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
('870616107', 'W11012381', 'W11012381', 'UT01', 'UUHC - Greenwood Health Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012387', 'W11012387', 'UT01', 'University Health Care', 'Sumati', 'V', 'Gupta', 'MD', 'Internal Medicine', 'Geriatric Medicine', '', NULL, 'o', '26 S Main St', 'Centerville', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '26 S Main St', 'Centerville', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003906603', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012380', 'W11012380', 'UT01', 'UUHC - Parkway Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012348600', NULL, '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012348600', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012376', 'W11012376', 'UT01', 'UUHC - Stansbury Health Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', NULL, '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11012352', 'W11012352', 'UT01', 'Stansbury Springs Health Center', 'Scott', 'G', 'Anders', 'MD', 'Family Practice', '', '', NULL, 'O', '210 Millpond', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', '4358821275', '210 Millpond', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', '4358821275', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1194838128', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6329, -112.311, NULL, NULL),
('870616107', 'W11012378', 'W11012378', 'UT01', 'UUHC - South Jordan Health Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012375', 'W11012375', 'UT01', 'UUHC - Redstone Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11012385', 'W11012385', 'UT01', 'University Health Care', 'Michelle', 'H', 'Gilbert', 'MD', 'Hematology and Oncology', 'Internal Medicine', '', NULL, 'o', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-08-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992876452', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'W11012392', 'W11012392', 'UT01', 'Pediatric Emergency Medicine-Department of University of Utah', 'Katherine', NULL, NULL, 'MD', 'Pediatric Emergency Medicine', NULL, NULL, NULL, 'o', '100 N Medical Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326229550', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012379', 'W11012379', 'UT01', 'UUHC - Westridge Center', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', NULL, '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012374', 'W11012374', 'UT01', 'University Health Care', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'N', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11012370', 'W11012370', 'UT01', 'University Health Care', 'Susan', 'L', 'Martini', 'MD', 'Pediatrics', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952333528', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11012368', 'W11012368', 'UT01', 'University Health Care', 'Andrew', 'L', 'Freeman', 'MD', 'Internal Medicine', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-07-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376720326', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870442129', 'W11012372', 'W11012372', 'UT01', 'University Health Care', 'Rebecca', 'J', 'Wood', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, '1000', '47.52', NULL, NULL, 3, '2008-08-01', '2006-08-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245396167', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11012383', 'W11012383', 'UT01', 'University Health Care', 'Vincent', 'B', 'Herlihy', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558533356', 0, 'Y', 0, '2008-09-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11012388', 'W11012388', 'UT01', 'University Health Care', 'Lubdha', 'M', 'Shah', 'MD', 'Radiologist', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-04-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902955255', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11012382', 'W11012382', 'UT01', 'University of Utah Hospitals and Clinics', 'Dennis', 'A', 'Blackburn', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306852249', 0, 'y', 0, '2011-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11012371', 'W11012371', 'UT01', 'University of Utah General Pediatrics', 'Susan', 'L', 'Martini', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952333528', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870442129', 'W11012373', 'W11012373', 'UT01', 'U of U Dept of Anesthesiology', 'Rebecca', 'J', 'Wood', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'B', 'PO Box 581053', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, '1000', '47.52', NULL, NULL, 3, '2008-08-01', '2006-08-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245396167', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11012384', 'W11012384', 'UT01', 'University Radiology Associates', 'Vincent', 'B', 'Herlihy', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558533356', 0, 'y', 0, '2008-09-02', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11012386', 'W11012386', 'UT01', 'U-U Hematology / Oncology Division', 'Michelle', 'H', 'Gilbert', 'MD', 'Hematology and Oncology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-08-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992876452', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11012389', 'W11012389', 'UT01', 'University Radiology Associates', 'Lubdha', 'M', 'Shah', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-04-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902955255', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11012391', 'W11012391', 'UT01', 'U of U Pediatric Orthopedics', 'Kevin', 'B', 'Jones', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-05', '2012-08-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750599114', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11012369', 'W11012369', 'UT01', 'U-U General Medicine Division', 'Andrew', 'L', 'Freeman', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-07-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376720326', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('820487495', 'W11012178', 'W11012178', 'ID01', NULL, 'Michele', 'L', 'Boyer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', NULL, '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '', 'IDMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770513939', 0, 'n', 0, '2012-11-13', NULL, NULL, 0, 0, NULL, NULL),
('820487495', 'W11012177', 'W11012177', 'ID01', NULL, 'Michele', 'L', 'Boyer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', NULL, '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '', 'IDMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', '2013-02-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770513939', 0, 'n', 0, '2012-11-13', NULL, NULL, 0, 0, NULL, NULL),
('260267767', 'W11012393', 'W11012393', 'UTMH1', 'Journeys Mental Health Services', 'Kristie', '', 'Lemmon', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'O', '9253 S Redwood Rd Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015682898', NULL, '9253 S Redwood Rd Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015682898', '', 'ARNP', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306817457', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012189', 'W11012189', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Joe', 'A', 'Lipetzky', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467440065', 0, 'n', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012183', 'W11012183', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Steve', 'L', 'Meharry', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '          ', 'IDPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-09-01', '2012-02-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720076326', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012179', 'W11012179', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Tammy', 'L', 'Morehouse', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-01', '2008-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558476721', 0, 'n', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012180', 'W11012180', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Robert', 'T', 'Bennett', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962490474', 0, 'n', 0, '2011-11-07', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012181', 'W11012181', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Craig', 'R', 'Herzog', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2008-09-01', '2012-02-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639365026', 0, 'N', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11012184', 'W11012184', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Becky', 'J', 'Huskinson', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972645711', 0, 'n', 0, '2012-01-06', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('820299260', 'W11012857', 'W11012857', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Charles', 'P', 'Schneider', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '206 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', 'Mercy', 'HCFA|UB|', '1538158225', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W11012856', 'W11012856', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'George', 'A', 'Nicola', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '206 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', NULL, 'HCFA|UB|', '1427047117', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W11012855', 'W11012855', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'George', 'A', 'Nicola', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '206 