084', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.9811, -95.5144, NULL, NULL),
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('462667717', 'W12034138', 'W12034138', 'TXHOUSTD', 'Clear Lake OBGYN PLLC', '', '', 'Clear Lake OBGYN PLLC', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639515091', 0, 'Y', 0, '2013-06-18', NULL, NULL, 29.5425, -95.1241, NULL, NULL),
('462667717', 'W12034140', 'W12034140', 'TXHOUSTD', 'Clear Lake OBGYN PLLC', 'Anitra', '', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497806699', 0, 'N', 0, '2013-06-19', NULL, NULL, 29.5425, -95.1241, NULL, NULL),
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('462667717', 'W12034144', 'W12034144', 'TXHOUSTD', 'Clear Lake OBGYN PLLC', 'Michelle', '', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', '251 Medical Ctr Blvd Ste 300', 'Webster', 'Harris', 'TX', '77598', '2815570300', '2815573301', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457515249', 0, 'N', 0, '2013-06-19', NULL, NULL, 29.5425, -95.1241, NULL, NULL),
('752536818', 'W12034148', 'W12034148', 'TXDALSTD', 'Health Texas Provider Network', 'Gerald', 'J', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1093739716', 0, 'N', 0, '2013-06-10', NULL, NULL, 33.2183, -96.6841, NULL, NULL),
('752536818', 'W12034147', 'W12034147', 'TXDALSTD', 'Health Texas Provider Network', 'Gerald', 'J', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1093739716', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12034151', 'W12034151', 'TXDALSTD', 'Diabetes America', 'Pablo', '', 'Mora', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306836168', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12034150', 'W12034150', 'TXDALSTD', 'Diabetes America', 'Pablo', '', 'Mora', 'MD', 'Endocrinology', '', '', NULL, 'O', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306836168', 0, 'N', 0, '2013-06-28', NULL, NULL, 32.8961, -96.9587, NULL, NULL),
('201435671', 'W12034149', 'W12034149', 'TXDALSTD', 'Diabetes America', 'Pablo', '', 'Mora', 'MD', 'Endocrinology', '', '', NULL, 'O', '1708 Coit Rd Ste 100', 'Plano', 'Collin', 'TX', '75075', '8232373500', '8882377954', '1708 Coit Rd Ste 100', 'Plano', 'Collin', 'TX', '75075', '8232373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306836168', 0, 'N', 0, '2013-06-28', NULL, NULL, 33.0228, -96.7691, 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
('460906063', 'W12034152', 'W12034152', 'UTMH1', 'The Counseling Center', 'Karen', '', 'Redd', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '1174 E Graystone Business Plaza Ste 11', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012982000', '8019511490', '1174 E Graystone Business Plaza Ste 11', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114266988', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('841377595', 'W12034156', 'W12034156', 'UT01', 'Murray Chiropractic Office', 'Anne', 'J', 'Binkerd', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 348', 'Heber City', 'Wasatch', 'UT', '84032', '8012622651', '8012622651', 'PO Box 348', 'Heber City', 'Wasatch', 'UT', '84032', '8012622651', '8012622651', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-06-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184977605', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('841377595', 'W12034155', 'W12034155', 'UT01', 'Murray Chiropractic Office', 'Anne', 'J', 'Binkerd', 'DC', 'Chiropractic', '', '', NULL, 'O', '431 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012622651', '8012622651', '431 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012622651', '8012622651', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-06-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184977605', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12034158', 'W12034158', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Mark', 'E', 'Mering', 'MD', 'Family Practice', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578527990', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('272481635', 'W12034161', 'W12034161', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Seana', 'K', 'Daly', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2084635000', '2532841881', 'PO Box 742128   ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558301929', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12034162', 'W12034162', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Seana', 'K', 'Daly', 'MD', 'Family Practice', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', '1512 12th Ave Rd   ', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558301929', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('273780811', 'W12034164', 'W12034164', 'ID02', 'The Pain Center', 'Nathan', 'D', 'Swartz', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1673 W Shoreline Ste 140', 'Boise', 'Ada', 'ID', '83702', '2083429800', '2083424223', '1673 W Shoreline Ste 140', 'Boise', 'Ada', 'ID', '83702', '2083429800', '2083424223', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-14', '2014-02-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316114135', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('452712822', 'W12034226', 'W12034226', 'UTDT01', 'Comfort Dental of Clinton', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', NULL, '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
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('452712822', 'W12034228', 'W12034228', 'UTDT01', 'Lomond View Dental', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', NULL, '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034229', 'W12034229', 'UTDT01', 'Mountain View Dental Associates', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034230', 'W12034230', 'UTDT01', 'Spring Creek Dental Associates', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034231', 'W12034231', 'UTDT01', 'Canyon Dental Care', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034232', 'W12034232', 'UTDT01', 'Canyon Dental Care', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', NULL, '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034233', 'W12034233', 'UTDT01', 'Logan Dental Associates', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034234', 'W12034234', 'UTDT01', 'Midland Dental', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034236', 'W12034236', 'UTDT01', 'Hillside Dental Associates', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', NULL, '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034237', 'W12034237', 'UTDT01', 'Comfort Family Dental of South Ogden', 'Michael', '', 'Bauman', '', 'Oral Surgeon', '', '', NULL, 'O', '5085 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', NULL, '5085 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009921', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('743002420', 'W12034241', 'W12034241', 'TXHOUSTD', 'Sealy Family Practice Clinic', 'Isidro', 'G', 'De Leon ', 'DO', 'Family Practice', '', '', NULL, 'O', '826 S Meyer St', 'Sealy', 'Austin', 'TX', '77474', '9796270795', '9796270799', '826 S Meyer St', 'Sealy', 'Austin', 'TX', '77474', '9796270795', '9796270799', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1942236856', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.779, -96.1563, NULL, NULL),
('752822536', 'W12034242', 'W12034242', 'TXDALSTD', 'Lake Pointe Pediatrics', 'Dynal', 'M', 'London', 'MD', 'Pediatrics', '', '', NULL, 'O', '6900 Scenic Dr Ste 103', 'Rowlett', 'Dallas', 'TX', '75088', '9724121034', '9724755708', '6900 Scenic Dr Ste 103', 'Rowlett', 'Dallas', 'TX', '75088', '9724121034', '9724755708', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932101078', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.9224, -96.5095, NULL, NULL),
('200718437', 'W12034243', 'W12034243', 'TXHOUSTD', 'Alivio Family Medical Center', 'Miguel', '', 'Morales', 'MD', 'Family Practice', '', '', NULL, 'O', '2409 Aldine Mail Dr', 'Houston', 'Harris', 'TX', '77039', '2812192455', '2812193959', '2409 Aldine Mail Dr', 'Houston', 'Harris', 'TX', '77039', '2812192455', '2812193959', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912123878', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.9024, -95.3474, NULL, NULL),
('752837570', 'W12034244', 'W12034244', 'TXDALSTD', 'Andew W Hoover MD', 'Andrew', 'W', 'Hoover', 'MD', 'Family Practice', '', '', NULL, 'O', '600 S Main Ste 100', 'Rhome', 'Wise', 'TX', '76078', '8176362018', '8176362022', '600 S Main Ste 100', 'Rhome', 'Wise', 'TX', '76078', '8176362018', '8176362022', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1902837727', 0, 'N', 0, '2013-06-20', NULL, NULL, 33.0526, -97.4719, NULL, NULL),
('752837570', 'W12034245', 'W12034245', 'TXDALSTD', 'Andew W Hoover MD', 'Andrew', 'W', 'Hoover', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 770', 'Rhome', 'Wise', 'TX', '76078', '8176362018', '8176362022', 'PO Box 770', 'Rhome', 'Wise', 'TX', '76078', '8176362018', '8176362022', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1902837727', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('412217043', 'W12034246', 'W12034246', 'TXHOUSTD', 'Abbas Jafri MD', 'Abbas', 'H', 'Jafri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1120 Medical Plaza Dr Ste 335', 'Shenandoah', 'Montgomery', 'TX', '77380', '2815284100', '2815284099', '1120 Medical Plaza Dr Ste 335', 'Shenandoah', 'Montgomery', 'TX', '77380', '2815284100', '2815284099', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1891798161', 0, 'N', 0, '2013-06-20', NULL, NULL, 30.1728, -95.455, NULL, NULL),
('760484064', 'W12034247', 'W12034247', 'TXHOUSTD', 'Priti Jadav', 'Priti', 'S', 'Jadav', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3507 Town Ctr Blvd S Ste S', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819802599', '2819803883', '3507 Town Ctr Blvd S Ste S', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819802599', '2819803883', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609806793', 0, 'N', 0, '2013-06-12', NULL, NULL, 29.5875, -95.6299, NULL, NULL),
('760484064', 'W12034248', 'W12034248', 'TXHOUSTD', 'Priti Jadav', 'Priti', 'S', 'Jadav', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 16700', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819802599', '2819803883', 'PO Box 16700', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819802599', '2819803883', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609806793', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('752775699', 'W12034249', 'W12034249', 'TXDALSTD', 'Lake Pointe Pediatrics ', 'Pamela', 'M', 'Wieland', 'MD', 'Pediatrics', '', '', NULL, 'O', '6900 Scenic Dr Ste 103', 'Rowlett', 'Dallas', 'TX', '75088', '9724121034', '9724755708', '6900 Scenic Dr Ste 103', 'Rowlett', 'Dallas', 'TX', '75088', '9724121034', '9724755708', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578656096', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.9224, -96.5095, NULL, NULL),
('760343455', 'W12034250', 'W12034250', 'TXHOUSTD', 'Gordon Bellah Jr MD', 'Gordon', '', 'Bellah', 'MD', 'Pediatrics', '', '', NULL, 'O', '2060 Space Park Dr Ste 204', 'Houston', 'Harris', 'TX', '77058', '2813331800', '2813351789', '2060 Space Park Dr Ste 204', 'Houston', 'Harris', 'TX', '77058', '2813331800', '2813351789', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457411985', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.5482, -95.0867, NULL, NULL),
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('621801973', 'W12034263', 'W12034263', 'UT01', 'Physician Group of Utah', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415  ', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2013-09-20', 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
('621801973', 'W12034264', 'W12034264', 'UT01', 'Physician Group of Utah Inc', 'Kendall', '', 'Grose', 'DO', 'Anesthesiology', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245406776', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12034265', 'W12034265', 'ILCHIGSTD', 'Presence Healthcare Services', 'Moona', '', 'Salamn Khan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '6309142499', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679876106', 0, 'N', 0, '2013-07-10', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'W12034266', 'W12034266', 'ILCHIGSTD', 'Presence Healthcare Services', 'Moona', '', 'Salamn Khan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679876106', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'W12034268', 'W12034268', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Michael', '', 'Fiorucci', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2850 W 95th St Ste 305', 'Evergreen Park', 'Cook', 'IL', '60805', '7084998500', '7082295193', '2850 W 95th St Ste 305', 'Evergreen Park', 'Cook', 'IL', '60805', '7084998500', '7082295193', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598760480', 0, 'N', 0, '2013-06-11', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('363383867', 'W12034270', 'W12034270', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Khalid', '', 'Yousuf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2850 W 95th St Ste 406', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994844', '7082295193', '2850 W 95th St Ste 406', 'Evergreen Park', 'Cook', 'IL', '60805', '7084994844', '7082295193', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', '', 'HCFA|UB|', '1417096199', 0, 'N', 0, '2013-06-11', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
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('753051218', 'W12034273', 'W12034273', 'UTDT01', 'A Kids Place Dentistry', 'Michael', '', 'Cottam', 'DMD', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001149', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
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('753051218', 'W12034275', 'W12034275', 'UTDT01', 'A Kids Place Dentistry', 'Rodney', '', 'Slater', 'DDS', 'Pedodontist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004126', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('208492649', 'W12034276', 'W12034276', 'UTDT01', 'Cedar View Pediatric Dentistry', 'Tyler', '', 'Albrecht', 'DMD', 'Dentist', 'Pedodontist', '', NULL, 'O', '1251 Northfield Rd Ste 201', 'Cedar City', 'Iron', 'UT', '84721', '4355868188', NULL, '1251 Northfield Rd Ste 201', 'Cedar City', 'Iron', 'UT', '84721', '4355868188', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004139', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034277', 'W12034277', 'UTDT01', 'The Center of Dental Professionals', 'Kris', 'H', 'Rosander', 'DDS', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1558422279', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034278', 'W12034278', 'UTDT01', 'The Center of Dental Professionals', 'Luke', '', 'Petersen', '', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009877', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034279', 'W12034279', 'UTDT01', 'The Center of Dental Professionals', 'Michael', '', 'Boyack', 'DDS', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1649424029', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('260334375', 'W12034281', 'W12034281', 'UTDT01', 'Jeppson Dental', 'Darren', '', 'Hatch', 'DMD', 'Dentist', '', '', NULL, 'O', '1224 S River Rd Bldg D', 'St George', 'Washington', 'UT', '84790', '4356289600', NULL, '1224 S River Rd Bldg D', 'St George', 'Washington', 'UT', '84790', '4356289600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010112', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870299377', 'W12034283', 'W12034283', 'UTDT01', 'Jeffrey F Ward DDS', 'Jeffrey', '', 'Ward', 'DDS', 'Dentist', '', '', NULL, 'O', '4020 S 700 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012664352', NULL, '4020 S 700 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012664352', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010113', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034285', 'W12034285', 'UTDT01', 'Cherry Creek Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', NULL, '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034286', 'W12034286', 'UTDT01', 'Payson Family and Cosmetic Dentistry', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034287', 'W12034287', 'UTDT01', 'Ridge View Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034288', 