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
('820312175', 'W11019375', 'W11019375', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820312175', 'W11019376', 'W11019376', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019377', 'W11019377', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'W', 'Moss', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-28', '2012-10-02', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1033384201', 0, 'N', 0, '2012-11-15', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'W11019378', 'W11019378', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'W', 'Moss', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1033384201', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820312175', 'W11019379', 'W11019379', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019380', 'W11019380', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820477852', 'W11019381', 'W11019381', 'ID01', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6481, -116.335, NULL, NULL),
('820432465', 'W11019382', 'W11019382', 'ID02', 'Family Care Physicians', 'Joshua', 'W', 'Kern', 'MD', 'Family Practice', '', '', NULL, 'O', '112 5th Ave West', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', '112 5th Ave West', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2013-06-01', 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1366486003', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019383', 'W11019383', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Julie', 'Anne', 'Lyons', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1982620787', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019384', 'W11019384', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Julie', 'Anne', 'Lyons', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083676030', '2083227018', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083676030', '2083227018', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1982620787', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019385', 'W11019385', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2014-03-18', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019386', 'W11019386', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083676030', '2083227018', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083676030', '2083227018', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2014-03-18', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477586162', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11019387', 'W11019387', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2009-07-28', '2010-01-30', 0, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356325666', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11019388', 'W11019388', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2009-07-28', '2010-01-30', 0, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356325666', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11019389', 'W11019389', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', NULL, '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2009-07-28', '2010-01-30', 0, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356325666', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('953134847', 'W11019390', 'W11019390', 'ID02', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2012-06-30', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('820477852', 'W11019391', 'W11019391', 'ID01', 'Saint Alphonsus Medical Group Womens Health', 'Juliana', 'L', 'DiGiosia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1144335332', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820477852', 'W11019392', 'W11019392', 'ID01', 'Saint Alphonsus Medical Group Pediatrics', 'Heather', 'N', 'Owens', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588688477', 0, 'N', 0, '2014-07-17', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820382500', 'W11019393', 'W11019393', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2013-01-22', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306064258', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W11019394', 'W11019394', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1828 Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088555955', '2088558740', '1828 Millennium Way', 'Meridian', 'Ada', 'ID', '83642', '2088555955', '2088558740', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2009-07-28', '2013-08-26', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306064258', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W11019395', 'W11019395', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1818 S 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2088555955', NULL, '1818 S 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2088555955', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2009-07-28', '2013-08-26', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306064258', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019396', 'W11019396', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '2083672989', 'IDRADIOLOGY', '', '', '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('826041596', 'W11019397', 'W11019397', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '927 W Myrtle', 'Boise', 'Ada', 'ID', '83702', '2083677510', '2083676367', '927 W Myrtle', 'Boise', 'Ada', 'ID', '83702', '2083677510', '2083676367', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019398', 'W11019398', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', '2929 E Magicview Dr', 'Meridian', 'Ada', 'ID', '83642', '2083678222', '2083678273', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019399', 'W11019399', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', NULL, '323 E Riverside Dr Ste 108', 'Eagle', 'Ada', 'ID', '83616', '2083675700', '', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('826041596', 'W11019400', 'W11019400', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2084553730', '2084553735', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2084553730', '2084553735', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019401', 'W11019401', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653651', NULL, '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653651', '', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('826041596', 'W11019402', 'W11019402', 'ID01', 'Gem State Radiology LLP dba Advanced Vein Therapy', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089470100', '2086396625', '161 E Mallard Ste 130', 'Boise', 'Ada', 'ID', '83706', '2089470100', '2086396625', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019403', 'W11019403', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', NULL, '6200 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083812055', '', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('202777185', 'W11019404', 'W11019404', 'ID02', 'Kinectic Chiropractic', 'James', 'B', 'Trapp', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '1819 W State St', 'Boise', 'Ada', 'ID', '83702', '2083892225', '2083362827', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194895276', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11019405', 'W11019405', 'ID01', 'Saint Alphonsus Addiction Recovery Center', 'Kenneth', 'E', 'Chandler', 'CADC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083673002', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083673002', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2010-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1629205570', 0, 'Y', 0, '2009-12-09', NULL, NULL, 0, 0, NULL, NULL),
('263031859', 'W11019406', 'W11019406', 'ID02', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '921 S Orchard Ste D', 'Boise', 'Ada', 'ID', '83705', '2089213501', '8883098143', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306974365', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019407', 'W11019407', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'B', 'Campbell', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-28', '2009-07-28', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1790981025', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019408', 'W11019408', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'B', 'Campbell', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1790981025', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019409', 'W11019409', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019410', 'W11019410', 'ID01', 'Idaho Emergency Physicians PA', 'Eric', 'T', 'Elliot', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-28', '2011-02-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1174655740', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019411', 'W11019411', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'W', 'Moss', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', 'West Valley', NULL, NULL, 'HCFA|UB|', '0103338421', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019412', 'W11019412', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', 'W', 'Moss', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-28', '2009-07-28', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1033384201', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019413', 'W11019413', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2009-07-28', '2011-02-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11019414', 'W11019414', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '0.00', '10.