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', NULL, 'HCFA|UB|', '1427047117', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820341682', 'W11012795', 'W11012795', 'ID02', 'The Surgical Group PA', 'Kent', 'A', 'Kreuder', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '404 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084590028', '2084590380', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', 'Mercy', 'HCFA|UB|', '1376506097', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820341682', 'W11012796', 'W11012796', 'ID02', 'The Surgical Group PA', 'Kent', 'A', 'Kreuder', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '404 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084590028', '2084590380', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', 'Mercy', 'HCFA|UB|', '1376506097', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820341682', 'W11012800', 'W11012800', 'ID02', 'The Surgical Group PA', 'Richard', NULL, 'Martin', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '404 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084590028', '2084590380', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', 'West Valley', NULL, 'HCFA|UB|', '1285698571', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820341682', 'W11012596', 'W11012596', 'ID02', 'Advanced Surgery of Idaho', 'Richard', NULL, 'Martin', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '520 S Eagle Rd Ste 1237', 'Meridian', 'Ada', 'ID', '83642', '2088886768', '2088889543', '520 S Eagle Rd Ste 1237', 'Meridian', 'Ada', 'ID', '83642', '2088886768', '2088889543', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, 'West Valley Medical Center', NULL, 'HCFA|UB|', '1285698571', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820498010', 'W11012884', 'W11012884', 'ID02', 'Meridian Pain Center', 'James', 'H', 'Morland', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', '3875 E Overland Rd Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2089557246', '2088886242', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1215975164', 0, 'Y', 0, NULL, 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
('820403643', 'W11012469', 'W11012469', 'ID01', 'Meridian Chiropractic & Acupuncture Center', 'Robert', 'L', 'Rutz', 'DC', 'Chiropractic', '', '', NULL, 'O', '323 W Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088885858', NULL, '323 W Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088885858', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295833390', 0, 'n', 0, '2011-11-10', NULL, NULL, 43.6119, -116.397, NULL, NULL),
('800010265', 'W11012562', 'W11012562', 'ID02', 'Cherry Lane Family Clinic', 'Timothy', 'E', 'McHugh', 'MD', 'Family Practice', '', '', NULL, 'O', '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-04-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1831143692', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('820535616', 'W11012638', 'W11012638', 'ID02', '', 'Marianne', 'L', 'Zakarian', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2536 N Stokesberry Pl', 'Meridian', 'Ada', 'ID', '83646', '2088550880', '2088550889', '2536 N Stokesberry Pl', 'Meridian', 'Ada', 'ID', '83646', '2088550880', '2088550889', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1134160062', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820535616', 'W11012842', 'W11012842', 'ID02', NULL, 'Marianne', 'L', 'Zakarian', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '2536 N Stokesberry Pl', 'Meridian', 'Ada', 'ID', '83646', '2088550880', '2088550889', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1134160062', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200192377', 'W11012542', 'W11012542', 'ID02', 'Meridian Family Medicine', 'David', 'J', 'Butuk', 'MD', 'Family Practice', '', '', NULL, 'O', '1525 E Leigh Field Dr Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2088881199', '2088880807', '1525 E Leigh Field Dr Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2088881199', '2088880807', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1942250972', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('930789977', 'W11012713', 'W11012713', 'id03', 'Iseri and Associates', 'Marc', '', 'Iseri', 'MD', 'Urology', '', '', NULL, 'O', '645 E 5th', 'Weiser', 'Washington', 'ID', '83672', '8773747374', '2088899204', '645 E 5th', 'Weiser', 'Washington', 'ID', '83672', '8773747374', '2088899204', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417909599', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012480', 'W11012480', 'ID01', 'Life Counseling Center', 'Darren', 'A', 'Bushee', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194854364', 0, 'n', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012557', 'W11012557', 'ID02', 'Mercy Physician Group Dallan Woods', 'John', 'A', 'Kremer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656910', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2009-01-15', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1407829435', 0, 'N', 0, '2008-09-11', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820527814', 'W11012598', 'W11012598', 'ID02', 'Dynamic Surgical Care Inc', 'Jim', 'F', 'Valentine', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084631455', '2084631434', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084631455', '2084631434', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2012-04-03', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1205939592', 0, 'N', 0, '2012-04-03', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012490', 'W11012490', 'ID01', 'Life Counseling Center', 'Melanie', 'T', 'Twite', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851510531', 0, 'n', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012483', 'W11012483', 'ID01', 'Life Counseling Center', 'Melanie', 'T', 'Twite', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2008-09-09', '2010-12-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851510531', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012489', 'W11012489', 'ID01', 'Life Counseling Center', 'Darren', 'A', 'Bushee', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194854364', 0, 'n', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012487', 'W11012487', 'ID01', 'Life Counseling Center', 'Emily', 'A', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518069426', 0, 'n', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012485', 'W11012485', 'ID01', 'Life Counseling Center', 'Glena', 'L', 'Andrews', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417024787', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820383939', 'W11012580', 'W11012580', 'ID02', NULL, 'Mark', 'S', 'Chown', 'MD', 'General Surgery', '', '', NULL, 'O', '1611-C 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663322', '2084650392', '1611-C 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663322', '2084650392', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1740374446', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012488', 'W11012488', 'ID01', 'Life Counseling Center', 'Peter', 'D', 'Billings', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730372129', 0, 'n', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W11012486', 'W11012486', 'ID01', 'Life Counseling Center', 'Glena', 'L', 'Andrews', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417024787', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820383939', 'W11012784', 'W11012784', 'ID02', NULL, 'Mark', 'S', 'Chown', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '1611-C 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663322', '2084650392', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', NULL, NULL, 'Mercy', 'HCFA|UB|', '1740374446', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820297206', 'W11012923', 'W11012923', 'ID02', 'Boise Surgical Group PA', 'Jeffrey', 'B', 'Symmonds', 'MD', 'Orthopedic Surgery', 'Vascular Surgery', NULL, NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1154370328', 0, 'N', 0, NULL, 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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('820297206', 'W11012585', 'W11012585', 'ID02', 'Boise Surgical Group PA', 'Jon', 'B', 'Getz', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-06-17', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1174575138', 0, 'N', 0, '2012-09-24', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('841385890', 'W11012905', 'W11012905', 'ID02', 'Podiatry Center of Idaho', 'Dana', 'S', 'Owen', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '900 N Liberty Ste 306', 'Boise', 'Ada', 'ID', '83704', '2083677887', '2083677888', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', NULL, NULL, 'HCFA|UB|', '1972595676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'W11012695', 'W11012695', 'ID02', 'Idaho Foot & Ankle Associates', 'Randall', 'L', 'Benedict', 'DPM', 'Podiatry', '', '', NULL, 'O', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1942239264', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('841385890', 'W11012906', 'W11012906', 'ID02', 'Podiatry Center of Idaho', 'James', 'J', 'Owen', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '900 N Liberty Ste 306', 'Boise', 'Ada', 'ID', '83704', '2083677887', '2083677888', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, 'St Lukes', NULL, NULL, 'HCFA|UB|', '1306838016', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202456406', 'W11012648', 'W11012648', 'ID02', '', 'Michael', 'D', 'Lahey', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2089384080', '2089388922', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2089384080', '2089388922', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2012-01-19', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1679510903', 0, 'N', 0, '2012-02-22', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820297206', 'W11012586', 'W11012586', 'ID02', 'Boise Surgical Group PA', 'Jonathan', 'V', 'Giles', 'MD', 'General Surgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-06-17', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1457382723', 0, 'N', 0, '2012-09-24', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('201710678', 'W11012687', 'W11012687', 'ID02', 'Orthopaedic Associates PA', 'Douglas', 'K', 'Casperson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-11-01', '2011-01-01', 0, 0, 1, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1336251610', 0, 'Y', 0, '2011-12-19', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820461139', 'W11012686', 'W11012686', 'ID02', 'Mountain View Medical Center', 'Alex', 'P', 'Casebolt', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '3301 N Sawgrass Way', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', '3301 N Sawgrass Way', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2008-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346283363', 0, 'Y', 0, '2013-02-19', NULL, NULL, 0, 0, NULL, NULL),