'W12034288', 'UTDT01', 'Aspen Dental Care of Cache Valley', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', NULL, '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034289', 'W12034289', 'UTDT01', 'Heritage Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', NULL, '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034290', 'W12034290', 'UTDT01', 'North View Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034291', 'W12034291', 'UTDT01', 'Comfort Dental of Clinton', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', NULL, '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034292', 'W12034292', 'UTDT01', 'Perry Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', NULL, '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034293', 'W12034293', 'UTDT01', 'Lomond View Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', NULL, '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034294', 'W12034294', 'UTDT01', 'Mountain View Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034295', 'W12034295', 'UTDT01', 'Spring Creek Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034296', 'W12034296', 'UTDT01', 'Canyon Dental Care', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034297', 'W12034297', 'UTDT01', 'Hyde Park Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', NULL, '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034298', 'W12034298', 'UTDT01', 'Logan Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034299', 'W12034299', 'UTDT01', 'Midland Dental', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034300', 'W12034300', 'UTDT01', 'Hillside Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', NULL, '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034301', 'W12034301', 'UTDT01', 'Comfort Family Dental of South Ogden', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '5085 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', NULL, '5085 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12034302', 'W12034302', 'UTDT01', 'South Valley Dental Associates', 'Karl', '', 'Koerner', 'DDS', 'Dentist', '', '', NULL, 'O', '9217 S Redwood Rd Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015661873', NULL, '9217 S Redwood Rd Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015661873', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010114', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870308946', 'W12034304', 'W12034304', 'UTDT01', 'Redwood Endodontics', 'Richard', '', 'Ellggren', 'DMD', 'Endodontist', '', '', NULL, 'O', '6287 Redwood Rd Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012667393', NULL, '6287 Redwood Rd Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012667393', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010115', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034306', 'W12034306', 'UTDT01', 'The Center of Dental Professionals', 'Willard', '', 'Maughan', 'DDS', 'Periodontist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'DEN|', '1699939603', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('455281404', 'W12034307', 'W12034307', 'UTDT01', 'Aspire Dental Care', 'Michael', '', 'Warner', 'DMD', 'Dentist', '', '', NULL, 'O', '2651 W 10400 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012544454', NULL, '2651 W 10400 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012544454', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009915', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('201851590', 'W12034308', 'W12034308', 'UTDT01', 'Smile Center', 'Mark', '', 'Ward', 'DDS', 'Dentist', '', '', NULL, 'O', '10 S 300 E', 'Provo', 'Utah', 'UT', '84606', '8013758770', NULL, '10 S 300 E', 'Provo', 'Utah', 'UT', '84606', '8013758770', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009506', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('452958326', 'W12034309', 'W12034309', 'UTDT01', 'Experienced Dental', 'Paul', '', 'Mackley', 'DDS', 'Dentist', '', '', NULL, 'O', '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', NULL, '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007383', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('461970049', 'W12034310', 'W12034310', 'UTDT01', 'Elite Dental', 'Randy', '', 'Braithwaite', 'DDS', 'Dentist', '', '', NULL, 'O', '218 N W State Rd', 'American Fork', 'Utah', 'UT', '84003', '8017637737', NULL, '218 N W State Rd', 'American Fork', 'Utah', 'UT', '84003', '8017637737', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009821', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034311', 'W12034311', 'UTDT01', 'The Center of Dental Professionals', 'Spencer', '', 'Updike', 'DDS', 'Dentist', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004090', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('454297916', 'W12034312', 'W12034312', 'UTDT01', 'Platinum Care Dental', 'Spencer', '', 'Wagner', 'DMD', 'Dentist', '', '', NULL, 'O', '279 E 5900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012931234', NULL, '279 E 5900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012931234', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009470', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('201385862', 'W12034314', 'W12034314', 'UTDT01', 'Dr Dougs Pediatric Dentistry', 'K Douglas', '', 'Fryer', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1300 N 200 E', 'Logan', 'Cache', 'UT', '84341', '4357923033', NULL, '1300 N 200 E', 'Logan', 'Cache', 'UT', '84341', '4357923033', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009870', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('568638655', 'W12034315', 'W12034315', 'UTDT01', 'Panguitch Dental', 'Shawn', '', 'Parkin', 'DDS', 'Dentist', '', '', NULL, 'O', '75 N 200 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356762443', NULL, '75 N 200 E', 'Panguitch', 'Garfield', 'UT', '84759', '4356762443', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009845', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('273193401', 'W12034316', 'W12034316', 'UTDT01', 'Nance Orthodontics', 'Brady M', '', 'Nance', 'DMD', 'Dentist', '', '', NULL, 'O', '3566 Pony Express Pkwy Ste 1', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017894800', NULL, '3566 Pony Express Pkwy Ste 1', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017894800', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004130', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12034317', 'W12034317', 'UTDT01', 'The Center of Dental Professionals', 'Cameron', '', 'Egbert', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', NULL, '3798 S 700 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017478007', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004210', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('371712885', 'W12034318', 'W12034318', 'UTDT01', 'Dentistry for Children', 'Erik', '', 'Rooklidge', 'DDS', 'Pedodontist', '', '', NULL, 'O', '6095 Fashion Blvd Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8012684986', NULL, '6095 Fashion Blvd Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8012684986', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008474', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('274637146', 'W12034320', 'W12034320', 'UTDT01', 'Coalville Family Dental', 'Michael', '', 'Judi', 'DMD', 'Dentist', '', '', NULL, 'O', '60 S Main St', 'Coalville', 'Summit', 'UT', '84017', '4353362657', NULL, '60 S Main St', 'Coalville', 'Summit', 'UT', '84017', '4353362657', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010117', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870529899', 'W12034322', 'W12034322', 'UTDT01', 'Mark L Pettit', 'Mark', 'L', 'Pettit', 'DDS', 'Dentist', '', '', NULL, 'O', '1060 E 100 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281633', NULL, '1060 E 100 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281633', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010118', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('461544956', 'W12034324', 'W12034324', 'UTDT01', 'Bonneville Preventive Dentistry', 'Matthew', '', 'Wolpert', 'DMD', 'Dentist', '', '', NULL, 'O', '3860 Jackson Ave Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016270420', NULL, '3860 Jackson Ave Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016270420', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '1093087629', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('364737423', 'W12034326', 'W12034326', 'UTDT01', 'Apex Dental', 'Neil', '', 'Baird', 'DDS', 'Dentist', '', '', NULL, 'O', '286 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015769725', NULL, '286 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015769725', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010120', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870286201', 'W12034333', 'W12034333', 'UTDT01', 'Ralph Wayne Binns, DDS', 'Ralph', '', 'Binns', 'DDS', 'Dentist', '', '', NULL, 'O', '150 E 200 N Ste F', 'Logan', 'Cache', 'UT', '84321', '4357531686', NULL, '150 E 200 N Ste F', 'Logan', 'Cache', 'UT', '84321', '4357531686', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010121', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('453161026', 'W12034335', 'W12034335', 'UTDT01', 'Sunset Dental Group', 'Stanley', '', 'Dorius', 'DDS', 'Dentist', '', '', NULL, 'O', '929 W Sunset Blvd Ste 15', 'St George', 'Washington', 'UT', '84770', '4356565900', NULL, '929 W Sunset Blvd Ste 15', 'St George', 'Washington', 'UT', '84770', '4356565900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010122', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('870452315', 'W12034338', 'W12034338', 'UTDT01', 'The Tooth Doctor', 'Tyler', '', 'May', 'DDS', 'Dentist', '', '', NULL, 'O', '2180 E Fort Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019444141', NULL, '2180 E Fort Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019444141', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010123', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('870452315', 'W12034337', 'W12034337', 'UTDT01', 'The Tooth Doctor', 'Tyler', '', 'May', 'DDS', 'Dentist', '', '', NULL, 'O', '3060 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720555', NULL, '3060 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720555', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010123', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('454297916', 'W12034340', 'W12034340', 'UTDT01', 'Platinum Care Dental', 'William', '', 'Burns', 'DDS', 'Dentist', '', '', NULL, 'O', '279 E 5900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012931234', NULL, '279 E 5900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012931234', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010124', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('272133292', 'W12034342', 'W12034342', 'UTDT01', 'Oral and Facial Surgery of Utah', 'Judd', '', 'Partridge', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '4775 W Daybreak Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012805535', NULL, '4775 W Daybreak Pkwy Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012805535', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN', '0000010125', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12034393', 'W12034393', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Christina', 'M', 'Knutson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1649212119', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12034395', 'W12034395', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Darrell', 'J', 'Ludders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1548214927', 0, 'N', 0, '2013-10-23', NULL, NULL, 43.6156, -116.261, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('820200895', 'W12034397', 'W12034397', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12034398', 'W12034398', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Lisa', 'M', 'Minge', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1467405787', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12034399', 'W12034399', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Sara', 'B', 'Thomson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1356316509', 0, 'N', 0, '2013-11-15', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12034400', 'W12034400', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'N', 0, '2014-03-21', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('820200895', 'W12034401', 'W12034401', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', '2014-01-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'N', 0, '2014-02-26', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('942854057', 'W12034403', 'W12034403', 'UTIHC01', '', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-08-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12034404', 'W12034404', 'UTIHC02', '', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-08-01', '2013-07-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034406', 'W12034406', 'UTIHC04', '', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7552, -111.827, NULL, NULL),
('942854057', 'W12034408', 'W12034408', 'UTIHC01', '', 'Blake', 'I', 'Gardner', 'MD', 'Cardiology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1134301997', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12034409', 'W12034409', 'UTIHC03', '', 'Blake', 'I', 'Gardner', 'MD', 'Cardiology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1134301997', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034414', 'W12034414', 'UTIHC04', '', 'James', 'R', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427157148', 0, 'N', 0, '2013-06-13', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12034412', 'W12034412', 'UTIHC01', '', 'James', 'R', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427157148', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12034413', 'W12034413', 'UTIHC03', '', 'James', 'R', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511050', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427157148', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034417', 'W12034417', 'UTIHC01', '', 'Nancy', 'Ann', 'Standler', 'MD', 'Pathology', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', NULL, '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669444535', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034421', 'W12034421', 'UTIHC03', '', 'John', 'P', 'Tully', 'PA', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992964563', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034424', 'W12034424', 'UTIHC01', '', 'Dallon', 'D', 'Whitney', 'PA', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511002', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1891914941', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12034429', 'W12034429', 'UTIHC03', '', 'Zachary', 'R', 'Williams', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134372584', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
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('205425823', 'W12034433', 'W12034433', 'TXHOUSTD', 'Southeast Medical Group', 'Adnan', '', 'Rafiq', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11914 Astoria Ste 185', 'Houston', 'Harris', 'TX', '77089', '2819227377', '2819227979', '11914 Astoria Ste 185', 'Houston', 'Harris', 'TX', '77089', '2819227377', '2819227979', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1831352269', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
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('010717279', 'W12034435', 'W12034435', 'TXHOUSTD', 'HSE Medicine', 'Alfredo', 'T', 'Ermac', 'MD', 'Family Practice', '', '', NULL, 'O', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649268384', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.9361, -95.6816, NULL, NULL),
('751878141', 'W12034438', 'W12034438', 'TXDALSTD', 'Texas FamiliCare Medical Group', 'Robert', 'A', 'Strzinek', 'MD', 'Family Practice', '', '', NULL, '', '1725 Chadwick Ct', 'Hurst', 'Tarrant', 'TX', '76054', '8172814446', '8172814990', '1725 Chadwick Ct', 'Hurst', 'Tarrant', 'TX', '76054', '8172814446', '8172814990', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568480457', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('200319102', 'W12034439', 'W12034439', 'TXDALSTD', 'North Texas Heart Care', 'Vidyasagar', '', 'Chodimella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4325 N Josey Ln Plaza 3 Ste 204', 'Carrollton', 'Denton', 'TX', '75010', '9723957400', '9723957440', '4325 N Josey Ln Plaza 3 Ste 204', 'Carrollton', 'Denton', 'TX', '75010', '9723957400', '9723957440', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB', '1215972419', 0, 'N', 0, '2013-06-20', NULL, NULL, 33.0276, -96.8847, NULL, NULL),