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11019415', 'W11019415', 'ID01', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820432465', 'W11019416', 'W11019416', 'ID02', 'Family Care Physicians', 'Joshua', 'W', 'Kern', 'MD', 'Family Practice', '', '', NULL, 'B', '112 W 5th', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', '112 W 5th', 'Jerome', 'Jerome', 'ID', '83338', '2083241157', '2083243406', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2013-06-01', 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1366486003', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019417', 'W11019417', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Julie', 'Anne', 'Lyons', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083227018', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1982620787', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019418', 'W11019418', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Julie', 'Anne', 'Lyons', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083227018', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1982620787', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019419', 'W11019419', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083227018', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1477586162', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019420', 'W11019420', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Stacia', 'M', 'Munn', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676030', '2083227018', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1477586162', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11019421', 'W11019421', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4008', 'Portland', NULL, 'ID', NULL, '8002758752', '5033722754', 'PO Box 4008', 'Portland', '', 'ID', '', '8002758752', '5033722754', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2009-07-28', '2010-01-30', 0, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356325666', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11019422', 'W11019422', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'B', 'PO Box 4008', 'Portland', NULL, 'ID', NULL, '8002758752', '5033722754', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '55.81', '10.00', NULL, 3, '2000-01-01', '2000-01-01', 1, 15, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1356325666', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11019423', 'W11019423', 'ID01', 'Boise Anesthesia PA', 'Joseph', 'C', 'Skinner', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'B', 'PO Box 4008', 'Portland', NULL, 'ID', NULL, '8002758752', '5033722754', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSAMG3', NULL, NULL, '55.81', '10.00', NULL, 3, '2000-01-01', '2000-01-01', 1, 15, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1356325666', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019424', 'W11019424', 'ID02', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-07-28', '2012-06-30', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'Y', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11019425', 'W11019425', 'ID01', 'Saint Alphonsus Medical Group Womens Health', 'Juliana', 'L', 'DiGiosia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1144335332', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11019426', 'W11019426', 'ID01', 'Saint Alphonsus Medical Group Pediatrics', 'Heather', 'N', 'Owens', 'MD', 'Pediatrics', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-07-28', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588688477', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W11019427', 'W11019427', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, 'Mercy', 'HCFA|UB|', '1306064258', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W11019428', 'W11019428', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, 'Mercy', 'HCFA|UB|', '1306064258', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820382500', 'W11019429', 'W11019429', 'ID02', 'Foot & Ankle Medical Center', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '203 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084663338', '2084663554', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, 'Mercy', 'HCFA|UB|', '1306064258', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019430', 'W11019430', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-07-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019431', 'W11019431', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019432', 'W11019432', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019433', 'W11019433', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019434', 'W11019434', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019435', 'W11019435', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019436', 'W11019436', 'ID01', 'Gem State Radiology LLP dba Advanced Vein Therapy', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('826041596', 'W11019437', 'W11019437', 'ID01', 'Gem State Radiology LLP', 'Shane', 'J', 'McGonegle', 'MD', 'Radiology', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728100', '2084728172', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDRADIOLOGY', NULL, NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639341068', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11019453', 'W11019453', 'UT01', NULL, 'Jeremy', 'J', 'Griffin', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '942 Chambers St Ste 11', 'Ogden', 'Weber', 'UT', '84403', '8014750360', NULL, '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-07-21', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043310840', 0, 'N', 0, '2009-08-04', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11019438', 'W11019438', 'UT01', 'Heart of Dixie PC', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('205934739', 'W11019439', 'W11019439', 'ID02', 'Family Medicine Health Center', 'Sarah', 'R', 'Cox', 'NP', 'Family Practice', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083676030', NULL, '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083676030', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-06-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1609884014', 0, 'n', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('264159952', 'W11019440', 'W11019440', 'ID02', 'Idaho Gastroenterology Associates', 'Chad', 'A', 'Morse', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', NULL, '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-08-03', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588794135', 0, 'n', 0, '2012-03-30', NULL, NULL, 0, 0, NULL, NULL),
('264159952', 'W11019441', 'W11019441', 'ID02', 'Idaho Gastroenterology Associates', 'Chad', 'A', 'Morse', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', NULL, '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '', 'IDPPONONFAC', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-08-03', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588794135', 0, 'n', 0, '2012-03-30', NULL, NULL, 0, 0, NULL, NULL),
('399908214', 'W11019442', 'W11019442', 'ID02', NULL, 'Stephanie', 'L', 'Hauser', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '6203 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2089493056', NULL, '6203 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2089493056', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-07-30', '2010-03-21', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316042799', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019443', 'W11019443', 'UT01', 'Salt Lake Regional Hospital', 'Matthew', 'T', 'Rondina', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538183991', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019444', 'W11019444', 'UT01', 'University of Utah Medical Center', 'Matthew', 'T', 'Rondina', 'MD', 'Internal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012132270', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012132270', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538183991', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019445', 'W11019445', 'UT01', 'Salt Lake Regional Hospital', 'Matthew', 'T', 'Rondina', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012132270', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012132270', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538183991', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11019446', 'W11019446', 'UT01', 'Granger Medical Clinic', 'Jeremy', 'P', 'Gerritsen', 'OD', 'Optometry', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1538321237', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870284475', 'W11019447', 'W11019447', 'UT01', 'Granger Medical Clinic', 'Jeremy', 'P', 'Gerritsen', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013021700', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013021700', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1538321237', 0, 'y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019448', 'W11019448', 'UTMH1', 'Axis-One Inc', 'Scott', 'M', 'Howes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811928526', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019449', 'W11019449', 'UTMH1', 'Axis-One Inc', 'Scott', 'M', 'Howes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '20 W 100 N', 'Tremonton', 'Cache', 'UT', '84332', '4352576999', NULL, '20 W 100 N', 'Tremonton', 'Cache', 'UT', '84332', '4352576999', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811928526', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019450', 'W11019450', 'UTMH1', 'Axis-One Inc', 'Scott', 'M', 'Howes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '60 S Main Ste 109', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230210', NULL, '60 S Main Ste 109', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230210', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811928526', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('352293133', 'W11019451', 'W11019451', 'WY01', 'Alternative Counseling Associates', 'Patricia', 'J', 'Vazquez', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '315 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073324515', NULL, '315 