('202809445', 'W11012662', 'W11012662', 'ID02', '', 'Mark', 'A', 'Spelich', 'MD; Jnt Replc/Recon, Genrl, Foot/Ankle, Peds', 'Orthopedic Surgery', '', '', NULL, 'O', '6590 W Norwood Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', '6590 W Norwood Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-06-23', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972513083', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'W11012907', 'W11012907', 'ID02', 'Idaho Foot & Ankle Associates', 'Rebecca', NULL, 'Smiley-Leis', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083756454', '2083765258', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, NULL, NULL, 'Mercy', 'HCFA|UB|', '1689629024', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202975807', 'W11012605', 'W11012605', 'ID02', 'Idaho Gynecology Oncology', 'Gerardo', 'M', 'Perez', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083814044', '2083814002', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083814044', '2083814002', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2013-02-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1730103995', 0, 'Y', 0, '2013-11-14', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('202975807', 'W11012603', 'W11012603', 'ID02', 'Idaho Gynecology Oncology', 'Amy', 'L', 'Cooper', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083814044', '2083814002', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083814044', '2083814002', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2013-02-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306880398', 0, 'N', 0, '2013-11-14', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820442659', 'W11012699', 'W11012699', 'ID02', 'Idaho Foot & Ankle Associates', 'Stewart', 'O', 'Jones', 'DPM', 'Podiatry', '', '', NULL, 'O', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083643464', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W11012599', 'W11012599', 'ID02', 'Boise Surgical Group PA', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083674227', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083674227', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-06-17', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820297206', 'W11012589', 'W11012589', 'ID02', 'Boise Surgical Group PA', 'Scott', 'A', 'Henson', 'MD', 'General Surgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-06-17', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1023060258', 0, 'N', 0, '2012-01-30', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('432010107', 'W11012655', 'W11012655', 'ID02', '', 'Roman', '', 'Schwartsman', 'MD; Shoulder, Jnt Replace/Reconst, General', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '6590 W Norwood Dr', 'Boise', 'Ada', 'ID', '83704', '2083774003', '2083779006', '6590 W Norwood Dr', 'Boise', 'Ada', 'ID', '83704', '2083774003', '2083779006', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1356378723', 0, 'N', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W11012789', 'W11012789', 'ID02', 'Boise Surgical Group PA', 'Jon', 'B', 'Getz', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083672834', '2083768266', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1174575138', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012758', 'W11012758', 'ID02', 'Mountain View Medical ', 'Russell', 'M', 'Kocemba', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3301 Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1588629406', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012763', 'W11012763', 'ID02', 'Mountain View Medical ', 'Mike', 'K', 'Maier', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3301 N Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1912963828', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012764', 'W11012764', 'ID02', 'Mountain View Medical ', 'Eric', 'L', 'Maier', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3301 N Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1831154707', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012767', 'W11012767', 'ID02', 'Mountain View Medical ', 'Gertjan', NULL, 'Mulder', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3301 N Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1659336691', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012555', 'W11012555', 'ID02', 'Mountain View Medical ', 'Russell', 'M', 'Kocemba', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3301 Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2008-10-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1588629406', 0, 'N', 0, '2008-09-11', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'W11012700', 'W11012700', 'ID02', 'Idaho Foot & Ankle Associates', 'Stanley', 'B', 'Leis', 'DPM', 'Podiatry', '', '', NULL, 'O', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1194779066', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820461139', 'W11012552', 'W11012552', 'ID02', 'Mountain View Medical Center', 'Mark', 'C', 'Johnson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3301 N Sawgrass', 'Boise', 'Ada', 'ID', '83704', '2083750862', '2083752658', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2008-10-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1831155365', 0, 'N', 0, '2008-09-11', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('820484706', 'W11012830', 'W11012830', 'ID02', 'Idaho Nephrology Associates', 'Valerie', 'L', 'Lee', 'NP-C', 'Nephrology', '', '', NULL, 'O', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316975899', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820477688', 'W11012873', 'W11012873', 'ID02', 'Intermountain Hand Clinic', 'William', 'D', 'Lenzi', 'MD', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'B', '914 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083761230', '2083761232', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1396746202', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820444934', 'W11012880', 'W11012880', 'ID02', 'Boise Physical Medicine and Rehabilitation', 'Rodde', 'D', 'Cox', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', '1000 N Curtis Ste 202', 'Boise', 'Ada', 'ID', '83706', '2083773435', '2083773147', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', 'West Valley', NULL, 'HCFA|UB|', '1417950213', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012831', 'W11012831', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578635405', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012832', 'W11012832', 'ID02', 'Saint Alphonsus Medical Group Heart Care Boise ', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578635405', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('820530720', 'W11012743', 'W11012743', 'ID02', 'Family Health Care', 'David', 'A', 'Ballance', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '1075 N Curtis Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083775166', '2083750599', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1881654820', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820444934', 'W11012881', 'W11012881', 'ID02', 'Boise Physical Medicine and Rehabilitation', 'Vivek', NULL, 'Kadyan', 'MD', 'Physical Medicine and Rehabilitation', 'Rehabilitation Practitioner', NULL, NULL, 'B', '1000 N Curtis Ste 202', 'Boise', 'Ada', 'ID', '83706', '2083773435', '2083773147', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417950205', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200324983', 'W11012868', 'W11012868', 'ID02', 'Idaho Sports Medicine Institute PA', 'George', 'A', 'Wade', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1063418903', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012833', 'W11012833', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'Jean', 'M', 'Rohrer', 'NP-C', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578635405', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820357655', 'W11012850', 'W11012850', 'ID02', NULL, 'Ari', 'J', 'Kaz', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083771000', '2083771003', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2009-01-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '0000007047', 0, 'Y', 0, '2008-09-11', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820444934', 'W11012883', 'W11012883', 'ID02', 'Boise Physical Medicine and Rehabilitation', 'Michael', 'R', 