('752748235', 'W12034440', 'W12034440', 'TXDALSTD', 'Novaks Office', 'Jayshree', 'J', 'Novak', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 N Cottonwood Dr Ste 105', 'Richardson', 'Dallas', 'TX', '75080', '9722314605', '9722312731', '100 N Cottonwood Dr Ste 105', 'Richardson', 'Dallas', 'TX', '75080', '9722314605', '9722312731', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1164426573', 0, 'N', 0, '2013-06-18', NULL, NULL, 32.9513, -96.766, NULL, NULL),
('205425823', 'W12034441', 'W12034441', 'TXHOUSTD', 'Southeast Medical Group', 'Maqsood', '', 'Javed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11914 Astoria Ste 185', 'Houston', 'Harris', 'TX', '77089', '2819227377', '2819227979', '11914 Astoria Ste 185', 'Houston', 'Harris', 'TX', '77089', '2819227377', '2819227979', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1073568713', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('731667104', 'W12034443', 'W12034443', 'TXDALSTD', 'Omni Medical Center', 'Yan', '', 'Li', 'MD', 'Family Practice', '', '', NULL, 'O', '3413 Spectrum Blvd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '9728844160', '9726681618', '3413 Spectrum Blvd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '9728844160', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1619932076', 0, 'N', 0, '2013-06-18', NULL, NULL, 32.9973, -96.6623, NULL, NULL),
('731667104', 'W12034442', 'W12034442', 'TXDALSTD', 'Omni Medical Center', 'Yan', '', 'Li', 'MD', 'Family Practice', '', '', NULL, 'O', '4040 McDermott Rd Ste 100', 'Plano', 'Collin', 'TX', '75024', '9726686868', '9726681618', '4040 McDermott Rd Ste 100', 'Plano', 'Collin', 'TX', '75024', '9726686868', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1619932076', 0, 'N', 0, '2013-06-18', NULL, NULL, 33.101, -96.7719, NULL, NULL),
('731667104', 'W12034444', 'W12034444', 'TXDALSTD', 'Omni Medical Center', 'Yan', '', 'Li', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 250434', 'Plano', 'Collin', 'TX', '75025', '9728844160', '9726681618', 'PO Box 250434', 'Plano', 'Collin', 'TX', '75025', '9728844160', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1619932076', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('731667104', 'W12034446', 'W12034446', 'TXDALSTD', 'Omni Medical Center', 'Priti', '', 'Ranjan', 'MD', 'Family Practice', '', '', NULL, 'O', '3413 Spectrum Blvd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '9728844160', '9726681618', '3413 Spectrum Blvd Ste 100', 'Richardson', 'Dallas', 'TX', '75082', '9728844160', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1356579247', 0, 'N', 0, '2013-06-18', NULL, NULL, 32.9973, -96.6623, NULL, NULL),
('731667104', 'W12034445', 'W12034445', 'TXDALSTD', 'Omni Medical Center', 'Priti', '', 'Ranjan', 'MD', 'Family Practice', '', '', NULL, 'O', '4040 McDermott Rd Ste 100', 'Plano', 'Collin', 'TX', '75024', '9726686868', '9726681618', '4040 McDermott Rd Ste 100', 'Plano', 'Collin', 'TX', '75024', '9726686868', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1356579247', 0, 'N', 0, '2013-06-18', NULL, NULL, 33.101, -96.7719, NULL, NULL),
('731667104', 'W12034447', 'W12034447', 'TXDALSTD', 'Omni Medical Center', 'Priti', '', 'Ranjan', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 250434', 'Plano', 'Collin', 'TX', '75025', '9728844160', '9726681618', 'PO Box 250434', 'Plano', 'Collin', 'TX', '75025', '9728844160', '9726681618', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1356579247', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('010717279', 'W12034436', 'W12034436', 'TXHOUSTD', 'HSE Medicine', 'Paul', 'E', 'Shepard', 'MD', 'Family Practice', '', '', NULL, 'O', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467440131', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.9361, -95.6816, NULL, NULL),
('010717279', 'W12034437', 'W12034437', 'TXHOUSTD', 'HSE Medicine', 'S Giovanni', '', 'Revossa', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', '10720 Barker Cypress Rd', 'Cypress', 'Harris', 'TX', '77433', '2813454800', '2013454803', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316086317', 0, 'N', 0, '2013-06-18', NULL, NULL, 29.9361, -95.6816, NULL, NULL),
('820445140', 'W12034448', 'W12034448', 'ID01', 'The Eye Associates', 'Drew', 'C', 'Dayton', 'OD', 'Optometry', '', '', NULL, 'O', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1740231737', 0, 'N', 0, '2013-06-14', NULL, NULL, 43.5809, -116.354, NULL, NULL),
('820445140', 'W12034449', 'W12034449', 'ID01', 'The Eye Associates', 'Stephen', '', 'Hunter', 'OD', 'Optometry', '', '', NULL, 'O', '1602 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083425151', '2084590725', '1602 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083425151', '2084590725', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-04', '2014-03-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285748772', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6561, -116.696, NULL, NULL),
('820445140', 'W12034450', 'W12034450', 'ID01', 'The Eye Associates', 'Stephen', '', 'Hunter', 'OD', 'Optometry', '', '', NULL, 'O', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-04', '2014-03-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285748772', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.5809, -116.354, NULL, NULL),
('460600325', 'W12034451', 'W12034451', 'TXSATSTD', 'Ostrower Nieheisel & Davis MD', 'Valerie', 'G', 'Ostrower', 'MD', 'Pediatrics', '', '', NULL, 'O', '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', NULL, '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', '', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659328359', 0, 'N', 0, '2014-04-04', NULL, NULL, 29.5094, -98.5732, NULL, NULL),
('460600325', 'W12034452', 'W12034452', 'TXSATSTD', 'Night and Day Pediatrics', 'Deepali', 'J', 'Dubal', 'MD', 'Pediatrics', '', '', NULL, 'O', '502 Madison Oak Dr Ste 340', 'San Antonio', 'Bexar', 'TX', '78258', '2104955552', NULL, '502 Madison Oak Dr Ste 340', 'San Antonio', 'Bexar', 'TX', '78258', '2104955552', '          ', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-07-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959447', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('460600325', 'W12034453', 'W12034453', 'TXSATSTD', 'Ostrower Nieheisel & Davis MD', 'Laura', 'F', 'Davis', 'MD', 'Pediatrics', '', '', NULL, 'O', '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', NULL, '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', '          ', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1578666947', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.5094, -98.5732, NULL, NULL),
('460600325', 'W12034454', 'W12034454', 'TXSATSTD', 'Ostrower Nieheisel & Davis MD', 'Margaret', 'D', 'Neiheisel', 'MD', 'Pediatrics', '', '', NULL, 'O', '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', NULL, '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', '          ', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1073627741', 0, 'N', 0, '2014-03-24', NULL, NULL, 29.5094, -98.5732, NULL, NULL),
('201435671', 'W12034456', 'W12034456', 'TXHOUSTD', 'Diabetes America', 'Tina', '', 'Pariarin', 'MD', 'Endocrinology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083845523', 0, 'N', 0, '2013-07-12', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('201435671', 'W12034457', 'W12034457', 'TXHOUSTD', 'Diabetes America', 'Tina', '', 'Pariarin', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083845523', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('826001139', 'W12034460', 'W12034460', 'ID02', 'Weiser Memorial Specialty Clinic', 'Bryan', 'L', 'Drake', 'DO', 'Family Practice', '', '', NULL, 'O', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1972545556', 0, 'N', 0, '2014-06-19', NULL, NULL, 44.2487, -116.962, NULL, NULL),
('826001139', 'W12034462', 'W12034462', 'ID02', 'Weiser Memorial Specialty Clinic', 'Bryon', 'D', 'Hemphill', 'DO', 'Family Practice', '', '', NULL, 'O', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1598707226', 0, 'N', 0, '2013-07-05', NULL, NULL, 44.2487, -116.962, NULL, NULL),
('261253824', 'W12034464', 'W12034464', 'ID02', 'Idaho Hand Center', 'Jeffrey', 'S', 'Boyer', 'MD', 'Hand Surgery', '', '', NULL, 'O', '901 N Curtis Ste 304', 'Boise', 'Ada', 'ID', '83706', '2083424263', '2083750597', '901 N Curtis Ste 304', 'Boise', 'Ada', 'ID', '83706', '2083424263', '2083750597', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205032901', 0, 'N', 0, '2013-06-14', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('870218917', 'W12034471', 'W12034471', 'UT01', 'Tanner Memorial Clinic Mon-Fri 5pm-8pm Sat 9am-3pm', '', '', 'Tanner Memorial Clinic', 'GROUP', 'Family Practice', 'Primary Care with Extended Hours', 'Urgent Care', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009000', 0, 'N', 0, '2014-06-02', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('820445140', 'W12034472', 'W12034472', 'IDBOISTD', 'The Eye Associates', 'Gregory', 'J', 'Kent', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1891868006', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.5809, -116.354, NULL, NULL),
('820445140', 'W12034473', 'W12034473', 'IDBOISTD', 'The Eye Associates', 'Katherine', 'O', 'Whitfield', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', NULL, NULL, 'O', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', '2620 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2083425151', '2083753154', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1336255223', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.5809, -116.354, NULL, NULL),
('820425454', 'W12034469', 'W12034469', 'ID01', 'Boise Anesthesia', 'Michael', 'S', 'Mickelsen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-04', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275838021', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820425454', 'W12034470', 'W12034470', 'ID01', 'Boise Anesthesia', 'Michael', 'S', 'Mickelsen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '2083676416', '2083759530', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.79', '10.00', '0.00', 3, '2013-06-04', '2013-06-04', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275838021', 0, 'N', 0, '2013-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12034475', 'W12034475', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN', 'Jeffrey', 'R', 'Jacobs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-04', '2013-12-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1154454098', 0, 'N', 0, '2014-01-21', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W12034477', 'W12034477', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN', 'Alison', '', 'Shearer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-04', '2013-12-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1396898482', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W12034482', 'W12034482', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Sean', 'A', 'McKay', 'MD', 'Pulmonary', '', '', NULL, 'O', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1417918004', 0, 'N', 0, '2013-06-14', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('621762570', 'W12034484', 'W12034484', 'UT01', 'Roosevelt Community Clinic', 'Melanie', 'A', 'Hardy', 'DO', 'Family Practice', '', '', NULL, 'O', '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357839272', '4357899222', '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357839272', '4357899222', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-03', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1891941662', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.4582, -109.53, NULL, NULL),
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('742031086', 'W12034492', 'W12034492', 'TXHOUSTD', '', 'Heena', 'N', 'Thakkar', 'MD', 'Pediatrics', '', '', NULL, 'O', '1740 W 27th Ste 305', 'Houston', 'Harris', 'TX', '77008', '7138614800', '7138617762', '1740 W 27th Ste 305', 'Houston', 'Harris', 'TX', '77008', '7138614800', '7138617762', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558361923', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.8104, -95.4298, NULL, NULL),
('830182821', 'W12034494', 'W12034494', 'WY01', 'Gottsche Rehabilitation Center ', 'Welton ', 'S', 'Wittwer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', '2013-05-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1548522634', 0, 'N', 0, '2014-04-02', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830182821', 'W12034493', 'W12034493', 'WYT2', 'Gottsche Rehab Center ', 'Welton ', 'S', 'Wittwer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', '2013-05-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548522634', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12034095', 'W12034095', 'UT01', 'Salt lake Regional Medical Center ', 'Phillip', '', 'Gale', '', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1205953445', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('460703284', 'W12034100', 'W12034100', 'ID02', 'JC Hospitalists', 'Lisa', 'M', 'Hunt', 'MD', 'Hospitalist', '', '', NULL, 'O', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225066103', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12034101', 'W12034101', 'ID02', 'JC Hospitalists', 'Lisa', 'M', 'Hunt', 'MD', 'Hospitalist', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225066103', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('272114039', 'W12034495', 'W12034495', 'NM01', 'NM Heart Emergency Physicians LLC', '', '', 'NM Heart Emergency Physicians LLC', '', 'Emergency Medicine', '', '', NULL, 'O', '504 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057242000', '9543678433', '504 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057242000', '9543678433', 'NMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1467776641', 0, 'Y', 0, '2013-07-02', NULL, NULL, 35.0866, -106.638, NULL, NULL),
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('272114039', 'W12034497', 'W12034497', 'NM01', 'NM Heart Emergency Physicians LLC', '', '', 'NM Heart Emergency Physicians LLC', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 731197', 'Dallas', 'Dallas', 'TX', '75373', '5057242000', '9543678433', 'PO Box 731197', 'Dallas', 'Dallas', 'TX', '75373', '5057242000', '9543678433', 'NMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1467776641', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
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('454141660', 'W12034521', 'W12034521', 'UTDT01', 'Cameron Orthodontics', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '2940 N Church St Ste 302', 'Layton', 'Davis', 'UT', '84040', '8015441184', NULL, '2940 N Church St Ste 302', 'Layton', 'Davis', 'UT', '84040', '8015441184', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255661039', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('510509395', 'W12034523', 'W12034523', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Stringham', 'DDS', 'Dentist', '', '', NULL, 'O', '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', NULL, '3707 N Canyon Rd Ste 7D', 'Provo', 'Utah', 'UT', '84604', '8012215859', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009831', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('900941378', 'W12034526', 'W12034526', 'UTDT01', 'Layton Smiles Dentistry and Orthodontics', 'Darin', '', 'Dickerson', 'DDS', 'Dentist', '', '', NULL, 'O', '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', NULL, '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004114', 0, 'N', 0, '2013-06-18', 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