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073324515', '', 'WYMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669594958', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('352293133', 'W11019452', 'W11019452', 'WY01', 'Alternative Counseling Associates', 'Patricia', 'J', 'Vazquez', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 279', 'Lander', 'Fremont', 'WY', '82520', '3073324515', NULL, 'PO Box 279', 'Lander', 'Fremont', 'WY', '82520', '3073324515', '', 'WYMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669594958', 0, 'y', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11019454', 'W11019454', 'UT01', NULL, 'David', 'T', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', NULL, '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-07-21', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275752164', 0, 'N', 0, '2009-08-04', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11019455', 'W11019455', 'UT01', '', 'G', 'Shaun', 'Reynolds', 'DC', 'Chiropractic', '', '', NULL, 'O', '826 E 12300 S Ste 4', 'Draper', 'Salt Lake', 'UT', '84020', '8015761155', NULL, '826 E 12300 S Ste 4', 'Draper', 'Salt Lake', 'UT', '84020', '8015761155', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-06-03', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134363351', 0, 'N', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019456', 'W11019456', 'UT01', 'Ogden Clinic', 'Randy', 'S', 'Alejo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', NULL, '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-12-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1922204775', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11019527', 'W11019527', 'ID01', 'Saint Alphonsus OB Hospitalist Program', 'Julia', 'K', 'Bouchard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674505', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674505', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-08-16', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861436081', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('270285894', 'W11019457', 'W11019457', 'TX01', '', 'Anne', 'M', 'Esquivel', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', NULL, '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '          ', 'TXPHD', '', '', '0.00', '100.00', '0.00', 6, '2009-08-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285822379', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019458', 'W11019458', 'UT01', 'Davis Hospital (Hospitalist)', 'Steven', 'H', 'Lofgran', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154524734', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019459', 'W11019459', 'UT01', 'Pioneer Valley Hospital', 'Steven', 'H', 'Lofgran', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 S Pioneer Parkway', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Parkway', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154524734', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019460', 'W11019460', 'UT01', 'Pioneer Valley Hospital', 'Steven', 'H', 'Lofgran', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154524734', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019461', 'W11019461', 'UTMH1', 'Resilient Solutions Inc', 'Lisa', '', 'Bradford', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417007311', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('263747461', 'W11019462', 'W11019462', 'TX01', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '515 N King St Ste 104', 'Seguin', 'Guadalupe', 'TX', '78155', '83030031121', NULL, '515 N King St Ste 104', 'Seguin', 'Guadalupe', 'TX', '78155', '83030031121', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5734, -97.95, NULL, NULL),
('263747461', 'W11019463', 'W11019463', 'TX01', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '116 Gallery Cir Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104954999', NULL, '116 Gallery Cir Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104954999', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('263747461', 'W11019464', 'W11019464', 'TX01', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '925 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102276156', NULL, '925 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102276156', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.4423, -98.4998, NULL, NULL),
('263747461', 'W11019465', 'W11019465', 'TX01', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 781905', 'San Antonio', 'Bexar', 'TX', '78278', '2102470920', NULL, 'PO Box 781905', 'San Antonio', 'Bexar', 'TX', '78278', '2102470920', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('263747461', 'W11019466', 'W11019466', 'TX01', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '9102 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78240', '2102470920', NULL, '9102 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78240', '2102470920', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5287, -98.5918, NULL, NULL),
('205463078', 'W11019467', 'W11019467', 'ID02', 'Speech Tree Inc', 'M', 'Celeste', 'Howard', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '935 E Winding Creek Dr Ste 120', 'Eagle', 'Ada', 'ID', '83616', '2089384748', NULL, '935 E Winding Creek Dr Ste 120', 'Eagle', 'Ada', 'ID', '83616', '2089384748', '', 'IDSPEECH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1396993077', 0, 'n', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('450579015', 'W11019468', 'W11019468', 'UT01', 'South Jordan Family Practice', 'David', 'D', 'Poor', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-08-31', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1275589699', 0, 'y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11019469', 'W11019469', 'UT01', 'South Jordan Family Practice', 'David', 'D', 'Poor', 'MD', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', NULL, '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', '2010-08-31', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1275589699', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019470', 'W11019470', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', '', 'ME', '04915', '8014921611', NULL, 'PO Box 8476', 'Belfast', '', 'ME', '04915', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019471', 'W11019471', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019472', 'W11019472', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', NULL, '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019473', 'W11019473', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', NULL, '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019474', 'W11019474', 'UT01', 'After Hours Medical American Fork', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019475', 'W11019475', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2013-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019476', 'W11019476', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', '', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', NULL, '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2011-10-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720268204', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11019477', 'W11019477', 'ID02', 'Childrens Therapy Place Inc', 'Serena', 'D', 'Huff', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-08-01', '2010-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1902072986', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019479', 'W11019479', 'UTIHCPHY', 'Utah Heart', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019480', 'W11019480', 'UTIHCPHY', 'Dixie Hospitalists', 'Benjamin', NULL, 'Casillas', 'MD', 'Family Practice', 'Hospitalist', NULL, NULL, 'o', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-20', '2011-05-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578739835', 0, 'N', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019481', 'W11019481', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Michael', 'R', 'Francis', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '          ', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-13', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104093996', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11019482', 'W11019482', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Nathan', 'William', 'Hanson', 'MD', 'Dermatology', '', '', NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407048515', 0, 'n', 0, '2012-01-24', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11019483', 'W11019483', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Derrick', 'S', 'Haslem', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', NULL, 'o', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1730389701', 0, 'n', 0, '2009-08-06', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W11019484', 'W11019484', 'UTIHCPHY', 'Utah Heart', 'Gary', 'D', 'Hood', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306022603', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019485', 'W11019485', 'UTIHCPHY', 'Utah Heart', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019486', 'W11019486', 'UTIHCPHY', 'Southwest Neurology Associates', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'o', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', NULL, '652 S Medical Center Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-23', '2012-04-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019487', 'W11019487', 'UTIHCPHY', 'Utah Heart', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019488', 'W11019488', 'UTIHCPHY', 'Utah Heart', 'Rebecca', 'Lynn', 'McCollaum', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669658969', 0, 'N', 0, '2010-10-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019489', 'W11019489', 'UTIHCPHY', 'Utah