'McMartin', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', '1000 N Curtis Ste 202', 'Boise', 'Ada', 'ID', '83706', '2083773435', '2083773147', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174526974', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200324983', 'W11012885', 'W11012885', 'ID02', 'Idaho Sports Medicine Institute', 'Jay', 'R', 'Armstrong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447256086', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012728', 'W11012728', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881611424', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012727', 'W11012727', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881611424', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012726', 'W11012726', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'J Antonio', 'G', 'Lopez', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326011503', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012725', 'W11012725', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'J Antonio', 'G', 'Lopez', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326011503', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820484706', 'W11012820', 'W11012820', 'ID02', 'Idaho Nephrology Associates', 'Robert', 'L', 'Davidson', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673332', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, 'Mercy', 'HCFA|UB|', '1144275694', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('010711948', 'W11012722', 'W11012722', 'ID02', 'Cardiovascular Consultants of Idaho PA', 'Steven', 'J', 'Fonken', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083771415', '2083753451', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063437630', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820484706', 'W11012626', 'W11012626', 'ID02', 'Idaho Nephrology Associates', 'Valerie', 'L', 'Lee', 'NP-C', 'Nephrology', '', '', NULL, 'B', '5610 W Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', '5610 W Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673003', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2008-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316975899', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820455447', 'W11012787', 'W11012787', 'ID02', NULL, 'Austin', 'R', 'Cushman', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '901 N Curtis Rd  Ste 103', 'Boise', 'Ada', 'ID', '83706', '2083672670', '2083672673', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1336290915', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820518830', 'W11012818', 'W11012818', 'ID02', NULL, 'Michael', 'A', 'Adcox', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673332', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, 'Mercy', 'HCFA|UB|', '1851345193', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820484706', 'W11012817', 'W11012817', 'ID02', 'Idaho Nephrology Associates', 'Michael', 'A', 'Adcox', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673332', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, 'Mercy', 'HCFA|UB|', '1851345193', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201710678', 'W11012860', 'W11012860', 'ID02', 'Orthopaedic Associates PA', 'Gregory', 'P', 'Schweiger', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083674888', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1851340020', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('201710678', 'W11012891', 'W11012891', 'ID02', 'Orthopaedic Associates PA', 'Douglas', 'K', 'Casperson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-11-01', '2012-03-29', 0, 0, 1, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1336251610', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.6126, -116.255, NULL, NULL),
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('200324983', 'W11012846', 'W11012846', 'ID02', 'Idaho Sports Medicine Institute PA', 'Patrick', 'A', 'Dawson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1831233139', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820525791', 'W11012761', 'W11012761', 'ID02', 'Genesis Medical Center', 'Gregory', 'S', 'Lewer', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'St Alphonsus', 'St Lukes', NULL, NULL, 'HCFA|UB|', '1669414975', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820525791', 'W11012772', 'W11012772', 'ID02', 'Genesis Medical Center', 'Scott', 'A', 'Shappard', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649275587', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820525791', 'W11012775', 'W11012775', 'ID02', 'Genesis Medical Center', 'Karl', 'N', 'Watts', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578591053', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('820514419', 'W11012870', 'W11012870', 'ID02', 'Horizon Orthopedics and  Hand Clinic', 'Dominic', 'L', 'Gross', 'MD; Hand Shoulder', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'B', 'PO Box 4598', 'Boise', 'Ada', 'ID', '83711', '2088882080', '2088884296', 'PO Box 4598', 'Boise', 'Ada', 'ID', '83711', '2088882080', '2088884296', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1275572307', 0, 'Y', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
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('820514419', 'W11012838', 'W11012838', 'ID02', 'Horizon Health PA', 'Margaret', 'M', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 4598', 'Boise', 'Ada', 'ID', '83711', '2088882080', '2088884296', 'PO Box 4598', 'Boise', 'Ada', 'ID', '83711', '2088882080', '2088884296', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1003835042', 0, 'Y', 0, '2011-12-21', NULL, NULL, 0, 0, NULL, NULL),
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('870526462', 'W11012424', 'W11012424', 'UT01', 'University of Utah Plastic Surgery Associates', 'Alison', 'E', 'Evans', 'APRN', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015817073', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015817073', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-09', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427231521', 0, 'N', 0, '2008-09-08', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W11012415', 'W11012415', 'UT01', 'Pediatric Emergency Medicine-Department of University of Uta', 'Brian', 'D', 'Clothier', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', 'Emergency Medicine', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-15', '2012-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184756603', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11012430', 'W11012430', 'UT01', 'University of Utah Surgical Associates', 'Mark', 'H', 'Stevens', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-17', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770504953', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('870476269', 'W11012420', 'W11012420', 'UT01', 'Department of Pediatrics University of Utah', 'Melissa', 'A', 'Boll', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-12-03', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124080775', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W11012422', 'W11012422', 'UT01', 'University Ear, Nose, and Throat Associates', 'Michael', 'H', 'Stevens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-01-18', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699959460', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W11012515', 'W11012515', 'UT01', 'University Health Care', 'Kathy', 'Y', 'Fu', 'APRN', 'General Surgery', 'Nurse Practitioner', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679663272', 0, 'Y', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('743134268', 'W11012453', 'W11012453', 'UT01', 'Pediatric Sleep Medicine- Dept of University of Utah', 'June-Ku', 'B', 'Kang', 'MD', 'Pediatric Pulmonology', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235285909', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11012459', 'W11012459', 'UT01', 'University Radiology Associates', 'Jonathan', 'S', 'Silverstein', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-06-01', '2010-07-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639175144', 0, 'N', 0, '2008-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W11012460', 'W11012460', 'UT01', 'U-U Endocrinology Division', 'Gitana', NULL, 'Staskus', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-05-28', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790842706', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11012457', 'W11012457', 'UT01', 'U-U Cardiology Division', 'Charlotte', 'E', 'Schafer', 'APRN', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-06-05', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841459666', 0, 'y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11012455', 'W11012455', 'UT01', 'U-U Pulmonary Division', 'Britta', 'T', 'Schaer', 'PA', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-06-06', '2012-08-26', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750471348', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870442845', 'W11012938', 'W11012938', 'UT01', 'U-U Hematology / Oncology Division', 'Scott', 'P', 'Deaton', 'PA', 'Physician Assistant', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-02-05', '2009-02-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396831020', 0, 'y', 0, '2008-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870541480', 'W11012432', 'W11012432', 'UT01', 'University of Utah Division of Pediatric Neurosurgery', 'Randy', 'L', 'Jensen', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982794582', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11012942', 'W11012942', 'UT01', 'U-U Hematology / Oncology Division', 'Abigail', 'G', 'Staible', 'PA', 'Internal Medicine', 'Physician Assistant', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-02-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124206131', 0, 'y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11012450', 'W11012450', 'UT01', 'U-U Hematology / Oncology Division', 'Kelli', 'E', 'Groomer', 'PA', 'Pediatric Hematology and Oncolocy', 'Physician Assistant', NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2005-12-19', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568412724', 0, 'y', 0, '2008-09-09', NULL, NULL, 0, 0, NULL, NULL),