('452403034', 'W12034527', 'W12034527', 'UTDT01', 'Stonehaven Dental', 'Guy', '', 'Leavitt', 'DMD', 'Dentist', '', '', NULL, 'O', '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', NULL, '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001159', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870542485', 'W12034528', 'W12034528', 'UTDT01', 'Oral Maxillofacial Surgery', 'William', '', 'McBee', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '912 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017560766', NULL, '912 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017560766', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009814', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870542485', 'W12034529', 'W12034529', 'UTDT01', 'Castle Valley Dental Specialists', 'William', '', 'McBee', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '391 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4356379590', NULL, '391 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4356379590', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009814', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('900941378', 'W12034533', 'W12034533', 'UTDT01', 'Layton Smiles Dentistry and Orthodontics', 'Michael', '', 'Meru', 'DDS', 'Orthodontist', '', '', NULL, 'O', '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', NULL, '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', '          ', 'UTSPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009906', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('451810554', 'W12034534', 'W12034534', 'UTDT01', 'Smart Pediatric Dentistry', 'Nathan F', '', 'Smith', 'DDS', 'Pedodontist', '', '', NULL, 'O', '2230 N University Pkwy Bldg 8 Ste B', 'Provo', 'Utah', 'UT', '84604', '8013776400', NULL, '2230 N University Pkwy Bldg 8 Ste B', 'Provo', 'Utah', 'UT', '84604', '8013776400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1811918329', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('263316336', 'W12034535', 'W12034535', 'TXDALSTD', 'Shepherd Health Care ', 'Carl', 'L', 'Russell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Valley Pkwy Ste 101', 'Lewisville', 'Denton', 'TX', '75067', '9724208777', '9722191978', '500 N Valley Pkwy Ste 101', 'Lewisville', 'Denton', 'TX', '75067', '9724208777', '9722191978', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982632857', 0, 'N', 0, '2013-06-20', NULL, NULL, 33.0478, -97.0207, NULL, NULL),
('263316336', 'W12034536', 'W12034536', 'TXDALSTD', 'Shepherd Health Care ', 'Melissa', '', 'Linares', 'FNP', 'Family Practice', '', '', NULL, 'O', '500 N Valley Pkwy Ste 101', 'Lewisville', 'Denton', 'TX', '75067', '9724208777', '9722191978', '500 N Valley Pkwy Ste 101', 'Lewisville', 'Denton', 'TX', '75067', '9724208777', '9722191978', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1699047241', 0, 'Y', 0, '2013-06-20', NULL, NULL, 33.0478, -97.0207, NULL, NULL),
('421563371', 'W12034537', 'W12034537', 'TXHOUSTD', 'Rajnikant Kushwaha MD', 'Rajnikant', '', 'Kushwaha', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17198 St Lukes Way Ste 500', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362734666', '9362714666', '17198 St Lukes Way Ste 500', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362734666', '9362714666', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629072335', 0, 'N', 0, '2013-06-20', NULL, NULL, 30.2057, -95.4608, NULL, NULL),
('421563371', 'W12034538', 'W12034538', 'TXHOUSTD', 'Rajnikant Kushwaha MD', 'Rajnikant', '', 'Kushwaha', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 7129', 'The Woodlands', 'Montgomery', 'TX', '77387', '9362734666', '9362714666', 'PO Box 7129', 'The Woodlands', 'Montgomery', 'TX', '77387', '9362734666', '9362714666', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629072335', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12034539', 'W12034539', 'UT01', 'Associates in Orthopaedic Surgery', 'Mohammad', '', 'Shoari', 'MD', 'Neurology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', '3336 S Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 35, 0, 'Davis Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1740483395', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('363330928', 'W12034540', 'W12034540', 'ILCHIGSTD', '', 'Joshua', '', 'Zavitz', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '6309142499', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437479151', 0, 'N', 0, '2014-01-23', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'W12034541', 'W12034541', 'ILCHIGSTD', '', 'Joshua', '', 'Zavitz', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '0000000000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '0000000000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437479151', 0, 'N', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('741895428', 'W12034555', 'W12034555', 'TXSATSTD', 'Ear Nose and Throat Clinics of San Antonio', 'Harry', '', 'Schilling', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', '', NULL, 'O', '3154 SE Military Dr Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103371050', NULL, '3154 SE Military Dr Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103371050', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-24', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578561825', 0, 'N', 0, '2013-06-19', NULL, NULL, 29.3517, -98.4361, NULL, NULL),
('208448222', 'W12034556', 'W12034556', 'TXDALSTD', 'Lovette August Pediatrics', 'Anissa', 'G', 'August', 'MD', 'Pediatrics', '', '', NULL, 'O', '2401 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406278044', '9406278055', '2401 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406278044', '9406278055', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1881630929', 0, 'N', 0, '2013-06-20', NULL, NULL, 33.2035, -97.6028, NULL, NULL),
('208448222', 'W12034557', 'W12034557', 'TXDALSTD', 'Lovette August Pediatrics', 'Anissa', 'G', 'August', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 203474', 'Dallas', 'Dallas', 'TX', '75320', '9406278044', '9406278055', 'PO Box 203474', 'Dallas', 'Dallas', 'TX', '75320', '9406278044', '9406278055', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1881630929', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('436979877', 'W12034558', 'W12034558', 'TXHOUSTD', 'Premier Internal Medicine Associates', 'Satyadevi', 'R', 'Sista', 'MD', 'Family Practice', '', '', NULL, 'O', '15200 SW Hwy Ste 301', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812423737', '2812428848', '15200 SW Hwy Ste 301', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812423737', '2812428848', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275632044', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.6072, -95.6143, NULL, NULL),
('752725305', 'W12034559', 'W12034559', 'TXDALSTD', 'Samuel Ngwu MD', 'Samuel', 'C', 'Ngwu', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5959 Harry Hines Blvd Ste 204', 'Dallas', 'Dallas', 'TX', '75235', '2148798820', '2148796890', '5959 Harry Hines Blvd Ste 204', 'Dallas', 'Dallas', 'TX', '75235', '2148798820', '2148796890', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1528144706', 0, 'N', 0, '2013-06-20', NULL, NULL, 32.8178, -96.8447, NULL, NULL),
('752694562', 'W12034562', 'W12034562', 'TXDALSTD', 'Dr Ezekiel''s Office', 'Kalavalli', '', 'Ezekiel', 'MD', 'Pediatrics', '', '', NULL, 'O', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315364', '9722315357', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315364', '9722315357', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', '2013-08-14', 0, 0, 0, NULL, 'Houston Methodist Hospital', '', '', 'HCFA|UB|', '1598836116', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.973, -96.7255, NULL, NULL),
('263420389', 'W12034563', 'W12034563', 'UT01', 'Retina and Vitreous Surgeons of Utah ', 'Ryan', 'F', 'Isom', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577705', '8013577424', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577705', '8013577424', 'WISESTD3', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679756019', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('263420389', 'W12034564', 'W12034564', 'UT01', 'Retina & Vitreous Surgeons of Utah ', 'Ryan', 'F', 'Isom', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5171 Cottonwood St Ste 700', 'Murray', 'Salt Lake', 'UT', '84107', '8018928200', '8018928299', '5171 Cottonwood St Ste 700', 'Murray', 'Salt Lake', 'UT', '84107', '8018928200', '8018928299', 'WISESTD3', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679756019', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.659, -111.894, NULL, NULL),
('202798379', 'W12034565', 'W12034565', 'TXHOUSTD', 'Clear Lake Specialties', '', '', 'Clear Lake Specialities', '', 'Clinics', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1750305355', 0, 'Y', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034566', 'W12034566', 'TXHOUSTD', 'Clear Lake Specialties', '', '', 'Clear Lake Specialities', '', 'Clinics', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1750305355', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034568', 'W12034568', 'TXHOUSTD', 'Clear Lake Specialties', 'Mohammad', 'J', 'Baba', 'MD', 'Pulmonary', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1699764811', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034569', 'W12034569', 'TXHOUSTD', 'Clear Lake Specialties', 'Mohammad', 'J', 'Baba', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1699764811', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202249032', 'W12034570', 'W12034570', 'TXDALSTD', 'Lovette August Pediatrics', 'Amanda', 'P', 'Lovette', 'MD', 'Pediatrics', '', '', NULL, 'O', '2401 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406278044', '9406278055', '2401 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406278044', '9406278055', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144209545', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.2035, -97.6028, NULL, NULL),
('202798379', 'W12034572', 'W12034572', 'TXHOUSTD', 'Clear Lake Specialties', 'Husam', 'I', 'Issa', 'MD', 'Infectious Disease', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1821064304', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034573', 'W12034573', 'TXHOUSTD', 'Clear Lake Specialties', 'Husam', 'I', 'Issa', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1821064304', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034577', 'W12034577', 'TXHOUSTD', 'Clear Lake Specialties', 'Mahmood', 'O', 'Dweik', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '2817241861', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1245228741', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034575', 'W12034575', 'TXHOUSTD', 'Clear Lake Specialties', 'Mahmood', 'O', 'Dweik', 'MD', 'Pulmonary', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1245228741', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034579', 'W12034579', 'TXHOUSTD', 'Clear Lake Specialties', 'Luigi', '', 'Terminella', 'MD', 'Pulmonary', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1063400406', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034580', 'W12034580', 'TXHOUSTD', 'Clear Lake Specialties', 'Luigi', '', 'Terminella', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1063400406', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034583', 'W12034583', 'TXHOUSTD', 'Clear Lake Specialties', 'Maha', 'K', 'Al-Lahiq', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1023008190', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034582', 'W12034582', 'TXHOUSTD', 'Clear Lake Specialties', 'Maha', 'K', 'Al-Lahiq', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1023008190', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034585', 'W12034585', 'TXHOUSTD', 'Clear Lake Specialties', 'Abdul', 'A', 'Abdellatif', 'MD', 'Nephrology', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1164560595', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034586', 'W12034586', 'TXHOUSTD', 'Clear Lake Specialties', 'Abdul', 'A', 'Abdellatif', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1164560595', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034588', 'W12034588', 'TXHOUSTD', 'Clear Lake Specialties', 'Abdelnaser', '', 'Elkhalili', 'MD', 'Rheumatology', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1316935836', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034589', 'W12034589', 'TXHOUSTD', 'Clear Lake Specialties', 'Abdelnaser', '', 'Elkhalili', 'MD', 'Rheumatology', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1316935836', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034591', 'W12034591', 'TXHOUSTD', 'Clear Lake Specialties', 'Regina', 'R', 'Pillai', 'MD', 'Pulmonary', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1720273121', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034592', 'W12034592', 'TXHOUSTD', 'Clear Lake Specialties', 'Regina', 'R', 'Pillai', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1720273121', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034594', 'W12034594', 'TXHOUSTD', 'Clear Lake Specialties', 'Omar', 'M', 'Albustami', 'MD', 'Pulmonary', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1205846334', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034595', 'W12034595', 'TXHOUSTD', 'Clear Lake Specialties', 'Omar', 'M', 'Albustami', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1205846334', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034597', 'W12034597', 'TXHOUSTD', 'Clear Lake Specialties', 'Vikas', '', 'Jogi', 'MD', 'Infectious Disease', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1053406546', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034598', 'W12034598', 'TXHOUSTD', 'Clear Lake Specialties', 'Vikas', '', 'Jogi', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1053406546', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202798379', 'W12034600', 'W12034600', 'TXHOUSTD', 'Clear Lake Specialties', 'Mohamed', 'A', 'Khalil', 'MD', 'Neurology', '', '', NULL, 'O', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste A', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1124391198', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('202798379', 'W12034601', 'W12034601', 'TXHOUSTD', 'Clear Lake Specialties', 'Mohamed', 'A', 'Khalil', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 58538', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB', '1124391198', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('460796181', 'W12034602', 'W12034602', 'TXHOUSTD', 'Clear Lake Primary Care', '', '', 'Clear Lake Primary Care ', '', 'Family Practice', '', '', NULL, 'O', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1861743247', 0, 'Y', 0, '2013-06-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('460796181', 'W12034603', 'W12034603', 'TXHOUSTD', 'Clear Lake Primary Care', '', '', 'Clear Lake Primary Care ', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1861743247', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('460796181', 'W12034605', 'W12034605', 'TXHOUSTD', 'Clear Lake Primary Care', 'Isra', 'M', 'Amer', 'MD', 'Family Practice', '', '', NULL, 'O', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB', '1356469142', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('460796181', 'W12034606', 'W12034606', 'TXHOUSTD', 'Clear Lake Primary Care', 'Isra', 'M', 'Amer', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB', '1356469142', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('460796181', 'W12034608', 'W12034608', 'TXHOUSTD', 'Clear Lake Primary Care', 'Tammi', 'R', 'Peck-Samman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB', '1639420003', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5341, -95.1306, NULL, NULL),
('460796181', 'W12034610', 'W12034610', 'TXHOUSTD', 'Clear Lake Primary Care', 'Tammi', 'R', 'Peck-Samman', 'MD', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'PO Box 57845', 'Webster', 'Harris', 'TX', '77598', '2817241912', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB', '1639420003', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('680580620', 'W12034611', 'W12034611', 'TXHOUSTD', 'The Center For Family and Preventive Medicine', 'Robert', 'G', 'Roach', 'DO', 'Family Practice', '', '', NULL, 'O', '14700 FM 2100 Ste A', 'Crosby', 'Harris', 'TX', '77532', '2813282568', '2813282039', '14700 FM 2100 Ste A', 'Crosby', 'Harris', 'TX', '77532', '2813282568', '2813282039', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA', '1043259807', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.9002, -95.0635, NULL, NULL),