Heart', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019490', 'W11019490', 'UTIHCPHY', 'Bear River Family Medicine', 'Todd', 'J', 'Miller', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, NULL, NULL, 'Box Elder', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780877191', 0, 'n', 0, '2009-08-06', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W11019491', 'W11019491', 'UTIHCPHY', 'Utah Heart', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019492', 'W11019492', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Jon', 'B', 'Obray', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'o', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', NULL, '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-21', '2011-09-10', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1205814803', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019493', 'W11019493', 'UTIHCPHY', 'Utah Heart', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019494', 'W11019494', 'UTIHCPHY', 'Canyon View Orthopedics & Podiatry Associates ', 'Cameron', 'G', 'Peterson', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'o', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-07-15', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164604765', 0, 'n', 0, '2009-08-06', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W11019495', 'W11019495', 'UTIHCPHY', 'Utah Heart', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019496', 'W11019496', 'UTIHCPHY', 'Utah Heart', 'Mandy', 'L', 'Snyder', 'APRN', 'Cardiovascular Disease', 'Family Practice', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Summit', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336394501', 0, 'N', 0, '2010-06-28', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019497', 'W11019497', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'Matthew', 'B', 'Sperry', 'MD', 'Pulmonary', 'Internal Medicine', NULL, NULL, 'o', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871773168', 0, 'n', 0, '2009-08-06', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W11019498', 'W11019498', 'UTIHCPHY', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11019499', 'W11019499', 'UTIHCPHY', 'Utah Heart', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019500', 'W11019500', 'UTIHCPHY', 'Bountiful Clinic', 'Tyler', 'Ray', 'Williams', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'o', '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073798377', 0, 'n', 0, '2009-08-06', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W11019501', 'W11019501', 'UTIHCPHY', 'Utah Heart', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', '2012-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019502', 'W11019502', 'UTPEHP', 'Utah Heart', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'n', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019503', 'W11019503', 'UTPEHP', 'Dixie Hospitalists', 'Benjamin', NULL, 'Casillas', 'MD', 'Family Practice', 'Hospitalist', NULL, NULL, 'o', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-20', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578739835', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019504', 'W11019504', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Michael', 'R', 'Francis', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-13', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104093996', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019505', 'W11019505', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Nathan', 'William', 'Hanson', 'MD', 'Dermatology', '', '', NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407048515', 0, 'n', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019506', 'W11019506', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Derrick', 'S', 'Haslem', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', NULL, 'o', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1730389701', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019507', 'W11019507', 'UTPEHP', 'Utah Heart', 'Gary', 'D', 'Hood', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'o', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-08-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306022603', 0, 'n', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019508', 'W11019508', 'UTPEHP', 'Utah Heart', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019509', 'W11019509', 'UTPEHP', 'Southwest Neurology Associates', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'o', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', NULL, '652 S Medical Center Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-07-23', '2012-04-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019510', 'W11019510', 'UTPEHP', 'Utah Heart', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019511', 'W11019511', 'UTPEHP', 'Utah Heart', 'Rebecca', 'Lynn', 'McCollaum', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669658969', 0, 'N', 0, '2010-10-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019512', 'W11019512', 'UTPEHP', 'Utah Heart', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019513', 'W11019513', 'UTPEHP', 'Bear River Family Medicine', 'Todd', 'J', 'Miller', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, NULL, NULL, 'Box Elder', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780877191', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019514', 'W11019514', 'UTPEHP', 'Utah Heart', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019515', 'W11019515', 'UTPEHP', 'Southwest Spine & Pain Center', 'Jon', 'B', 'Obray', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'o', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', NULL, '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-07-21', '2011-09-10', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1205814803', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019516', 'W11019516', 'UTPEHP', 'Utah Heart', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019517', 'W11019517', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates ', 'Cameron', 'G', 'Peterson', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'o', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-15', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164604765', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019518', 'W11019518', 'UTPEHP', 'Utah Heart', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019519', 'W11019519', 'UTPEHP', 'Utah Heart', 'Mandy', 'L', 'Snyder', 'APRN', 'Cardiovascular Disease', 'Family Practice', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336394501', 0, 'N', 0, '2010-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019520', 'W11019520', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Matthew', 'B', 'Sperry', 'MD', 'Pulmonary', 'Internal Medicine', NULL, NULL, 'o', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871773168', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019521', 'W11019521', 'UTPEHP', 'Utah Heart', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019522', 'W11019522', 'UTPEHP', 'Utah Heart', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019523', 'W11019523', 'UTPEHP', 'Bountiful Clinic', 'Tyler', 'Ray', 'Williams', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'o', '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073798377', 0, 'n', 0, '2009-08-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019524', 'W11019524', 'UTPEHP', 'Utah Heart', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'o', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11019525', 'W11019525', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'Sheri', 'W', 'Malakhova', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-08-10', '2009-12-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164465417', 0, 'Y', 0, '2009-08-07', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820477852', 'W11019526', 'W11019526', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'Michael', 'B', 'Wells', 'DO', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-08-10', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114909579', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('331078261', 'W11019528', 'W11019528', 'ID01', 'Saint Alphonsus Coughlin Clinic', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-08-05', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'n', 0, '2014-01-06', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820477852', 'W11019529', 'W11019529', 'ID01', 'Saint Alphonsus Medical Group Womens Health', 'William', 'T', 'Madland', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'o', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2009-08-05', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487742151', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('942854057', 'W11019530', 'W11019530', 'UTIHC04', 'Center for Counseling', 'John', 'E', 'Clift', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-08-01', '2011-08-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649293408', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('262199004', 'W11019537', 'W11019537', 'TX01', 'Northeast Internal Medicine Associates', 'Randy', 'N', 'Bergman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', NULL, '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-04-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1457401101', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019547', 'W11019547', 'UTMH1', 'Axis-One Inc', 'June', 'C', 'Singletary', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '8014757464', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '8014757464', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396891420', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('742591869', 'W11019531', 'W11019531', 'TX01', 'Women Partners in OBGYN', 'Susan', 'P', 'Novak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2109461300', NULL, '502 Madison Oak Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2109461300', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-15', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720075021', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('742591869', 'W11019532', 'W11019532', 'TX01', 'Women Partners in OBGYN', 'Susan', 'P', 'Novak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Baptist Health Dr Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2109461300', NULL, '5000 Baptist Health Dr Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2109461300', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-15', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720075021', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5978, -98.2751, NULL, NULL),