('743134268', 'W11012445', 'W11012445', 'UT01', 'Pediatric Adolescent Medicine-Department of University of Ut', 'Ameet', 'S', 'Daftary', 'MD', 'Pediatric Pulmonology', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891889119', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'W11012442', 'W11012442', 'UT01', 'University Heath Care', 'Phillip', 'T', 'Burch', 'MD', 'General Surgery', 'Cardiovascular Disease', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-07-13', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215027800', 0, 'Y', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870410144', 'W11012441', 'W11012441', 'UT01', 'University of Utah Dept of OB/GYN', 'Wallace', 'F', 'Bryner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015855172', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015855172', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-06-03', '2012-08-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578746459', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('519561377', 'W11012952', 'W11012952', 'UTMH1', 'ISAT', 'Mellie', 'F', 'Patterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 65709', 'Salt Lake City', 'Salt Lake', 'UT', '84165', '4356374852', NULL, 'PO Box 65709', 'Salt Lake City', 'Salt Lake', 'UT', '84165', '4356374852', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-08', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609932300', 0, 'y', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('900136549', 'W11012953', 'W11012953', 'UTMH1', NULL, 'Catharina', 'H', 'Kang', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', NULL, '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-08', '2013-02-14', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609927466', 0, 'N', 0, '2012-06-11', NULL, NULL, 0, 0, NULL, NULL),
('519561377', 'W11012951', 'W11012951', 'UTMH1', 'ISAT', 'Mellie', 'F', 'Patterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '23 S Carbon Ave Ste 10', 'Price', 'Carbon', 'UT', '84501', '4356374852', NULL, '23 S Carbon Ave Ste 10', 'Price', 'Carbon', 'UT', '84501', '4356374852', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-08', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609932300', 0, 'N', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11012402', 'W11012402', 'UT01', 'Canyon View Womens Care', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11012401', 'W11012401', 'UT01', 'Canyon View Medical Group', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11012936', 'W11012936', 'UT01', 'Desert Valley Dialysis', 'Abinash', 'C', 'Roy', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'o', '350 Falcon Ridge Pkwy #700', 'Mesquite', 'Clark', 'NV', '89027', '          ', NULL, '350 Falcon Ridge Pkwy #700', 'Mesquite', 'Clark', 'NV', '89027', '          ', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295825818', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012721', 'W11012721', 'ID02', 'Mercy Physician Group Cardiology', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2008-10-01', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012729', 'W11012729', 'ID02', 'Mercy Physician Group Cardiology', 'Peter', 'G', 'Roan', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326037342', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012742', 'W11012742', 'ID02', 'Mercy Physician Group Mercy North', 'Jaiyeola', '', 'Ashaye', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1952488561', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012829', 'W11012829', 'ID02', 'Mercy Physician Group Cardiology', 'Tosha', 'J', 'Johnson', 'NPC', 'Cardiology', 'Nurse Practitioner', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1639214216', 0, 'Y', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11012750', 'W11012750', 'ID02', 'Mercy Physician Group Mercy North', 'Austin', 'J', 'Graham', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-12-06', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1548228844', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
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('208192593', 'W11012760', 'W11012760', 'ID02', 'Mercy Physician Group Dallan Woods', 'John', 'A', 'Kremer', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '5485374866', NULL, NULL, 'Los Angeles', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2009-01-15', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1407829435', 0, 'Y', 0, '2008-09-11', NULL, NULL, 0, 0, NULL, NULL),
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('593580141', 'W11012988', 'W11012988', 'ID02', 'Life Chiropractic Center', 'Edwin', 'B', 'Rabin', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083881895', NULL, '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-11', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215076484', 0, 'n', 0, '2008-09-15', NULL, NULL, 0, 0, NULL, NULL),
('371542327', 'W11012990', 'W11012990', 'ID02', 'Rae Chiropractic Center', 'Brian', 'J', 'Rae', 'DC', 'Chiropractic', '', '', NULL, 'O', '2200 Warm Spring Ave Ste 106', 'Boise', 'Ada', 'ID', '83712', '2083317000', NULL, '2200 Warm Spring Ave Ste 106', 'Boise', 'Ada', 'ID', '83712', '2083317000', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598802753', 0, 'n', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('820511749', 'W11012991', 'W11012991', 'ID02', 'Life Chiropractic Center', 'Toby', 'O', 'Bingham', 'DC', 'Chiropractic', '', '', NULL, 'O', '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083881895', NULL, '1080 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083881895', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306985247', 0, 'n', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('205506855', 'W11012965', 'W11012965', 'ID01', 'Northwest Radiation Oncology', 'Jennifer', 'T', 'Shalz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-10-05', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1245346303', 0, 'N', 0, '2012-07-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('205506855', 'W11012964', 'W11012964', 'ID01', 'Northwest Radiation Oncology', 'Jennifer', 'T', 'Shalz', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 5145', 'Boise', 'Ada', 'ID', '83706', '2083673131', NULL, 'PO Box 5145', 'Boise', 'Ada', 'ID', '83706', '2083673131', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-10-05', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1245346303', 0, 'N', 0, '2012-07-23', NULL, NULL, 0, 0, NULL, NULL),
('262403449', 'W11012987', 'W11012987', 'ID02', 'Valley Pediatric Feeding', 'Jennifer', 'A', 'Dahms', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'B', '3388 E Anemine Ct', 'Boise', 'Ada', 'ID', '83716', '2085592348', NULL, '3388 E Anemine Ct', 'Boise', 'Ada', 'ID', '83716', '2085592348', '', 'IDMED', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-20', '2012-01-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013178730', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('263201394', 'W11012971', 'W11012971', 'UTMH1', 'All Ages & Life Stages Counseling ', 'Larry', 'A', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8012993411', '8017979942', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8012993411', '8017979942', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-08-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700942281', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870800272', 'W11012959', 'W11012959', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', NULL, '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-10', '2011-09-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('131860387', 'W11012960', 'W11012960', 'UT01', 'Ogden Internal Medicine', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-15', '2011-02-15', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W11012962', 'W11012962', 'UT01', 'Utah County Surgical Associates', 'David', 'M', 'Watts', 'MD', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-01', '2011-01-10', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700932068', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W11012963', 'W11012963', 'UT01', 'Utah County Surgical Associates', 'Cindy', '', 'Stock', 'APRN', 'General Surgery', 'Family Practice', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-10', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841470879', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('204585947', 'W11012968', 'W11012968', 'UT01', NULL, 'Ronald', 'C', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'O', '3325 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013731275', NULL, '3325 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013731275', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-04', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1245290295', 0, 'n', 0, '2013-10-08', NULL, NULL, 40.2777, -111.658, NULL, NULL),