('752671796', 'W12034612', 'W12034612', 'TXDALSTD', 'Pecan Creek Pediatrics', 'Glenna', '', 'Harris', 'MD', 'Pediatrics', '', '', NULL, 'O', '1100 Dallas Dr Ste 108', 'Denton', 'Denton', 'TX', '76205', '9404840065', '9404842205', '1100 Dallas Dr Ste 108', 'Denton', 'Denton', 'TX', '76205', '9404840065', '9404842205', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1205944196', 0, 'N', 0, '2013-06-20', NULL, NULL, 33.1982, -97.1229, NULL, NULL),
('752937389', 'W12034613', 'W12034613', 'TXDALSTD', 'Ahtaram M Khan', 'Ahtaram', 'M', 'Khan', 'md', 'Family Practice', '', '', NULL, 'O', '4002 W Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9729858000', '9729850050', '4002 W Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9729858000', '9729850050', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-20', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1336258003', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0267, -96.7703, NULL, NULL),
('752937389', 'W12034614', 'W12034614', 'TXDALSTD', 'Ahtaram M Khan', 'Ahtaram', 'M', 'Khan', 'md', 'Family Practice', '', '', NULL, 'B', 'PO Box 262129', 'Plano', 'Collin', 'TX', '75026', '9729858000', '9729850050', 'PO Box 262129', 'Plano', 'Collin', 'TX', '75026', '9729858000', '9729850050', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-20', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1336258003', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12034615', 'W12034615', 'UT01', 'Utah Orthopaedics', 'Jeffrey', 'L', 'Biehn', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669637062', 0, 'N', 0, '2013-09-20', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12034616', 'W12034616', 'UT01', 'Utah Orthopaedics', 'Jeffrey', 'L', 'Biehn', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '8019178001', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669637062', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('680580620', 'W12034617', 'W12034617', 'TXHOUSTD', 'The Center For Family and Preventive Medicine', 'Judson', 'S', 'Henderson', 'DO', 'Family Practice', '', '', NULL, 'O', '14700 FM 2100 Ste A', 'Crosby', 'Harris', 'TX', '77532', '2813282568', '2813282039', '14700 FM 2100 Ste A', 'Crosby', 'Harris', 'TX', '77532', '2813282568', '2813282039', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA', '1720027576', 0, 'N', 0, '2013-06-20', NULL, NULL, 29.9002, -95.0635, NULL, NULL),
('876000545', 'W12034618', 'W12034618', 'UT01', 'Health Clinics of Utah', '', '', 'Health Clinics of Utah', 'GROUP', 'Family Practice', '', '', NULL, 'O', '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', NULL, '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834802', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.773, -111.947, NULL, NULL),
('362708347', 'W12034619', 'W12034619', 'ILCHIGSTD', 'Associates in Nephrology ', 'Minh Son', '', 'Bui', 'MD', 'Nephrology', '', '', NULL, 'O', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1437371440', 0, 'N', 0, '2014-02-11', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('362708347', 'W12034620', 'W12034620', 'ILCHIGSTD', 'Associates in Nephrology ', 'Minh Son', '', 'Bui', 'MD', 'Nephrology', '', '', NULL, 'O', '5600 W Addison 5th Fl, Suite 505', 'Chicago', 'Cook', 'IL', '60634', '7732823311', '3126540118', '5600 W Addison 5th Fl, Suite 505', 'Chicago', 'Cook', 'IL', '60634', '7732823311', '3126540118', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1437371440', 0, 'N', 0, '2013-06-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('362708347', 'W12034621', 'W12034621', 'ILCHIGSTD', 'Associates in Nephrology ', 'Minh Son', '', 'Bui', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '0000000000', '3126549930', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '0000000000', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1437371440', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034622', 'W12034622', 'ILCHIGSTD', 'Associates in Nephrology ', 'Minh Son', '', 'Bui', 'MD', 'Nephrology', '', '', NULL, 'M', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1437371440', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12034623', 'W12034623', 'ILCHIGSTD', 'Presence Healthcare Services', 'Ahmad', '', 'Alwakkaf', 'MD', 'Hospitalist', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881031755', 0, 'N', 0, '2013-06-25', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363330928', 'W12034624', 'W12034624', 'ILCHIGSTD', 'Presence Healthcare Services', 'Ahmad', '', 'Alwakkaf', 'MD', 'Hospitalist', '', '', NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881031755', 0, 'N', 0, '2013-06-25', NULL, NULL, 42.024, -87.6852, NULL, NULL),
('363330928', 'W12034625', 'W12034625', 'ILCHIGSTD', 'Presence Healthcare Services', 'Ahmad', '', 'Alwakkaf', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881031755', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034631', 'W12034631', 'ILCHIGSTD', 'Associates in Nephrology ', 'Constantine', '', 'Delis', 'DO', 'Nephrology', '', '', NULL, 'M', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-17', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1003892043', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034628', 'W12034628', 'ILCHIGSTD', 'Associates in Nephrology ', 'Constantine', '', 'Delis', 'DO', 'Nephrology', '', '', NULL, 'O', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-17', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1003892043', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('362708347', 'W12034630', 'W12034630', 'ILCHIGSTD', 'Associates in Nephrology ', 'Constantine', '', 'Delis', 'DO', 'Nephrology', '', '', NULL, 'O', '3250 W Franklin Blvd', 'Chicago', 'Cook', 'IL', '60624', '7736381160', '7736382020', '3250 W Franklin Blvd', 'Chicago', 'Cook', 'IL', '60624', '7736381160', '7736382020', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-17', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1003892043', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8903, -87.7078, NULL, NULL),
('362708347', 'W12034629', 'W12034629', 'ILCHIGSTD', 'Associates in Nephrology ', 'Constantine', '', 'Delis', 'DO', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542783', '3126549930', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542783', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-17', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1003892043', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12034632', 'W12034632', 'UT01', 'Granger Medical Clinic ', 'Carina', 'H', 'Lesser', 'NP', 'Family Practice', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114364197', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12034633', 'W12034633', 'UT01', 'Granger Medical Clinic ', 'Carina', 'H', 'Lesser', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114364197', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12034634', 'W12034634', 'UT01', 'Central Utah Clinic PC ', 'Ryan', '', 'Slater', 'MD', 'Family Medicine', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', '8017633887', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', '8017633887', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1346478476', 0, 'N', 0, '2013-12-17', NULL, NULL, 40.3784, -111.766, NULL, NULL),
('870281028', 'W12034638', 'W12034638', 'UT01', 'Central Utah Clinic PC', 'Ryan', '', 'Slater', 'MD', 'Family Medicine', '', '', NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1346478476', 0, 'N', 0, '2013-12-17', NULL, NULL, 40.248, -111.667, NULL, NULL),
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('870281028', 'W12034637', 'W12034637', 'UT01', 'Central Utah Clinic PC', 'Ryan', '', 'Slater', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1346478476', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12034639', 'W12034639', 'ID02', 'Family Medicine Health Center', 'Aurelia', '', 'Watson Nelson', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376761437', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034640', 'W12034640', 'ILCHIGSTD', 'Associates in Nephrology ', 'Neetha', 'S.', 'Dhananjaya', 'MD', 'Nephrology', '', '', NULL, 'O', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', '1111 Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7083381780', '7083381790', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1720058639', 0, 'N', 0, '2013-06-20', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('362708347', 'W12034643', 'W12034643', 'ILCHIGSTD', 'Associates in Nephrology ', 'Neetha', 'S.', 'Dhananjaya', 'MD', 'Nephrology', '', '', NULL, 'M', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', '210 S DesPlaines St', 'Chicago', 'Cook', 'IL', '80881', '3126542700', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1720058639', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034641', 'W12034641', 'ILCHIGSTD', 'Associates in Nephrology ', 'Neetha', 'S.', 'Dhananjaya', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542783', '3126549930', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542783', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1720058639', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'W12034642', 'W12034642', 'ILCHIGSTD', 'Associates in Nephrology ', 'Neetha', 'S.', 'Dhananjaya', 'MD', 'Nephrology', '', '', NULL, 'O', '7357 N Ave 1st Floor', 'River Forest', 'Cook', 'IL', '60305', '7084056210', '7084056222', '7357 N Ave 1st Floor', 'River Forest', 'Cook', 'IL', '60305', '7084056210', '7084056222', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1720058639', 0, 'N', 0, '2013-06-20', NULL, NULL, 41.9088, -87.8094, NULL, NULL),
('201780406', 'W12034644', 'W12034644', 'ILCHIGSTD', 'UroPartners', 'Steven', '', 'Koopman', 'MD', 'Urology', '', '', NULL, 'O', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-03', '2013-11-15', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1811199573', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.975, -87.7005, NULL, NULL),
('201780406', 'W12034645', 'W12034645', 'ILCHIGSTD', 'UroPartners', 'Steven', '', 'Koopman', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '0000000000', '0000000000', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '0000000000', '0000000000', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-03', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1811199573', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12034646', 'W12034646', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Benjamin', '', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055300', '8013239546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055300', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013184431', 0, 'N', 0, '2013-06-20', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12034647', 'W12034647', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Benjamin', '', 'Williams', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9350 S 150 E Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', '9350 S 150 E Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013184431', 0, 'N', 0, '2013-06-20', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12034648', 'W12034648', 'UT01', 'Physician Group of Utah', 'Benjamin', '', 'Williams', 'MD', '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, '2013-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013184431', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('826003449', 'W12034649', 'W12034649', 'UT01', 'Willow Valley Urgent Care', '', '', 'Willow Valley Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '47 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088522900', '0000000000', '47 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088522900', '0000000000', '', '', '', '0.00', '5.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093056475', 0, 'N', 0, '2013-06-26', NULL, NULL, 42.0972, -111.874, NULL, NULL),
('461640431', 'W12034650', 'W12034650', 'TXHOUSTD', 'Herrin Pediatric Clinic', '', '', 'Herrin Pediatric Clinic', 'MD', 'Pediatrics', '', '', NULL, 'O', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1871833251', 0, 'Y', 0, '2013-07-10', NULL, NULL, 30.3006, -95.4739, NULL, NULL),
('461640431', 'W12034652', 'W12034652', 'TXHOUSTD', 'Herrin Pediatric Clinic', 'James', 'R', 'Herrin', 'MD', 'Pediatrics', '', '', NULL, 'O', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1447291158', 0, 'N', 0, '2013-07-10', NULL, NULL, 30.3006, -95.4739, NULL, NULL),
('461640431', 'W12034654', 'W12034654', 'TXHOUSTD', 'Herrin Pediatric Clinic', 'Patricia', 'L', 'Ardeel', 'NP', 'Pediatrics', '', '', NULL, 'O', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1134455884', 0, 'N', 0, '2013-07-10', NULL, NULL, 30.3006, -95.4739, 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
('461640431', 'W12034656', 'W12034656', 'TXHOUSTD', 'Herrin Pediatric Clinic', 'Laurie', 'E', 'Brown', 'NP', 'Pediatrics', '', '', NULL, 'O', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1790059657', 0, 'N', 0, '2013-07-10', NULL, NULL, 30.3006, -95.4739, NULL, NULL),
('461640431', 'W12034658', 'W12034658', 'TXHOUSTD', 'Herrin Pediatric Clinic', 'Heather', 'L', 'King', 'NP', 'Pediatrics', '', '', NULL, 'O', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', '601 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367886060', '9367886061', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1114258928', 0, 'N', 0, '2013-07-10', NULL, NULL, 30.3006, -95.4739, NULL, NULL),
('461375202', 'W12034659', 'W12034659', 'TXHOUSTD', 'Pulmonary and Sleep Physicians of Houston', '', '', 'Pulmonary and Sleep Physicians of Houston', '', 'Pulmonary', '', '', NULL, 'O', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649519943', 0, 'Y', 0, '2013-06-21', NULL, NULL, 29.5429, -95.1302, NULL, NULL),
('461375202', 'W12034661', 'W12034661', 'TXHOUSTD', 'Pulmonary and Sleep Physicians of Houston', 'Alfred', 'S', 'Maksoud', 'MD', 'Pulmonary', '', '', NULL, 'O', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1043287022', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5429, -95.1302, NULL, NULL),
('461375202', 'W12034663', 'W12034663', 'TXHOUSTD', 'Pulmonary and Sleep Physicians of Houston', 'Syed', 'H', 'Jaffery', 'MD', 'Pulmonary', '', '', NULL, 'O', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1699724112', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5429, -95.1302, NULL, NULL),
('461375202', 'W12034665', 'W12034665', 'TXHOUSTD', 'Pulmonary and Sleep Physicians of Houston', 'Niranjan', '', 'Iyer', 'MD', 'Pulmonary', '', '', NULL, 'O', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1174583751', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5429, -95.1302, NULL, NULL),
('461375202', 'W12034667', 'W12034667', 'TXHOUSTD', 'Pulmonary and Sleep Physicians of Houston', 'Majd', '', 'Alnas', 'MD', 'Pulmonary', '', '', NULL, 'O', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', '501 Orchard St Ste 200', 'Webster', 'Harris', 'TX', '77598', '2815578555', '2815543657', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1396944658', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.5429, -95.1302, NULL, NULL),
('752780119', 'W12034668', 'W12034668', 'TXDALSTD', 'Heart Center of North Texas', '', '', 'Heart Center of North Texas', '', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1396762357', 0, 'Y', 0, '2013-06-21', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('752780119', 'W12034670', 'W12034670', 'TXDALSTD', 'Heart Center of North Texas', 'Farhan', '', 'Ali', 'MD', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1396936357', 0, 'N', 0, '2013-06-24', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('752780119', 'W12034672', 'W12034672', 'TXDALSTD', 'Heart Center of North Texas', 'Dennis', 'P', 'Doan', 'MD', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1366776502', 0, 'N', 0, '2013-06-24', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('752780119', 'W12034674', 'W12034674', 'TXDALSTD', 'Heart Center of North Texas', 'George', 'S', 'Khammar', 'MD', 'Cardiology', '', '', NULL, 'O', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', '1017 12th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-21', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1619927373', 0, 'N', 0, '2013-06-24', NULL, NULL, 32.7341, -97.3475, NULL, NULL),