('870524176', 'W11019533', 'W11019533', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11019534', 'W11019534', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019653759', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019653759', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019535', 'W11019535', 'UTMH1', 'LDS Family Services', 'Mark', 'T', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588716039', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W11019536', 'W11019536', 'UT01', 'South Summit Ambulance', NULL, NULL, 'South Summit Ambulance', 'Group', NULL, NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529502', '          ', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529502', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008835', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('262199004', 'W11019538', 'W11019538', 'TX01', 'Northeast Internal Medicine Associates', 'Barbara', 'J', 'Forseth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', NULL, '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-04-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1114077161', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('262199004', 'W11019539', 'W11019539', 'TX01', 'Northeast Internal Medicine Associates', 'Heine', NULL, 'Ruiz', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', NULL, '12602 Toepperwein', 'San Antonio', 'Bexar', 'TX', '78233', NULL, NULL, 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-04-01', '2010-06-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962553255', 0, 'N', 0, '2009-08-11', NULL, NULL, 0, 0, NULL, NULL),
('262199004', 'W11019540', 'W11019540', 'TX01', 'Northeast Internal Medicine Associates', 'Harmeet', 'S', 'Mangat', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', NULL, '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-04-01', '2012-08-19', 0, 0, 0, 'Baptist Beaumont Hospital', '', '', '', 'HCFA|UB|', '1992856272', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('262199004', 'W11019541', 'W11019541', 'TX01', 'Northeast Internal Medicine Associates', 'Randall', 'M', 'Vanover', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '12602 Toepperwein Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106509669', NULL, '12602 Toepperwein', 'San Antonio', 'Bexar', 'TX', '78233', NULL, NULL, 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-04-01', '2009-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009420', 0, 'N', 0, '2009-08-11', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019542', 'W11019542', 'UT01', 'Jordan Valley Hospital', 'Brittany', 'A', 'Hixon', 'MD', 'Internal Medicine', 'Pulmonary', 'Critical Care', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015618888', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015618888', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538342209', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('261555983', 'W11019543', 'W11019543', 'UT01', 'Promontory Family Vision', 'Michael', 'M', 'Judkins', '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', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699774026', 0, 'n', 0, '2014-02-19', NULL, NULL, 41.1349, -112.064, NULL, NULL),
('261555983', 'W11019544', 'W11019544', 'UT01', 'Promontory Family Vision', 'Michael', 'M', 'Judkins', 'OD', 'Optometry', '', '', NULL, 'O', '5331 S Adams Ave Ste B', 'Ogden', 'Weber', 'UT', '84405', '8014797850', NULL, '5331 S Adams Ave Ste B', 'Ogden', 'Weber', 'UT', '84405', '8014797850', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699774026', 0, 'n', 0, '2011-10-05', NULL, NULL, 41.1665, -111.969, NULL, NULL),
('262257669', 'W11019545', 'W11019545', 'UT01', 'Rocky Mountain Allergy', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '1660 W Antelope Dr Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017759800', NULL, '1660 W Antelope Dr Ste 310', 'Layton', 'Davis', 'UT', '84041', '8017759800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2009-08-15', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'n', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W11019546', 'W11019546', 'UT01', 'Rocky Mountain Allergy', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8017759800', NULL, 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8017759800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2009-08-15', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'Y', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019548', 'W11019548', 'UTMH1', 'Axis-One Inc', 'B', 'S', 'Harmon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700882172', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019549', 'W11019549', 'UTMH1', 'Axis-One Inc', 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019550', 'W11019550', 'UTMH1', 'Axis-One Inc', 'Paula', '', 'Sever', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154300234', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019551', 'W11019551', 'UTMH1', 'Axis-One Inc', 'Scott', 'M', 'Howes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811928526', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019552', 'W11019552', 'UTMH1', 'Axis-One Inc', 'Blake', 'T', 'Halliday', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2009-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710068473', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11019553', 'W11019553', 'UTMH1', 'Axis-One Inc', 'Theresa', 'S', 'Kay', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', NULL, '810 S 100 W', 'Logan', 'Cache', 'UT', '84321', '4357539545', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053466169', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019554', 'W11019554', 'UT01', 'Pioneer Valley Hospital Hospitalist', 'Geetha', '', 'Nallamothu', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-06', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144496019', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019555', 'W11019555', 'UT01', NULL, 'Merium', 'K', 'Saidi', 'MD', 'Pediatrics', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643492', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643492', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-15', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336314145', 0, 'y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019556', 'W11019556', 'UT01', NULL, 'Merium', 'K', 'Saidi', 'MD', 'Pediatrics', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 205', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643492', NULL, '4052 W Pioneer Pkwy Ste 205', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643492', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-15', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336314145', 0, 'N', 0, '2013-04-26', NULL, NULL, 40.6985, -111.988, NULL, NULL),
('942854057', 'W11019557', 'W11019557', 'UTIHC04', 'Dixie Regional Medical Center', 'Robert', 'N', 'Bertoldo', 'DO', 'Hyperbaric Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356886868', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356886868', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275509176', 0, 'N', 0, '2009-08-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019597', 'W11019597', 'UTPEHP', 'Utah Valley Hospitalists', 'Glenn', 'K', 'Schemmer', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '1034 N 500 W Ste E388', 'Provo', 'Utah', 'UT', '84604', '8013577850', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689628992', 0, 'Y', 0, '2009-08-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019558', 'W11019558', 'UTIHC04', 'Primary Childrens Medical Center', 'Jason', 'M', 'Blocksom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2010-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144488495', 0, 'N', 0, '2010-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019559', 'W11019559', 'UTIHC04', 'Sleep Medicine Department', 'Mark', 'C', 'Boyer', 'NP', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', NULL, '652 S Medical Center Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-22', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093812604', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W11019560', 'W11019560', 'UTIHC04', 'Sevier Valley Medical Center', 'Ronald', 'H', 'Crouch', 'MD', 'Urology', '', '', NULL, 'O', '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2010-08-19', 0, 0, 0, 'Valley View Medical Center', 'Dixie Regional Medical Center', '', '', 'HCFA|UB|', '1952342248', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019561', 'W11019561', 'UTIHC04', 'Logan Regional Hospital', 'James', 'W', 'Davis', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '500 E 1400 N', 'North Logan', 'Cache', 'UT', '84341', '4357161000', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801878095', 0, 'N', 0, '2009-08-10', NULL, NULL, 41.7574, -111.822, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W11019562', 'W11019562', 'UTIHC04', 'Colorectal / Spina Bifida', 'Catherine', 'R', 'DeVries', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310731', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11019563', 'W11019563', 'UTIHC04', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019564', 'W11019564', 'UTIHC04', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019565', 'W11019565', 'UTIHC04', 'Park City Medical Center', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019566', 'W11019566', 'UTIHC04', 'Colorectal / Spina Bifida', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11019567', 'W11019567', 'UTIHC04', 'Dixie Regional Medical Center', 'Lewis', 'D', 'Taub', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730102963', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019568', 'W11019568', 'UTIHC01', 'Dixie Regional Medical Center', 'Robert', 'N', 'Bertoldo', 'DO', 'Hyperbaric Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356886868', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356886868', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275509176', 0, 'N', 0, '2009-08-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019569', 'W11019569', 'UTIHC01', 'Primary Childrens Medical Center', 'Jason', 'M', 'Blocksom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2010-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144488495', 0, 'N', 0, '2010-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019570', 'W11019570', 'UTIHC01', 'Sleep Medicine Department', 'Mark', 'C', 'Boyer', 'NP', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', NULL, '652 S Medical Center Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-22', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093812604', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019571', 'W11019571', 'UTIHC01', 'Sevier Valley Medical Center', 'Ronald', 'H', 'Crouch', 'MD', 'Urology', '', '', NULL, 'O', '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2010-08-19', 0, 0, 0, 'Valley View Medical Center', 'Dixie Regional Medical Center', '', '', 'HCFA|UB|', '1952342248', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019572', 'W11019572', 'UTIHC01', 'Logan Regional Hospital', 'James', 'W', 'Davis', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '500 E 1400 N', 'North Logan', 'Cache', 'UT', '84341', '4357161000', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-07-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801878095', 0, 'N', 0, '2009-08-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019573', 'W11019573', 'UTIHC01', 'Primary Childrens Medical Center', 'Catherine', 'R', 'DeVries', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310731', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019574', 'W11019574', 'UTIHC01', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019575', 'W11019575', 'UTIHC01', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019576', 'W11019576', 'UTIHC01', 'Park City Medical Center', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019577', 'W11019577', 'UTIHC01', 'Primary Childrens Medical Center', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2013-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019578', 'W11019578', 'UTIHC01', 'Dixie Regional Medical Center', 'Lewis', 'D', 'Taub', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730102963', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019579', 'W11019579', 'UTIHC03', 'Dixie Regional Medical Center', 'Robert', 'N', 'Bertoldo', 'DO', 'Hyperbaric Medicine', NULL, NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356886868', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275509176', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019580', 'W11019580', 'UTIHC03', 'Primary Childrens Medical Center', 'Jason', 'M', 'Blocksom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2010-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144488495', 0, 'N', 0, '2010-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019581', 'W11019581', 'UTIHC03', 'Sleep Medicine Department', 'Mark', 'C', 'Boyer', 'NP', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', NULL, '652 S Medical Center Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-22', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093812604', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019582', 'W11019582', 'UTIHC03', 'Primary Childrens Medical Center', 'Catherine', 'R', 'DeVries', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310731', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019583', 'W11019583', 'UTIHC03', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019584', 'W11019584', 'UTIHC03', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019585', 'W11019585', 'UTIHC03', 'Park City Medical Center', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019586', 'W11019586', 'UTIHC03', 'Primary Childrens Medical Center', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2013-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019587', 'W11019587', 'UTIHC03', 'Dixie Regional Medical Center', 'Lewis', 'D', 'Taub', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84770', '4352512600', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730102963', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019588', 'W11019588', 'UTIHC02', 'Primary Childrens Medical Center', 'Jason', 'M', 'Blocksom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2010-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144488495', 0, 'N', 0, '2010-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019589', 'W11019589', 'UTIHC02', 'Primary Childrens Medical Center', 'Catherine', 'R', 'DeVries', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310731', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019590', 'W11019590', 'UTIHC02', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019591', 'W11019591', 'UTIHC02', 'Primary Childrens Medical Center', 'Francis', 'M', 'Filloux', 'MD', 'Pediatric Neurology', 'Neurology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625691', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942389515', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019592', 'W11019592', 'UTIHC02', 'Park City Medical Center', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019593', 'W11019593', 'UTIHC02', 'Primary Childrens Medical Center', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-01', '2013-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('830249721', 'W11019594', 'W11019594', 'WY01', 'Johnson County Hospital District', '', '', 'Johnson County Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', '', '', NULL, NULL, '0.00', '5.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006978', 0, 'n', 0, '2011-08-23', NULL, NULL, 44.3496, -106.705, NULL, NULL),
('870284475', 'W11019595', 'W11019595', 'UT01', 'Granger Medical Clinic', 'Robert', 'G', 'Parker', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699865212', 0, 'Y', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11019596', 'W11019596', 'UT01', 'Granger Medical Clinic', 'Robert', 'G', 'Parker', 'DO', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699865212', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.682, -111.979, NULL, NULL),
('611572907', 'W11019608', 'W11019608', 'UT01', 'Mountain Star Medical Group', 'Nadya', 'P', 'Wayment', 'MD', 'Family Practice', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1821274655', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019598', 'W11019598', 'UT01', 'Jordan Family Health LLC', 'Joanne', '', 'Haeffele', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952326795', 0, 'y', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019599', 'W11019599', 'UT01', 'Jordan Family Health LLC', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019600', 'W11019600', 'UT01', 'Jordan Family Health LLC', 'Bari', 'M', 'King', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063445948', 0, 'y', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019601', 'W11019601', 'UT01', 'Jordan Family Health LLC', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019602', 'W11019602', 'UT01', 'Jordan Family Health LLC', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019603', 'W11019603', 'UT01', 'Jordan Family Health LLC', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019604', 'W11019604', 'UT01', 'Jordan Family Health LLC', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019605', 'W11019605', 'UT01', 'Jordan Family Health LLC', 'Bari', 'M', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063445948', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019606', 'W11019606', 'UT01', 'Jordan Family Health LLC', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11019607', 'W11019607', 'UT01', 'Jordan Family Health LLC', 'Joanne', '', 'Haeffele', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952326795', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11019610', 'W11019610', 'UT01', 'MountainStar Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11019609', 'W11019609', 'UT01', 'Mountain Star Medical Group', 'Nadya', 'P', 'Wayment', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1821274655', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11019611', 'W11019611', 'UT01', 'Mountain Star Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11019612', 'W11019612', 'UT01', 'Mountain Star Medical Group', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11019613', 'W11019613', 'UT01', 'Mountain Star Medical Group', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('270176336', 'W11019614', 'W11019614', 'UT01', '', 'Edward', 'Joe', 'Eyring', 'MD', 'Colon and Rectal Surgery', 'General Surgery', '', NULL, 