('204585947', 'W11012969', 'W11012969', 'UT01', NULL, 'Ronald', 'C', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 219', 'Oak City', 'Millard', 'UT', '84649', '8013731275', NULL, 'PO Box 219', 'Oak City', 'Millard', 'UT', '84649', '8013731275', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-04', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1245290295', 0, 'y', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'W11012993', 'W11012993', 'WY01', 'Big Horn Pediatrics', 'Julie', 'S', 'Fall', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2008-09-10', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306959267', 0, 'n', 0, '2012-04-12', NULL, NULL, 44.291, -105.521, NULL, NULL),
('830251081', 'W11013023', 'W11013023', 'WY01', 'Powder River Orthopedics & Spine PC', 'Hans', 'C', 'Kioschos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740274265', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'W11013022', 'W11013022', 'WY01', 'Powder River Orthopedics & Spine PC', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'W11013021', 'W11013021', 'WY01', 'Powder River Orthopedics & Spine PC', 'Gerald', 'L', 'Baker', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316932783', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'W11012992', 'W11012992', 'WY01', 'Big Horn Pediatrics', 'Jennifer', 'M', 'Peterson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2008-09-10', '2009-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144333022', 0, 'N', 0, '2012-07-23', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'W11013024', 'W11013024', 'WY01', 'Powder River Orthopedics & Spine PC', 'John', 'P', 'Dunn', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163702', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11013003', 'W11013003', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Natasha', '', 'Miller', 'MD', 'Pediatrics', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-09-15', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1144299678', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('870395551', 'W11013011', 'W11013011', 'UT01', '', 'Todd', '', 'Cramer', 'DC', 'Chiropractic', '', '', NULL, 'O', '233 W State Ste A', 'Eagle', 'Ada', 'ID', '83616', '2089393737', '8017749650', '233 W State Ste A', 'Eagle', 'Ada', 'ID', '83616', '2089393737', '8017749650', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-06-19', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760551956', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11012999', 'W11012999', 'ID01', 'Saint Alphonsus Physicians PA', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', NULL, '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-12', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820403643', 'W11013043', 'W11013043', 'ID02', 'Meridian Chiropractic & Acupuncture Center', 'Robert', 'L', 'Rutz', 'DC', 'Chiropractic', '', '', NULL, 'O', '323 W Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088885858', NULL, '323 W Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088885858', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-04', '2008-09-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295833390', 0, 'n', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11013001', 'W11013001', 'ID01', 'Saint Alphonsus Physicians PA', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', NULL, '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-12', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820528942', 'W11013005', 'W11013005', 'ID02', 'Idaho Pulmonary Associates PA', 'Karen', 'S', 'Miller', 'MD', 'Pulmonary', '', '', NULL, 'B', '2347 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2083230031', NULL, '2347 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2083230031', '', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-09-12', '2008-09-12', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1629117619', 0, 'Y', 0, '2011-03-23', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11013013', 'W11013013', 'ID02', '', 'Nathan', 'E', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'O', '2058 E Fairview Ave Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2082862124', '2088555915', '2058 E Fairview Ave Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2082862124', '2088555915', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-08-04', '2010-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417089442', 0, 'N', 0, '2011-05-26', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11013009', 'W11013009', 'ID02', 'Mercy Physician Group General Surgery', 'Richard', '', 'Ballantyne', 'DO', 'General Surgery', '', '', NULL, 'O', '1603 E 12th St', 'Nampa', 'Canyon', 'ID', '83686', '2084631455', NULL, '1603 E 12th St', 'Nampa', 'Canyon', 'ID', '83686', '2084631455', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-09-12', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174745582', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11013000', 'W11013000', 'ID01', 'Saint Alphonsus Physicians PA', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', NULL, '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-12', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.587, -116.549, NULL, NULL),
('208192593', 'W11013007', 'W11013007', 'ID02', 'Mercy Physician Group Family Practice', 'Jay', 'H', 'Hansen', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', NULL, '4400 Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-09-15', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710084363', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820533863', 'W11012995', 'W11012995', 'ID01', 'Idaho Sleep Specialists PC', 'Brett (CPAP)', '', 'Troyer', 'MD', 'Sleep Medicine', 'Sleep Disorders', 'Durable Medical Equipment', NULL, 'O', '403 S 11th St Ste 210', 'Boise', 'Ada', 'ID', '83702', '2088950411', NULL, '403 S 11th St', 'Boise', 'Ada', 'ID', '83702', NULL, NULL, 'IDSLEEP', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, 'St Lukes', NULL, NULL, 'HCFA|UB|', '1841385523', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202523793', 'W11013020', 'W11013020', 'ID01', 'Ada Orthopaedic Clinic', 'John', 'J', 'Mohr', 'MD', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083672121', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083672121', '          ', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-09-12', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124073077', 0, 'Y', 0, '2013-11-15', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('518806646', 'W11013016', 'W11013016', 'ID01', 'Ada Orthopaedic Clinic', 'Mark', 'S', 'Williams', 'DO; Sports Med', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-09-12', '2009-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114961166', 0, 'n', 0, '2013-07-03', NULL, NULL, 43.612, -116.262, NULL, NULL),
('820441031', 'W11013017', 'W11013017', 'ID01', 'Ada Orthopaedic Clinic', 'Phillip', 'J', 'Norris', 'PA-C', 'Mental Health', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-09-12', '2012-02-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497790224', 0, 'N', 0, '2014-06-30', NULL, NULL, 43.612, -116.262, NULL, NULL),
('202523793', 'W11013019', 'W11013019', 'ID01', 'Ada Orthopaedic Clinic', 'William', 'C', 'Lindner', 'MD; Shoulder, General', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-09-12', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1982649927', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.612, -116.262, NULL, NULL),
('820482736', 'W11013047', 'W11013047', 'ID01', NULL, 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', NULL, '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', '', 'IDMD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11012998', 'W11012998', 'ID01', 'Saint Alphonsus Physicians PA', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', NULL, '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-12', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('262050357', 'W11012996', 'W11012996', 'ID02', 'Retina Specialists of Idaho', 'Denton', 'R', 'Roberts', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '13923 W Wainwright Ste 301', 'Boise', 'Ada', 'ID', '83704', '2089385624', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-09-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1699742395', 0, 'n', 0, '2008-09-16', 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
('820482736', 'W11013045', 'W11013045', 'ID01', '', 'Kimberly (Kim)', '', 'Spears', 'ARNP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', NULL, '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', '', 'IDARNP', '', '', '0.00', '35.00', '0.00', 6, '2008-09-08', '2012-05-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558564138', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('208038922', 'W11013042', 'W11013042', 'ID02', '21st Century Chiropractic', 'Alan', 'R', 'Barnes', 'DC', 'Chiropractic', '', '', NULL, 'O', '9508 Fairview Ave', 'Boise', 'Ada', 'ID', '83704', '2083231313', NULL, '9508 Fairview Ave', 'Boise', 'Ada', 'ID', '83704', '2083231313', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730127291', 0, 'n', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('820315557', 'W11013027', 'W11013027', 'ID01', 'Boise Psychological Services', 'Michael', 'A', 'McCoy', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', NULL, '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2008-09-15', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0170759284', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('820315557', 'W11013028', 'W11013028', 'ID01', 'Boise Psychological Services', 'Michael', 'A', 'McCoy', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', NULL, '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0170759284', 0, 'n', 0, '2012-08-09', NULL, NULL, 0, 0, NULL, NULL),