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('836000331', 'W12034769', 'W12034769', 'WYT1', 'UW Family Medicine Residency Cheyenne', 'Douglas', '', 'Parks', 'MD', 'Family Practice', '', '', NULL, 'O', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 35, 0, NULL, '', '', '', 'HCFA', '1619058963', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12034771', 'W12034771', 'WY01', 'UW Family Medicine Residency Cheyenne', 'Mathew', '', 'Hagemeyer', 'MD', 'Family Practice', '', '', NULL, 'O', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 35, 0, NULL, '', '', '', 'HCFA', '1720209380', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.137, -104.807, NULL, NULL),
('836000331', 'W12034772', 'W12034772', 'WYT1', 'UW Family Medicine Residency Cheyenne', 'Mathew', '', 'Hagemeyer', 'MD', 'Family Practice', '', '', NULL, 'O', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', '820 E 17th St', 'Cheyenne', 'Laramie', 'WY', '82001', '3076322434', '3076383616', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 35, 0, NULL, '', '', '', 'HCFA', '1720209380', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12034775', 'W12034775', 'UT01', 'Wasatch Therapy Inc', 'Rusty', 'L', 'Jenkins', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1376723106', 0, 'N', 0, '2013-06-21', NULL, NULL, 41.0876, -111.98, NULL, NULL),
('870656811', 'W12034773', 'W12034773', 'UT01', 'ProRehab Price', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12034774', 'W12034774', 'UT01', 'Wasatch Therapy Inc', 'Melissa', 'A', 'Ita aehau', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1043319528', 0, 'N', 0, '2013-08-09', NULL, NULL, 41.0876, -111.98, NULL, NULL),
('364288180', 'W12034778', 'W12034778', 'UT01', 'Cache Valley Specialty Hospital', 'Kimberly', 'Ann', 'Hoth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', '1655 N 200 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790888394', 0, 'N', 0, '2013-07-16', NULL, NULL, 41.7624, -111.829, NULL, NULL),
('711048468', 'W12034777', 'W12034777', 'UT01', 'Cutting Edge Physical Therapy', 'Stacie', 'B', 'Garner', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-06-01', '2014-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720325822', 0, 'N', 0, '2014-03-13', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('364288180', 'W12034779', 'W12034779', 'UT01', 'Cache Valley Specialty Hospital', 'Kimberly', 'Ann', 'Hoth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357531844', '4357532986', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790888394', 0, 'N', 0, '2013-07-16', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12034781', 'W12034781', 'UT01', 'Cache Valley Specialty Hospital', 'Sheila', '', 'Waddoups', 'PT', 'Physical Therapy', '', '', NULL, 'O', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427255579', 0, 'N', 0, '2013-07-16', NULL, NULL, 41.7118, -111.829, NULL, NULL),
('364288180', 'W12034782', 'W12034782', 'UT01', 'Cache Valley Specialty Hospital', 'Sheila', '', 'Waddoups', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357558500', '4357552836', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357558500', '4357552836', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427255579', 0, 'N', 0, '2013-07-16', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12034783', 'W12034783', 'UT01', 'Cache Valley Specialty Hospital', 'Sheila', '', 'Waddoups', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1950 S Hwy 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357231902', '4357231908', '1950 S Hwy 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357231902', '4357231908', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427255579', 0, 'N', 0, '2013-07-16', NULL, NULL, 41.4747, -112.025, NULL, NULL),
('364288180', 'W12034784', 'W12034784', 'UT01', 'Cache Valley Specialty Hospital', 'Sheila', '', 'Waddoups', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2310 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', '2310 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427255579', 0, 'N', 0, '2013-07-16', NULL, NULL, 41.7738, -111.823, 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
('870656811', 'W12034785', 'W12034785', 'UT01', 'ProRehab Physical Therapy', 'Brad', '', 'Stilson', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4357811502', '4357811505', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4357811502', '4357811505', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609006741', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12034786', 'W12034786', 'UT01', 'ProRehab Physical Therapy', 'David', 'Edmond', 'Nelson', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1568454858', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12034787', 'W12034787', 'UT01', 'ProRehab Physical Therapy', 'Scott', 'Ross', 'Labrum', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4353815100', '4353815099', 'PO Box 933', 'Price', 'Carbon', 'UT', '84501', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457343725', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12034789', 'W12034789', 'NM01', 'ABQ Health Partners', 'Paul', '', 'Friedman', 'MD', 'Hospitalist', '', '', NULL, 'O', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278039', '5057278086', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278039', '5057278086', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114279957', 0, 'N', 0, '2014-06-13', NULL, NULL, 35.0863, -106.64, NULL, NULL),
('204043287', 'W12034790', 'W12034790', 'NM01', 'ABQ Health Partners', 'Paul', '', 'Friedman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114279957', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12034791', 'W12034791', 'NM01', 'ABQ Health Partners', 'Paul', '', 'Friedman', 'MD', 'Hospitalist', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114279957', 0, 'N', 0, '2014-03-18', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('800307419', 'W12034122', 'W12034122', 'WYT1', 'Wyoming Health Medical Group', 'Patrice', 'A', 'Weiner', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072330257', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072330257', '', '', '', '0.00', '18.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1912928557', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12034121', 'W12034121', 'WY01', 'Wyoming Health Medical Group', 'Patrice', 'A', 'Weiner', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072330257', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072330257', '', '', '', '0.00', '18.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1912928557', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.8487, -106.309, NULL, NULL),
('760440370', 'W12025140', 'W12025140', 'TXHOUSTD', 'McKinney Podiatric Associates', 'Edna', 'I', 'Reyes-Guerrero', '', 'Podiatry', '', '', NULL, 'O', '13111 E Fwy Ste 101', 'Houston', 'Harris', 'TX', '77015', '7134531600', '7134531698', '13111 E Fwy Ste 101', 'Houston', 'Harris', 'TX', '77015', '7134531600', '7134531698', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1821239583', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.7715, -95.1944, NULL, NULL),
('760440370', 'W12025139', 'W12025139', 'TXHOUSTD', 'McKinney Podiatric Associates', 'Edna', 'I', 'Reyes-Guerrero', '', 'Podiatry', '', '', NULL, 'O', '2707 W Baker Rd Ste B', 'Baytown', 'Harris', 'TX', '77521', '2818371500', '2818371704', '2707 W Baker Rd Ste B', 'Baytown', 'Harris', 'TX', '77521', '2818371500', '2818371704', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1821239583', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.7697, -94.9902, NULL, NULL),
('760440370', 'W12025138', 'W12025138', 'TXHOUSTD', 'McKinney Podiatric Associates', 'Edna', 'I', 'Reyes-Guerrero', '', 'Podiatry', '', '', NULL, 'O', '4102 Woodlawn Ste 140 and 150B', 'Pasadena', 'Harris', 'TX', '77504', '7139461500', '7139460200', '4102 Woodlawn Ste 140 and 150B', 'Pasadena', 'Harris', 'TX', '77504', '7139461500', '7139460200', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'East Houston Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1821239583', 0, 'N', 0, '2013-06-24', NULL, NULL, 29.6602, -95.1823, NULL, NULL),
('870284475', 'W12034800', 'W12034800', 'UT01', 'Granger Medical Clinic ', '', '', 'Granger Medical Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184657041', 0, 'N', 0, '2014-01-20', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870284475', 'W12034802', 'W12034802', 'UT01', 'Granger Medical Clinic ', '', '', 'Granger Medical Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184657041', 0, 'N', 0, '2014-01-20', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034803', 'W12034803', 'UT01', 'Granger Medical Clinic ', 'Reid', 'C', 'Harrison', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356373500', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034804', 'W12034804', 'UT01', 'Granger Medical Clinic ', 'Craig', 'A', 'Coleby', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386825024', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034805', 'W12034805', 'UT01', 'Granger Medical Clinic ', 'Bonnie', 'J', 'Shurtliff', 'PA', 'Family Practice', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487805743', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034806', 'W12034806', 'UT01', 'Granger Medical Clinic ', 'Dan', '', 'Richards', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1649455403', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034807', 'W12034807', 'UT01', 'Granger Medical Clinic ', 'Orrenzo', 'B', 'Snyder', 'MD', 'Urology', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1720171259', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034808', 'W12034808', 'UT01', 'Granger Medical Clinic ', 'Monica', 'C', 'Wonnacott', 'MD', 'Pediatrics', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003029935', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12034809', 'W12034809', 'UT01', 'Granger Medical Clinic ', 'Mary', 'J', 'Pennington', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1205868452', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('876000545', 'W12034810', 'W12034810', 'UT01', 'Health Clinics of Utah', 'Kathleen', '', 'Hogan', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', NULL, '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215999578', 0, 'N', 0, '2013-06-24', NULL, NULL, 40.773, -111.947, NULL, NULL),
('462206306', 'W12034813', 'W12034813', 'ID02', 'Stark Medical Group', 'Fred', 'R', 'Stark', 'MD', 'Internal Medicine', '', '', NULL, 'O', '932 W Idaho Ave Ste 100', 'Ontario', 'Malheur', 'OR', '97914', '5418892244', '5418892626', '932 W Idaho Ave Ste 100', 'Ontario', 'Malheur', 'OR', '97914', '5418892244', '5418892626', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609860774', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('820425454', 'W12034818', 'W12034818', 'ID01', 'Boise Anesthesia', 'Michael', 'S', 'Mickelsen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', '3025 W Cherry Ln    ', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-04', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275838021', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820425454', 'W12034819', 'W12034819', 'ID01', 'Boise Anesthesia', 'Michael', 'S', 'Mickelsen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-04', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275838021', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'W12034822', 'W12034822', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Rebecca', 'L', 'Legg', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1386611325', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('850232628', 'W12034902', 'W12034902', 'NM01', 'Womens Specialists of NM', '', '', 'Womens Specialists of NM', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009785', 0, 'Y', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('820425454', 'W12034824', 'W12034824', 'ID01', 'Boise Anesthesia', 'Timothy', 'A', 'Powell', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd    ', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-11', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1972617363', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820425454', 'W12034825', 'W12034825', 'ID01', 'Boise Anesthesia', 'Timothy', 'A', 'Powell', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '2083759530', 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-11', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1972617363', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12034828', 'W12034828', 'IDBOISTD', 'Saint Alphonsus Pain Management Clinic', 'Russell', 'B', 'Harmony', 'NP', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis 6th Fl', 'Boise', 'Ada', 'ID', '83706', '2083673053', '2083675688', '1055 N Curtis 6th Fl', 'Boise', 'Ada', 'ID', '83706', '2083673053', '2083675688', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-06-11', '2013-06-11', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1194065730', 0, 'N', 0, '2014-01-17', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12034831', 'W12034831', 'IDBOISTD', 'Saint Alphonsus Spine Care', 'Arden', '', 'Mahaffey', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '901 N Curtis Rd Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083678535', '901 N Curtis Rd Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083678535', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', '2013-10-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1891017190', 0, 'N', 0, '2013-11-15', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('275238772', 'W12034832', 'W12034832', 'ID02', 'Direct Surgical Assist', 'Jeffrey', 'D', 'Smith', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-06-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013905793', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('275238772', 'W12034833', 'W12034833', 'ID02', 'Direct Surgical Assist', 'Sadie', 'M', 'Trainor', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-06-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1952653081', 0, 'N', 0, '2013-07-10', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('275238772', 'W12034834', 'W12034834', 'ID02', 'Direct Surgical Assist', 'Jeffrey', 'D', 'Smith', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 8965', 'Boise', 'Ada', 'ID', '83707', '2084526794', '2089147522', 'PO Box 8965', 'Boise', 'Ada', 'ID', '83707', '2084526794', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-06-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013905793', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('275238772', 'W12034835', 'W12034835', 'ID02', 'Direct Surgical Assist', 'Sadie', 'M', 'Trainor', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 8965', 'Boise', 'Ada', 'ID', '83707', '2084526794', '2089147522', 'PO Box 8965', 'Boise', 'Ada', 'ID', '83707', '2084526794', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-06-12', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1952653081', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12034837', 'W12034837', 'ID01', 'Boise Anesthesia', 'Timothy', 'A', 'Powell', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '2083759530', '1717 Arlington Ave   ', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-17', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1972617363', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820425454', 'W12034838', 'W12034838', 'ID01', 'Boise Anesthesia', 'Timothy', 'A', 'Powell', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', '3025 W Cherry Ln    ', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-17', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1972617363', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820425454', 'W12034839', 'W12034839', 'ID01', 'Boise Anesthesia', 'Timothy', 'A', 'Powell', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-06-17', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1972617363', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('260553931', 'W12034840', 'W12034840', 'IDBOISTD', 'Saint Alphonsus Medical Group Vascular Services', 'Martha', 'G', 'Shelver', 'NPC', 'Diabetic Education', '', '', NULL, 'O', '6140 W Curtisian Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-07-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1528218625', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'W12034842', 'W12034842', 'IDBOISTD', 'Saint Alphonsus Behavioral Health', 'Helen', '', 'Holley', 'PHD', 'Psychology', '', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1801867817', 0, 'Y', 0, '2013-11-15', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('820200895', 'W12034843', 'W12034843', 'ID01', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Helen', '', 'Holley', 'PHD', 'Psychology', '', '', 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, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801867817', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12034845', 'W12034845', 'IDBOISTD', 'Saint Alphonsus Spine Care', 'Michael', 'R', 'McMartin', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '901 N Curtis Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083678535', '901 N Curtis Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083678535', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1174526974', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'W12034846', 'W12034846', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN EHP', 'Alison', '', 'Shearer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1396898482', 0, 'N', 0, '2014-03-21', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W12034847', 'W12034847', 'ID01', 'Saint Alphonsus Behavioral Health', 'Coire', 'C', 'Weathers', 'MD', 'Psychiatry', '', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437319662', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6062, -116.266, NULL, NULL),