'O', '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012653978', NULL, '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012653978', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-01', '2011-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427074582', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019615', 'W11019615', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Carol', 'S', 'Padgett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-10', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700080033', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11019616', 'W11019616', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Carol', 'S', 'Padgett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-10', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700080033', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019617', 'W11019617', 'UT01', 'Standard Optical', 'Stephen', 'C', 'Lewis', 'OD', 'Optometry', '', '', NULL, 'O', '1200 Provo Town Centre Ste 1060', 'Provo', 'Utah', 'UT', '84601', '8013732254', NULL, '1200 Provo Town Centre Ste 1060', 'Provo', 'Utah', 'UT', '84601', '8013732254', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184653818', 0, 'n', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019618', 'W11019618', 'UT01', 'Standard Optical', 'Stephen', 'C', 'Lewis', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184653818', 0, 'y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019619', 'W11019619', 'UT01', 'Standard Optical', 'William', 'C', 'Poulter', 'OD', 'Optometry', '', '', NULL, 'O', '196 E 2000 N Ste 101', 'Tooele', 'Tooele', 'UT', '84074', '4358824815', NULL, '196 E 2000 N Ste 101', 'Tooele', 'Tooele', 'UT', '84074', '4358824815', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-15', '2009-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932360690', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019620', 'W11019620', 'UT01', 'Standard Optical', 'William', 'C', 'Poulter', 'OD', 'Optometry', '', '', NULL, 'B', '1901 West Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 West Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-15', '2009-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932360690', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W11019621', 'W11019621', 'TX01', 'Gastroenterology Consultants of San Antonio', 'James', 'F', 'Jackson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2105828000', NULL, '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2105828000', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2009-08-14', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1730115528', 0, 'N', 0, '2012-05-18', NULL, NULL, 29.6127, -98.4809, NULL, NULL),
('741967809', 'W11019622', 'W11019622', 'TX01', 'Gastroenterology Consultants of San Antonio', 'James', 'F', 'Jackson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2009-08-14', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1730115528', 0, 'N', 0, '2012-05-18', NULL, NULL, 29.5159, -98.5758, NULL, NULL),
('522229954', 'W11019623', 'W11019623', 'UT01', 'Herriman Physical Therapy', 'Matthew', 'Philip', 'Sudweeks', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861627937', 0, 'N', 0, '2011-10-31', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019624', 'W11019624', 'UT01', 'Hand & Ortho Murray', 'Aaron', 'Jeremy', 'Lowry', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-07-01', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407010283', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019625', 'W11019625', 'UT01', 'Fast Track Physical Therapy & Sports', 'George', 'A', 'Shirley', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '6717 S 900 E Ste 201', 'Midvale', 'Salt Lake', 'UT', '84047', '8016494690', '8019844011', '6717 S 900 E Ste 201', 'Midvale', 'Salt Lake', 'UT', '84047', '8016494690', '8019844011', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942287040', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019626', 'W11019626', 'UT01', 'Precision Rehabilitation Inc. Blanding', 'Kathleen', '', 'Aldous', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-06', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366630774', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019627', 'W11019627', 'UT01', 'Precision Rehabilitation Inc. Blanding', 'Alan', 'Kenneth', 'Ward', 'PT', 'Physical Therapy', 'Occupational Therapy', NULL, NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-06', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965817', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019628', 'W11019628', 'UT01', 'Precision Rehabilitation Inc. Blanding', 'Richard', 'T', 'Ward', 'PT', 'Physical Therapy', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783869', '4356782326', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-06', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144223413', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019629', 'W11019629', 'UT01', 'Sports Med Brigham City', 'Roger', 'L', 'Colvin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '990 S Medical Dr U4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', '990 S Medical Dr U4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236487', '4357236490', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-07-06', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740390988', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11019630', 'W11019630', 'UT01', 'Blackfoot Physical Therapy', 'Ryan', 'Bosworth', 'Hurst', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '285 W Francis', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850123', NULL, '285 W Francis', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850123', '0         ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-06-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548429087', 0, 'N', 0, '2011-05-31', NULL, NULL, 0, 0, NULL, NULL),
('264572055', 'W11019631', 'W11019631', 'UT01', 'Old Farm OB/GYN', 'Spencer', 'P', 'Barney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', NULL, '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-28', '2011-04-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982839130', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('264790440', 'W11019632', 'W11019632', 'UT01', 'Old Farm OBGYN/', 'Erica', 'A', 'Faircloth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', NULL, '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-28', '2011-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1700011954', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W11019633', 'W11019633', 'UT01', 'University Health Care', 'Howard', 'J', 'Williams', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-10-02', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962602474', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W11019634', 'W11019634', 'UT01', 'U-U Rheumatology Division', 'Howard', 'J', 'Williams', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '          ', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-10-02', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962602474', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019635', 'W11019635', 'WYBILLINGS', 'Billings Clinic - GYN Oncology', 'Gerard', 'P', 'Connor', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382394', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382394', '', '', '', '0.00', '17.00', '0.00', 3, '2009-06-25', '2010-03-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669470274', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019636', 'W11019636', 'UT01', 'University Health Care', 'Zach', 'M', 'Beresford', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '          ', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922282458', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019637', 'W11019637', 'UT01', 'UUMC Rehab Medicine', 'Zach', 'M', 'Beresford', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', NULL, 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922282458', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W11019638', 'W11019638', 'UT01', 'University Health Care', 'Jessica', 'A', 'Walsh', 'MD', 'Rheumatology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814333', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814333', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467465401', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W11019639', 'W11019639', 'UT01', 'U-U Rheumatology Division', 'Jessica', 'A', 'Walsh', 'MD', 'Rheumatology', '', '', 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, '2009-07-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467465401', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11019640', 'W11019640', 'UT01', 'University Health Care', 'Michael', 'G', 'Henderson', 'PA-C', 'Emergency Medicine', 'Physician Assistant', 'Neurosurgery', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015857575', '8015814385', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015857575', '8015814385', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-21', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265423594', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11019641', 'W11019641', 'UT01', 'University Neurosurgery Associates', 'Michael', 'G', 'Henderson', 'PA-C', 'Emergency Medicine', 'Physician Assistant', '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', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-05-21', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265423594', 0, 'y', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019642', 'W11019642', 'UT01', 'University Health Care', 'Duncan', 'R', 'McGregor', 'MD', 'Nephrology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409483', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019643', 'W11019643', 'UT01', 'Division of Nephrology University of Utah', 'Duncan', 'R', 'McGregor', 'MD', 'Nephrology', '', '', 