('820482736', 'W11013046', 'W11013046', 'ID01', NULL, 'Kimberly (Kim)', '', 'Spears', 'ARNP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', NULL, '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', '', 'IDARNP', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558564138', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820441031', 'W11013018', 'W11013018', 'ID01', 'Ada Orthopaedic Clinic', 'Richard', 'E', 'Moore', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-09-12', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124221247', 0, 'n', 0, '2012-12-06', NULL, NULL, 43.612, -116.262, NULL, NULL),
('820482736', 'W11013044', 'W11013044', 'ID01', '', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', NULL, '413 N Allumbaugh Ste 103', 'Boise', 'Ada', 'ID', '83704', '2086580800', '', 'IDMD', '', '', '0.00', '35.00', '0.00', 6, '2008-09-08', '2012-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11013002', 'W11013002', 'ID01', 'Saint Alphonsus Medical Group Federal Way', 'Louis', 'A', 'Roser', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', NULL, '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2008-08-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497715866', 0, 'n', 0, '2012-11-16', NULL, NULL, 43.5916, -116.204, NULL, NULL),
('263031859', 'W11013031', 'W11013031', 'ID01', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', NULL, '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2008-09-15', '2011-04-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('263031859', 'W11013032', 'W11013032', 'ID01', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', NULL, '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820528942', 'W11013004', 'W11013004', 'ID02', 'Idaho Pulmonary Associates PA', 'Karen', 'S', 'Miller', 'MD', 'Pulmonary', '', '', NULL, 'B', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083230031', NULL, '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083230031', '', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-09-12', '2008-09-12', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1629117619', 0, 'Y', 0, '2011-03-23', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('331078261', 'W11012997', 'W11012997', 'ID01', 'Saint Alphonsus Physicians PA', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-12', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('263031859', 'W11013034', 'W11013034', 'ID01', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '2584 E Bergeson', 'Boise', 'Ada', 'ID', '83706', '2089213501', NULL, '2584 E Bergeson', 'Boise', 'Ada', 'ID', '83706', '2089213501', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11013006', 'W11013006', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Karen', 'S', 'Miller', 'MD', 'Pulmonary', '', '', NULL, 'B', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673722', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-09-15', '2011-02-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1629117619', 0, 'N', 0, '2011-03-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('870395551', 'W11013012', 'W11013012', 'UT01', NULL, 'John', 'L', 'Thiry', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '381 Park Center', 'Boise', 'Ada', 'ID', '83706', '2083448377', '8017749650', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-06-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114975612', 0, 'N', 0, '2008-09-19', NULL, NULL, 0, 0, NULL, NULL),
('263031859', 'W11013033', 'W11013033', 'ID01', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '2584 E Bergeson', 'Boise', 'Ada', 'ID', '83706', '2089213501', NULL, '2584 E Bergeson', 'Boise', 'Ada', 'ID', '83706', '2089213501', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820424193', 'W11013041', 'W11013041', 'ID02', 'King Chiropractic Health Center', 'Neil', 'E', 'King', 'DC', 'Chiropractic', '', '', NULL, 'O', '679 N Five Mile Rd', 'Boise', 'Ada', 'ID', '83713', '2083759993', NULL, '679 N Five Mile Rd', 'Boise', 'Ada', 'ID', '83713', '2083759993', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1962560219', 0, 'n', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870800272', 'W11013026', 'W11013026', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', NULL, '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('261555983', 'W11013040', 'W11013040', 'UT01', 'Promontory Family Vision', 'Clark', 'E', 'Fielden', 'OD', 'Optometry', '', '', NULL, 'O', '1448 N 2000 W Ste 11', 'Clinton', 'Davis', 'UT', '84015', '8017790708', NULL, '1448 N 2000 W Ste 11', 'Clinton', 'Davis', 'UT', '84015', '8017790708', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457339285', 0, 'n', 0, '2014-06-19', NULL, NULL, 41.1349, -112.064, NULL, NULL),
('870800272', 'W11013025', 'W11013025', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '114 E 12450 S Ste 206', 'Draper', 'Salt Lake', 'UT', '84020', '8015765930', NULL, '114 E 12450 S Ste 206', 'Draper', 'Salt Lake', 'UT', '84020', '8015765930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870281299', 'W11013030', 'W11013030', 'UT01', 'Lehi Medical Clinic', 'Cheryl', 'A', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017680821', NULL, '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017680821', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066671', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870550181', 'W11013037', 'W11013037', 'UT01', 'Interwest Anesthesia Associates LLC', '', '', 'Interwest Anesthesia Associates LLC', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357161000', NULL, '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357161000', '', '', NULL, '1000', '49.35', '35.00', '0.00', 3, '2008-10-01', '2008-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1841214483', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870550181', 'W11013038', 'W11013038', 'UT01', 'Interwest Anesthesia Associates LLC', '', '', 'Interwest Anesthesia Associates LLC', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '550 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '550 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357161000', '', '', NULL, '1000', '49.35', '35.00', '0.00', 3, '2008-10-01', '2008-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1841214483', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870550181', 'W11013039', 'W11013039', 'UT01', 'Interwest Anesthesia Associates LLC', '', '', 'Interwest Anesthesia Associates LLC', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '2380 N 400 E', 'North Logan', 'Cache', 'UT', '84341', '4357139700', NULL, '2380 N 400 E', 'North Logan', 'Cache', 'UT', '84341', '4357139700', '', '', NULL, '1000', '49.35', '35.00', '0.00', 3, '2008-10-01', '2008-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1841214483', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11013014', 'W11013014', 'UT01', NULL, 'Timothy', NULL, 'Annis', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '460 E 2nd Ste B', 'Ogden', 'Weber', 'UT', '84404', '8016212541', '8017749650', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-07-21', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851441786', 0, 'N', 0, '2008-09-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11013015', 'W11013015', 'UT01', NULL, 'Jesse', 'L', 'Meeks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '460 E 2nd Ste B', 'Ogden', 'Weber', 'UT', '84404', '8016212541', '8017749650', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-07-21', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902075104', 0, 'N', 0, '2008-09-16', NULL, NULL, 0, 0, NULL, NULL),
('680511576', 'W11012994', 'W11012994', 'UT01', '', 'Ray', 'A', 'Andrew', 'MD', 'Family Practice', '', '', NULL, 'O', '255 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352594466', NULL, '255 W Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352594466', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093804809', 0, 'Y', 0, '2013-03-14', NULL, NULL, 38.5744, -109.556, NULL, NULL),
('201501835', 'W11013036', 'W11013036', 'UT01', 'Retina & Vitreous Surgeons of Utah Inc', 'John', 'A', 'Carver', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', 'WiseSTD3', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', '2009-01-27', 0, 0, 0, 'St Marks Hospital', 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1669435160', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('201501835', 'W11013035', 'W11013035', 'UT01', 'Retina & Vitreous Surgeons of Utah Inc', 'Richard', 'P', 'Corey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', 'WiseSTD3', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', '2009-01-27', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1568529105', 0, 'N', 0, '2011-12-15', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11013029', 'W11013029', 'UT01', 'Canyon View Medical Group', 'David', 'E', 'Ludlow', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652590', NULL, '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652590', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1104864412', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11013010', 'W11013010', 'ID02', 'Mercy Physician Group General Surgery', 'Richard', '', 'Ballantyne', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', NULL, 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-09-12', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174745582', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('208192593', 'W11013008', 'W11013008', 'ID02', 'Mercy Physician Group Family Practice', 'Jay', 'H', 'Hansen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', NULL, 'PO Box 31001-1261', 'Pasadena', 'Los Angeles', 