('820200895', 'W12034848', 'W12034848', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN EHP', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'N', 0, '2014-03-21', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('204371916', 'W12008015', 'W12008015', 'UT01', 'Excel Eye Center of Payson', 'Todd', 'B', 'Engen', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1172 E 100 N Ste 4', 'Payson', 'Utah', 'UT', '84651', '8013792900', NULL, '1172 E 100 N Ste 4', 'Payson', 'Utah', 'UT', '84651', '8013792900', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1295705697', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.0451, -111.713, NULL, NULL),
('204371916', 'W12002847', 'W12002847', 'UT01', 'Excel Cosmetic Surgery', 'Todd', 'B', 'Engen', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1735 N State St Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013792900', '8013796295', '1735 N State St Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013792900', '8013796295', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1295705697', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.2568, -111.673, NULL, NULL),
('270852226', 'W12034863', 'W12034863', 'UT01', 'Silverton Group', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12034865', 'W12034865', 'UT01', 'Silverton Group', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'Y', 0, '2013-06-27', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('270852226', 'W12034866', 'W12034866', 'UT01', 'Silverton Group', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8014807100', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8014807100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('760665536', 'W12034867', 'W12034867', 'TXHOUSTD', 'Prem K Nowlakha', 'Prem', 'K', 'Nowlakha', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3511 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815650738', '2815650783', '3511 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815650738', '2815650783', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043245988', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.5875, -95.63, NULL, NULL),
('760665536', 'W12034868', 'W12034868', 'TXHOUSTD', 'Prem K Nowlakha', 'Prem', 'K', 'Nowlakha', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7500 Beechnut Ste 251', 'Houston', 'Harris', 'TX', '77074', '2815650738', '2815650783', '7500 Beechnut Ste 251', 'Houston', 'Harris', 'TX', '77074', '2815650738', '2815650783', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043245988', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.6912, -95.5182, NULL, NULL),
('201428952', 'W12034869', 'W12034869', 'UT01', 'Western Anesthesia Associates', 'Sloan', '', 'Taylor', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA', '1073624342', 0, 'Y', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('043726487', 'W12034870', 'W12034870', 'TXDALSTD', 'Sheridan Evans', 'Sheridan', 'S', 'Evans', 'MD', 'Family Practice', '', '', NULL, 'O', '5605 Virginia Pkwy Ste 4', 'Mckinney', 'Collin', 'TX', '75071', '9725485050', '9725486901', '5605 Virginia Pkwy Ste 4', 'Mckinney', 'Collin', 'TX', '75071', '9725485050', '9725486901', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1164439469', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.1986, -96.6901, NULL, NULL),
('200022831', 'W12034871', 'W12034871', 'ID02', 'Foothills Physical Therapy', 'David', 'D', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265870117', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12034872', 'W12034872', 'ID02', 'Foothills Physical Therapy', 'David', 'D', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2013-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265870117', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('741951870', 'W12034873', 'W12034873', 'TXHOUSTD', 'Plaza OB GYN Associates', '', '', 'Plaza OB GYN Associates', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 Binz St Ste 1100', 'Houston', 'Harris', 'TX', '77004', '7135223333', '7133740052', '1200 Binz St Ste 1100', 'Houston', 'Harris', 'TX', '77004', '7135223333', '7133740052', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1295787786', 0, 'Y', 0, '2013-06-27', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('741951870', 'W12034875', 'W12034875', 'TXHOUSTD', 'Plaza OB GYN Associates', 'Chundar', '', 'Tsai', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 Binz St Ste 1100', 'Houston', 'Harris', 'TX', '77004', '7135223333', '7138740052', '1200 Binz St Ste 1100', 'Houston', 'Harris', 'TX', '77004', '7135223333', '7138740052', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB', '1679530158', 0, 'N', 0, '2013-06-28', NULL, NULL, 29.7247, -95.3878, NULL, NULL),
('461801197', 'W12034879', 'W12034879', 'UT01', 'Wasatch Pain Solutions ', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '1988 W 930 N Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8013022690', '8013022693', '1988 W 930 N Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8013022690', '8013022693', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.383, -111.744, NULL, NULL),
('461801197', 'W12034878', 'W12034878', 'UT01', 'Wasatch Pain Solutions ', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '661 W 10600 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013022690', '8013022693', '661 W 10600 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013022690', '8013022693', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.5588, -111.908, NULL, NULL),
('850424076', 'W12034880', 'W12034880', 'NM01', 'New Mexico Heart Institute', 'Santosh', 'S', 'Oommen', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432844', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432844', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1427104256', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12034881', 'W12034881', 'NM01', 'New Mexico Heart Institute', 'Santosh', 'S', 'Oommen', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432844', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432844', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-06-08', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1427104256', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('453160445', 'W12034882', 'W12034882', 'WY01', 'Pain Care Center', 'Jed', '', 'Shay', 'MD', 'Pain Management', '', '', NULL, 'O', '1575 Dewar Dr Ste 430', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072126270', '3072126271', '1575 Dewar Dr Ste 430', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072126270', '3072126271', 'WY160', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1023398906', 0, 'N', 0, '2013-07-29', NULL, NULL, 41.5747, -109.24, NULL, NULL),
('453160445', 'W12034883', 'W12034883', 'WYT1', 'Pain Care Center', 'Jed', '', 'Shay', 'MD', 'Pain Management', '', '', NULL, 'O', '1575 Dewar Dr Ste 430', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072126270', '3072126271', '1575 Dewar Dr Ste 430', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072126270', '3072126271', 'WY160', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1023398906', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('431952937', 'W12034884', 'W12034884', 'TXDALSTD', 'Premier Health Clinic of Plano', 'Farah', '', 'Naz', 'MD', 'Pediatrics', '', '', NULL, 'O', '2459 E Hebron Pkwy Ste 100', 'Carrollton', 'Denton', 'TX', '75010', '9723958600', '9723957119', '2459 E Hebron Pkwy Ste 100', 'Carrollton', 'Denton', 'TX', '75010', '9723958600', '9723957119', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB', '1457458259', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.0243, -96.8612, NULL, NULL),
('203289822', 'W12034885', 'W12034885', 'TXDALSTD', 'Baylor Medical Center of Carrollton', 'Cynthia', 'R', 'Stuart', 'DO', 'Family Practice', '', '', NULL, 'O', '4323 N Josey Ln Ste 300', 'Carrollton', 'Denton', 'TX', '75010', '9724928272', '9724928275', '4323 N Josey Ln Ste 300', 'Carrollton', 'Denton', 'TX', '75010', '9724928272', '9724928275', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB', '1518924679', 0, 'N', 0, '2013-06-28', NULL, NULL, 33.0275, -96.8847, NULL, NULL),
('591268435', 'W12034886', 'W12034886', 'TXDALSTD', 'James G Pfister', 'James', 'G', 'Pfister', 'MD', 'Family Practice', '', '', NULL, 'O', '10218 Midway Rd', 'Dallas', 'Dallas', 'TX', '75229', '2143514084', '2143513768', '10218 Midway Rd', 'Dallas', 'Dallas', 'TX', '75229', '2143514084', '2143513768', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1578628558', 0, 'N', 0, '2013-06-27', NULL, NULL, 32.8856, -96.8383, NULL, NULL),
('274669912', 'W12034887', 'W12034887', 'TXHOUSTD', 'Northshore Medical Assocaites ', 'Donald', 'R', 'Hearn', 'MD', 'Family Practice', '', '', NULL, 'O', '15055 E Fwy Ste 30', 'Channelview', 'Harris', 'TX', '77530', '2814572236', '2814570500', '15055 E Fwy Ste 30', 'Channelview', 'Harris', 'TX', '77530', '2814572236', '2814570500', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659363307', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.7733, -95.1457, NULL, NULL),
('751779978', 'W12034888', 'W12034888', 'TXDALSTD', 'Kreislers Office', 'Aaron', '', 'Kreisler', 'MD', 'Pediatrics', '', '', NULL, 'O', '1151 N Buckner Blvd Ste 203', 'Dallas', 'Dallas', 'TX', '75218', '2143244221', '2143243705', '1151 N Buckner Blvd Ste 203', 'Dallas', 'Dallas', 'TX', '75218', '2143244221', '2143243705', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1659377893', 0, 'N', 0, '2013-07-09', NULL, NULL, 32.8347, -96.7036, NULL, NULL),
('751779978', 'W12034889', 'W12034889', 'TXDALSTD', 'Kreislers Office', 'Aaron', '', 'Kreisler', 'MD', 'Pediatrics', '', '', NULL, 'O', '2379 Gus Thomasson Ste 200', 'Mesquite', 'Dallas', 'TX', '75150', '9726866400', '9726866391', '2379 Gus Thomasson Ste 200', 'Mesquite', 'Dallas', 'TX', '75150', '9726866400', '9726866391', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1659377893', 0, 'N', 0, '2013-07-09', NULL, NULL, 32.7967, -96.6342, NULL, NULL),
('320158930', 'W12034894', 'W12034894', 'TXHOUSTD', 'Bernadette Bonaparte', 'Bernadette', '', 'Bonaparte', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1601 Liberty St Ste B', 'Richmond', 'Fort Bend', 'TX', '77469', '2812386222', '2812325900', '1601 Liberty St Ste B', 'Richmond', 'Fort Bend', 'TX', '77469', '2812386222', '2812325900', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB', '1932158458', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.5787, -95.7692, NULL, NULL),
('830330554', 'W12034891', 'W12034891', 'WY01', 'Evanston Clinic Corp', 'Micah', 'D', 'Pullins', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 7', 'Evanston', 'Uinta', 'WY', '82930', '3077838435', '3077892152', '196 Arrowhead Dr Ste 7', 'Evanston', 'Uinta', 'WY', '82930', '3077838435', '3077892152', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1730482167', 0, 'N', 0, '2013-12-11', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('830330554', 'W12034893', 'W12034893', 'WY01', 'Evanston Clinic Corp', 'Micah', 'D', 'Pullins', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838435', '3077892152', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838435', '3077892152', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1730482167', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12034890', 'W12034890', 'WYT1', 'Evanston Clinic Corp', 'Micah', 'D', 'Pullins', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 7', 'Evanston', 'Uinta', 'WY', '82930', '3077838435', '3077892152', '196 Arrowhead Dr Ste 7', 'Evanston', 'Uinta', 'WY', '82930', '3077838435', '3077892152', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1730482167', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12034892', 'W12034892', 'WYT1', 'Evanston Clinic Corp', 'Micah', 'D', 'Pullins', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838435', '3077892152', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838435', '3077892152', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1730482167', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('264756998', 'W12034895', 'W12034895', 'TXHOUSTD', 'Allergy Sinus and Asthma Professionals', 'D Lynn', '', 'Dickens', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '950 Threadneedle Ste 160', 'Houston', 'Harris', 'TX', '77079', '8323798200', '8323798201', '950 Threadneedle Ste 160', 'Houston', 'Harris', 'TX', '77079', '8323798200', '8323798201', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB', '1982604294', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.7833, -95.6093, NULL, NULL),
('461095962', 'W12034897', 'W12034897', 'TXDALSTD', 'Premier Health Clinic ', 'Farah', '', 'Naz', 'MD', 'Family Practice', '', '', NULL, 'O', '2459 E Hebron Pkwy Ste 100', 'Carrollton', 'Denton', 'TX', '75010', '9723958600', '9723957119', '2459 E Hebron Pkwy Ste 100', 'Carrollton', 'Denton', 'TX', '75010', '9723958600', '9723957119', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB', '1437493624', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.0243, -96.8612, NULL, NULL),
('461095962', 'W12034896', 'W12034896', 'TXDALSTD', 'Premier Health Clinic of Plano', 'Farah', '', 'Naz', 'MD', 'Family Practice', '', '', NULL, 'O', '8201 Ohio Dr Ste 112', 'Plano', 'Collin', 'TX', '75024', '2146194920', '2146194927', '8201 Ohio Dr Ste 112', 'Plano', 'Collin', 'TX', '75024', '2146194920', '2146194927', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB', '1437493624', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.0875, -96.7969, NULL, NULL),
('830326307', 'W12034899', 'W12034899', 'WY01', 'Community Health Center of Central Wyoming', 'Travis', 'L', 'Roberts', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104087048', 0, 'N', 0, '2013-12-17', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('205609568', 'W12034898', 'W12034898', 'TXDALSTD', 'Marcia S. Genta', 'Marcia', 'S', 'Genta', 'MD', 'Rheumatology', '', '', NULL, 'O', '221 W Colorado Blvd Pav 2 Ste 740', 'Dallas', 'Dallas', 'TX', '75208', '2149410198', '2149412380', '221 W Colorado Blvd Pav 2 Ste 740', 'Dallas', 'Dallas', 'TX', '75208', '2149410198', '2149412380', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1134233976', 0, 'N', 0, '2013-06-27', NULL, NULL, 32.7593, -96.8256, NULL, NULL),
('830326307', 'W12034900', 'W12034900', 'WYT1', 'Community Health Center of Central Wyoming', 'Travis', 'L', 'Roberts', 'MD', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104087048', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('270806125', 'W12034901', 'W12034901', 'NM01', 'Breathe America Albuquerque', 'Kristin', 'M', 'Leonard', 'CNP', 'Allergy and Immunology', '', '', NULL, 'O', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5052654033', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5052654033', 'NMALLERGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245571512', 0, 'N', 0, '2014-07-22', NULL, NULL, 35.1732, -106.59, NULL, NULL),