'CA', '91110', '8474951617', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-09-15', '2010-12-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710084363', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11013050', 'W11013050', 'UT01', 'University Health Care', 'Brian', 'P', 'Good', 'MD', 'Pediatrics', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-04-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770688335', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11013054', 'W11013054', 'UT01', 'University Health Care', 'Kathleen', 'K', 'Boynton', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-31', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174666739', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11013052', 'W11013052', 'UT01', 'University Health Care', 'Natalie', 'A', 'Sanders', 'DO', 'Internal Medicine', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-07-17', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811949001', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11013049', 'W11013049', 'UT01', 'University of Utah Dept of Ophthalmology', 'Balamurali', 'K', 'Ambati', 'MD', 'Ophthalmology', '', '', NULL, 'B', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2008-03-04', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750397576', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11013048', 'W11013048', 'UT01', 'University Health Care', 'Balamurali', 'K', 'Ambati', 'MD', 'Ophthalmology', '', '', NULL, 'o', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2008-03-04', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750397576', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11013055', 'W11013055', 'UT01', 'U-U Gastroenterology Division', 'Kathleen', 'K', 'Boynton', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-31', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174666739', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11013053', 'W11013053', 'UT01', 'U-U General Medicine Division', 'Natalie', 'A', 'Sanders', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-07-17', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811949001', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11013051', 'W11013051', 'UT01', 'Pediatric Inpatient Services', 'Brian', 'P', 'Good', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-04-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770688335', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('521262870', 'W11013089', 'W11013089', 'ID01', 'Dynasplint Systems (Custom Braces)', NULL, NULL, 'Dynasplint Systems Inc  (Custom Braces)', 'GROUP', 'Durable Medical Equipment', 'Custom Splints', NULL, NULL, 'O', '770 Ritchie Hwy Ste W 21', 'Severna Park', NULL, 'MD', NULL, '8006386771', NULL, '770 Ritchie Highway', 'Severna Park', NULL, 'MD', '211463923', NULL, NULL, 'WCSTDSS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006069', 0, 'Y', 0, '2008-10-08', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'W11013085', 'W11013085', 'ID01', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 727', 'Windsor', '', 'CT', '', '8003670300', NULL, 'PO Box 727', 'Windsor', '', 'CT', '', '8003670300', '          ', 'WCSTRCS5', '', '', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194776518', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'W11013083', 'W11013083', 'ID01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8884003522', NULL, 'Phone Number Only', '', '', '', '', '8884003522', '', 'wisecardio', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('541707322', 'W11013086', 'W11013086', 'ID01', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', '', '', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 716', 'Keysville', 'Charlotte', 'VA', '23947', '8004879644', NULL, 'PO Box 716', 'Keysville', 'Charlotte', 'VA', '23947', '8004879644', '', 'WCSTCROP5', NULL, NULL, '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578562468', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'W11013090', 'W11013090', 'ID01', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1810 Summit Commerce', 'Twinsburg', 'Lorain', 'OH', '44039', '8003075930', NULL, '1810 Summit Commerce', 'Twinsburg', 'Lorain', 'OH', '44039', '8003075930', '          ', 'WCSTEPSI5', 'DME80', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('411310335', 'W11013091', 'W11013091', 'ID01', 'Empi Inc (Neuromuscular Stimulator)', '', '', 'Empi Inc (Neuromuscular Stimulator)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '599 Cardigan Rd', 'St Paul', 'Ramsey', 'MN', '55126', '8003282536', NULL, '599 Cardigan Rd', 'St Paul', 'Ramsey', 'MN', '55126', '8003282536', '', 'WCSTEMPI5', 'DME90', NULL, '0.00', '15.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174574032', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('411694999', 'W11013087', 'W11013087', 'ID01', 'Disetronic Medical Systems (Diabetic Equipment and Supplies)', NULL, NULL, 'Disetronic Medical Systems (Diabetic Equipment and Supplies)', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', 'PO Box 86 SDS 12-2207', 'Minneapolis', 'Hennepin', 'MN', '55486', '8002807801', '8888100758', '11800 Exit 5 Pkwy', 'Fisher', 'Hennepin', 'IN', '46037', NULL, NULL, 'WDISETR', NULL, NULL, '0.00', '30.00', '0.00', 3, '2006-12-01', '2010-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710980156', 0, 'Y', 0, '2008-10-08', NULL, NULL, 0, 0, NULL, NULL),
('510123924', 'W11013094', 'W11013094', 'ID01', 'Smith Nephew Inc (Bone Stimulators)', '', '', 'Smith Nephew Inc (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 22987', 'Chicago', 'Cook', 'IL', '60673', '8006374391', NULL, 'PO Box 22987', 'Chicago', 'Cook', 'IL', '60673', '8006374391', '          ', '', '', '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000002531', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'W11013084', 'W11013084', 'ID01', 'LifeWatch', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', NULL, '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', '          ', 'WCSTLWI5', '', '', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11013088', 'W11013088', 'ID01', 'DJO (Orthopedic Supplies for Provider Use Only)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '3434 Solutions Ctr', 'Chicago', 'Cook', 'IL', '60677', '8003282536', NULL, '3434 Solutions Ctr', 'Chicago', 'Cook', 'IL', '60677', '8003282536', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'W11013092', 'W11013092', 'ID01', 'Orthofix (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005270404', '4697422881', 'PO Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005270404', '4697422881', 'WCSTORFIX5', '', '', '0.00', '100.00', '0.00', 3, '2006-11-01', '2014-06-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000647859', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11013060', 'W11013060', 'WY01', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', NULL, 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'n', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013120', 'W11013120', 'WY01', 'Campbell County Clinics Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889255', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889255', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'N', 0, '2013-11-04', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830234097', 'W11013112', 'W11013112', 'WY01', 'Campbell County Clinics Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-10-18', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830234097', 'W11013113', 'W11013113', 'WYWSBAIT', 'Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013116', 'W11013116', 'WY01', 'Cottonwood Clinic', 'Phillip', '', 'McMahill', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007529', 0, 'N', 0, '2014-06-23', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830234097', 'W11013117', 'W11013117', 'WYWSBAIT', 'Cottonwood Clinic', 'Phillip', '', 'McMahill', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007529', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013118', 'W11013118', 'WYWSBAIT', 'OB/Gyn Clinic', 'Angela', '', 'Biggs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', NULL, '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689787814', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013119', 'W11013119', 'WY01', 'Campbell County Clinics OB/GYN Specialists', 'Angela', '', 'Biggs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', NULL, '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689787814', 0, 'N', 0, '2013-10-18', NULL, NULL, 44.291, -105.523, NULL, NULL),
('830234097', 'W11013121', 'W11013121', 'WYWSBAIT', 'Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889258', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889258', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013123', 'W11013123', 'WY01', 'Pioneer Manor', '', '', 'Pioneer Manor', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', NULL, '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008208', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013126', 'W11013126', 'WYWSBAIT', 'Rehabilitation Services', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013127', 'W11013127', 'WY01', 'Campbell County Memorial Hospital', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 44.2899, -105.515, NULL, NULL),
('830234097', 'W11013111', 'W11013111', 'WY01', 'Campbell County Clinics Internal Medicine', 'Farrukh', '', 'Javaid', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001', '0.00', '100.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922094036', 0, 'N', 0, '2013-10-18', NULL, NULL, 44.29, -105.521, NULL, NULL),
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