('850232628', 'W12034903', 'W12034903', 'NM01', 'Womens Specialists of NM', 'Paul', 'B', 'Araiza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1457569758', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034904', 'W12034904', 'NM01', 'Womens Specialists of NM', 'Jennifer', '', 'Bach', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1578655254', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034905', 'W12034905', 'NM01', 'Womens Specialists of NM', '', '', 'Womens Specialists of NM', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009785', 0, 'Y', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034906', 'W12034906', 'NM01', 'Womens Specialists of NM', 'Jennifer', '', 'Bach', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1578655254', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034907', 'W12034907', 'NM01', 'Womens Specialists of NM', 'Lisa ', '', 'Bishop', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306919030', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034908', 'W12034908', 'NM01', 'Womens Specialists of NM', 'Julie', 'E', 'Carlson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1477723518', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034909', 'W12034909', 'NM01', 'Womens Specialists of NM', 'Consuelo', '', 'Carmona', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1093889537', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034910', 'W12034910', 'NM01', 'Womens Specialists of NM', 'Kristina', 'M', 'Chongsiriwatana', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-09-09', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1508907452', 0, 'N', 0, '2013-09-25', 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
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('850232628', 'W12034912', 'W12034912', 'NM01', 'Womens Specialists of NM', 'Mary', 'T', 'Cunnane', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1518920099', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034913', 'W12034913', 'NM01', 'Womens Specialists of NM', 'Gileen', '', 'Elder', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1962576603', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034914', 'W12034914', 'NM01', 'Womens Specialists of NM', '', '', 'Womens Specialists of NM', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009785', 0, 'Y', 0, '2013-06-26', NULL, NULL, 35.1568, -106.68, NULL, NULL),
('850232628', 'W12034915', 'W12034915', 'NM01', 'Womens Specialists of NM', 'Gileen', '', 'Elder', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1962576603', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1568, -106.68, NULL, NULL),
('850232628', 'W12034916', 'W12034916', 'NM01', 'Womens Specialists of NM', 'Steven ', '', 'Gough', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184783078', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034917', 'W12034917', 'NM01', 'Womens Specialists of NM', 'Steven ', '', 'Gough', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184783078', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034918', 'W12034918', 'NM01', 'Womens Specialists of NM', 'Patricia', '', 'Heinz', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1093741985', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034919', 'W12034919', 'NM01', 'Womens Specialists of NM', 'Patricia', '', 'Heinz', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1093741985', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034920', 'W12034920', 'NM01', 'Womens Specialists of NM', 'Carol ', '', 'Kiesling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1912075847', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034921', 'W12034921', 'NM01', 'Womens Specialists of NM', 'Carol ', '', 'Kiesling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1912075847', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034922', 'W12034922', 'NM01', 'Womens Specialists of NM', 'Rebecca ', '', 'Leeman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1508930256', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034923', 'W12034923', 'NM01', 'Womens Specialists of NM', 'Rebecca ', '', 'Leeman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1508930256', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034924', 'W12034924', 'NM01', 'Womens Specialists of NM', 'Mary', 'E', 'Mark', 'MD', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548334204', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034925', 'W12034925', 'NM01', 'Womens Specialists of NM', 'Mary', 'E', 'Mark', 'MD', 'Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1548334204', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1568, -106.68, NULL, NULL),
('850232628', 'W12034926', 'W12034926', 'NM01', 'Womens Specialists of NM', 'Nancy', 'J', 'Miller', 'CNM', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1407915317', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034927', 'W12034927', 'NM01', 'Womens Specialists of NM', 'Seddah', 'B', 'Moya', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1023269651', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034929', 'W12034929', 'NM01', 'Womens Specialists of NM', 'Seddah', 'B', 'Moya', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1023269651', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034930', 'W12034930', 'NM01', 'Womens Specialists of NM', 'Katrinia', '', 'Nardini', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1215193636', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034931', 'W12034931', 'NM01', 'Womens Specialists of NM', 'Rebecca', '', 'Okun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1881768547', 0, 'N', 0, '2014-06-13', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034932', 'W12034932', 'NM01', 'Womens Specialists of NM', 'Rebecca', '', 'Okun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2014-06-13', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1881768547', 0, 'N', 0, '2014-06-13', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034933', 'W12034933', 'NM01', 'Womens Specialists of NM', 'Stephanie', 'L', 'Philippides', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1316088263', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034934', 'W12034934', 'NM01', 'Womens Specialists of NM', 'Stephanie', 'L', 'Philippides', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1316088263', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034935', 'W12034935', 'NM01', 'Womens Specialists of NM', 'Eunice', 'B', 'Pino', 'CNM', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1164456208', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034936', 'W12034936', 'NM01', 'Womens Specialists of NM', 'Eunice', 'B', 'Pino', 'CNM', 'Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1164456208', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1502, -106.575, NULL, NULL),
('850232628', 'W12034937', 'W12034937', 'NM01', 'Womens Specialists of NM', 'Lydia', 'E', 'Prado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1598793655', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034938', 'W12034938', 'NM01', 'Womens Specialists of NM', 'Lydia', 'E', 'Prado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1598793655', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034939', 'W12034939', 'NM01', 'Womens Specialists of NM', 'Shamarie', '', 'Sais', 'MD', 'Gynecology', 'Urogynecology', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1801865878', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034940', 'W12034940', 'NM01', 'Womens Specialists of NM', 'Elizabeth ', 'A', 'Shanley', 'PA', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1437223070', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034941', 'W12034941', 'NM01', 'Womens Specialists of NM', 'Erika', '', 'Solis-Gilmore', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306987250', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034942', 'W12034942', 'NM01', 'Womens Specialists of NM', 'Erika', '', 'Solis-Gilmore', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306987250', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1568, -106.68, NULL, NULL),
('850232628', 'W12034943', 'W12034943', 'NM01', 'Womens Specialists of NM', 'Jeanine ', 'L', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1215078167', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034944', 'W12034944', 'NM01', 'Womens Specialists of NM', 'Jeanine ', 'L', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1215078167', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.1568, -106.68, NULL, NULL),
('850232628', 'W12034945', 'W12034945', 'NM01', 'Womens Specialists of NM', 'Analisa ', '', 'Villarreal', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1952460941', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034946', 'W12034946', 'NM01', 'Womens Specialists of NM', 'Donna', '', 'Walker', 'NP', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1922167816', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034947', 'W12034947', 'NM01', 'Womens Specialists of NM', 'James', '', 'Wurzel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1386718930', 0, 'N', 0, '2013-06-26', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('850232628', 'W12034948', 'W12034948', 'NM01', 'Womens Specialists of NM', 'Karen', 'A', 'Zimmerman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1790746808', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12034949', 'W12034949', 'NM01', 'Womens Specialists of NM', 'Karen', 'A', 'Zimmerman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-08-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1790746808', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034954', 'W12034954', 'WY01', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Hospital', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326085408', 0, 'N', 0, '2013-07-08', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('836000097', 'W12034956', 'W12034956', 'WY01', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Hospital', '', '', NULL, 'B', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326085408', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034955', 'W12034955', 'WYT1', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Hospital', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326085408', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034957', 'W12034957', 'WYT1', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Hospital', '', '', NULL, 'B', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326085408', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034958', 'W12034958', 'WY01', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035016', 'W12035016', 'WY01', 'Register Cliff Rural Health Clinic', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035017', 'W12035017', 'WYT1', 'Oregon Trail Rural Health Clinic', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034960', 'W12034960', 'WY01', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'B', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034959', 'W12034959', 'WYT1', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035018', 'W12035018', 'WYT1', 'Register Cliff Rural Health Clinic', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035019', 'W12035019', 'WY01', 'Oregon Trail Rural Health Clinic', 'James', '', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'O', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1235140989', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.8613, -105.857, NULL, NULL),
('836000097', 'W12034961', 'W12034961', 'WYT1', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'B', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', 'PO Box 1450', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034967', 'W12034967', 'WY01', 'Memorial Hospital of Converse County', 'Oscar', '', 'Aguirre', 'PA', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1821125493', 0, 'N', 1, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034968', 'W12034968', 'WYT1', 'Memorial Hospital of Converse County', 'Oscar', '', 'Aguirre', 'PA', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1821125493', 0, 'N', 1, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034970', 'W12034970', 'WY01', 'Memorial Hospital of Converse County', 'Twyla', '', 'Thalken', 'NP', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA', '1306946611', 0, 'N', 0, '2013-11-04', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('836000097', 'W12034971', 'W12034971', 'WYT1', 'Memorial Hospital of Converse County', 'Twyla', '', 'Thalken', 'NP', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA', '1306946611', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034973', 'W12034973', 'WY01', 'Memorial Hospital of Converse County', 'Christopher', '', 'Bodily', 'PA', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1891017448', 0, 'N', 1, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034974', 'W12034974', 'WYT1', 'Memorial Hospital of Converse County', 'Christopher', '', 'Bodily', 'PA', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1891017448', 0, 'N', 1, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034976', 'W12034976', 'WY01', 'Memorial Hospital of Converse County', 'Craig', '', 'Capron', 'DPM', 'Podiatry', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA', '1932118189', 0, 'N', 0, '2014-02-03', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('836000097', 'W12034977', 'W12034977', 'WYT1', 'Memorial Hospital of Converse County', 'Craig', '', 'Capron', 'DPM', 'Podiatry', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA', '1932118189', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034979', 'W12034979', 'WY01', 'Memorial Hospital of Converse County', 'Kellie', '', 'Clausen', 'NP', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1487616553', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('836000097', 'W12034980', 'W12034980', 'WYT1', 'Memorial Hospital of Converse County', 'Kellie', '', 'Clausen', 'NP', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1487616553', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12034982', 'W12034982', 'WY01', 'Memorial Hospital of Converse County', 'Deeanne', '', 'Engle', 'MD', 'Family Practice', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073582122', '3073589216', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1346433554', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.7594, -105.381, NULL, NULL),
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('836000097', 'W12035023', 'W12035023', 'WYT1', 'Oregon Trail Rural Health Clinic', 'Brian', '', 'Retherford', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '525 E Birch St', 'Glenrock', 'Converse', 'WY', '82637', '3074368838', '3074362476', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1134183080', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035025', 'W12035025', 'WY01', 'Register Cliff Rural Health Clinic', 'John', '', 'Thalken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1912007212', 0, 'N', 0, '2013-07-31', NULL, NULL, 42.2698, -104.75, NULL, NULL),
('836000097', 'W12035026', 'W12035026', 'WYT1', 'Register Cliff Rural Health Clinic', 'John', '', 'Thalken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1912007212', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035028', 'W12035028', 'WY01', 'Register Cliff Rural Health Clinic', 'Sheila', '', 'Sterkel', 'PA', 'Family Practice', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1225128754', 0, 'N', 0, '2013-12-09', NULL, NULL, 42.2698, -104.75, NULL, NULL),
('836000097', 'W12035029', 'W12035029', 'WYT1', 'Register Cliff Rural Health Clinic', 'Sheila', '', 'Sterkel', 'PA', 'Family Practice', '', '', NULL, 'O', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '650 W Whalen St', 'Guernsey', 'Platte', 'WY', '82214', '3078363009', '3078363022', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA', '1225128754', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL);