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, '2009-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409483', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11019644', 'W11019644', 'UT01', 'U Of U Dialysis Physicians', 'Duncan', 'R', 'McGregor', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409483', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('352275796', 'W11019645', 'W11019645', 'UT01', 'University of Utah Dialysis Center', 'Duncan', 'R', 'McGregor', 'MD', 'Nephrology', '', '', NULL, 'O', '3854 W 5400 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8015878578', '8019696816', '3854 W 5400 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8015878578', '8019696816', '', '', '', '0.00', '40.00', '0.00', 3, '2009-07-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409483', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542579', 'W11019646', 'W11019646', 'UT01', 'South Valley Dialysis Center', 'Duncan', 'R', 'McGregor', 'MD', 'Nephrology', '', '', NULL, 'O', '8750 Sandy Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338745', '8012338749', '8750 Sandy Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338745', '8012338749', '', '', '', '0.00', '40.00', '0.00', 3, '2009-07-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409483', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019647', 'W11019647', 'UT01', 'University Health Care', 'Janine', 'E', 'Morris', 'MD', 'Radiologist', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477766277', 0, 'N', 0, '2009-08-17', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019648', 'W11019648', 'UT01', 'University Radiology Associates', 'Janine', 'E', 'Morris', '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, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477766277', 0, 'N', 0, '2009-08-17', NULL, NULL, 0, 0, NULL, NULL),
('264312395', 'W11019649', 'W11019649', 'UT01', NULL, 'Ryan', '', 'Gilbert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', NULL, '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-10', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497930234', 0, 'n', 0, '2013-09-20', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('270003942', 'W11019650', 'W11019650', 'UT01', 'Nebo Vision Clinic', 'James', 'A', 'Cope', 'OD', 'Optometry', '', '', NULL, 'O', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358643243', '4356231671', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358643243', '4356231671', '', '', 'OPT01', '0.00', '35.00', '0.00', 3, '2009-07-01', '2011-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780611954', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('270003942', 'W11019651', 'W11019651', 'UT01', 'Nebo Vision Clinic', 'James', 'A', 'Cope', 'OD', 'Optometry', '', '', NULL, 'O', '48 S Main St', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', '48 S Main St', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', '', '', 'OPT01', '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780611954', 0, 'N', 0, '2013-11-15', NULL, NULL, 39.7056, -111.839, NULL, NULL),
('270003942', 'W11019652', 'W11019652', 'UT01', 'Nebo Vision Clinic', 'James', 'A', 'Cope', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 196', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', 'PO Box 196', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', '', '', 'OPT01', '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780611954', 0, 'Y', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870482687', 'W11019653', 'W11019653', 'UT01', 'Bear River Eye Center', 'Lynn', 'R', 'Purcell', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', NULL, 'PO Box 155', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '', '', NULL, 'OPT01', '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1013910397', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870482687', 'W11019654', 'W11019654', 'UT01', 'Bear River Eye Center', 'Lynn', 'R', 'Purcell', 'OD', 'Optometry', '', '', NULL, 'O', '495 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', NULL, '495 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577436', '', '', NULL, 'OPT01', '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1013910397', 0, 'N', 0, '2013-11-04', NULL, NULL, 41.7188, -112.175, NULL, NULL),
('870622942', 'W11019655', 'W11019655', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783993', NULL, '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783993', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 37.6098, -109.479, 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
('870524176', 'W11019656', 'W11019656', 'UTMH1', 'Comprehensive Psychological Services', 'Ryan', 'F', 'Houston', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2009-08-15', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811137318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11019657', 'W11019657', 'UTMH1', 'Comprehensive Psychological Services', 'Ryan', 'F', 'Houston', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2009-08-15', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811137318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W11019658', 'W11019658', 'ID02', 'Foothills Physical Therapy', 'James', 'D', 'Hammer', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-08-15', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245494269', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W11019659', 'W11019659', 'ID02', 'Foothills Physical Therapy', 'James', 'D', 'Hammer', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-08-15', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245494269', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('870347187', 'W11019660', 'W11019660', 'UT01', 'Utah Valley Eye Center', 'Michael', 'J', 'Lloyd', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', NULL, '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124239009', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('861078690', 'W11019661', 'W11019661', 'WY01', 'Absaroka Orthopedics', 'Jay', '', 'Winzenried', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '8775097100', NULL, '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '8775097100', '          ', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083603047', 0, 'Y', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('263541782', 'W11019662', 'W11019662', 'UT01', 'Ogden Pulmonary Associates', 'Julia', 'F', 'Whitaker', 'MD', 'Pulmonary', 'Critical Care', 'Internal Medicine', NULL, 'O', '4403 Harrison Blvd Ste 3815', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd Ste 3815', 'Ogden', 'Weber', 'UT', '84403', '8013872575', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003007', 0, 'N', 0, '2013-08-14', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('830216112', 'W11019663', 'W11019663', 'WY01', 'Lander Medical Clinic', 'Gentian', '', 'Scheer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912093667', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870583479', 'W11019664', 'W11019664', 'UT01', 'Phase II Center for Womens Health', 'Susan', 'R', 'Webb', 'NP', 'Gynecology', 'Family Practice', '', NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689777690', 0, 'N', 0, '2013-08-09', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870583479', 'W11019665', 'W11019665', 'UT01', 'Phase II Center for Womens Health', 'Holly', 'D', 'Stewart', 'NP', 'Family Practice', '', '', NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619160280', 0, 'N', 0, '2013-08-09', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870583479', 'W11019666', 'W11019666', 'UT01', 'Phase II Center for Womens Health', 'Elizabeth', 'N', 'Collins', 'FNP', 'Family Practice', '', '', NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326093436', 0, 'N', 0, '2013-08-09', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870583479', 'W11019667', 'W11019667', 'UT01', 'Phase II Center for Womens Health', 'Ronda', '', 'Lucey', 'NP', 'Family Practice', '', '', NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306902101', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870471677', 'W11019668', 'W11019668', 'UT01', 'Lone Peak Family Medicine', 'Breony', '', 'Stoddard', 'PA', 'Family Practice', '', '', NULL, 'O', '9829 S 1300 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015768855', NULL, '9829 S 1300 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015768855', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-09-23', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578711057', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870471677', 'W11019669', 'W11019669', 'UT01', 'South Valley Womens Health', 'Breony', '', 'Stoddard', 'PA', 'Family Practice', '', '', NULL, 'O', '3750 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', NULL, '3750 W 9000 S Ste 210', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-10-04', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578711057', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870471677', 'W11019670', 'W11019670', 'UT01', 'South Valley Womens Health', 'Breony', '', 'Stoddard', 'PA', 'Family Practice', '', '', NULL, 'B', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8015692626', NULL, '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8015692626', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-10-04', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578711057', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W11019671', 'W11019671', 'WY01', 'Lander Medical Clinic', 'Malachi', '', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1730275421', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('743066514', 'W11019672', 'W11019672', 'UTMH1', 'Integrity House', 'Ryan', 'R', 'Williams', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '465 W 1600 N', 'Cedar City', 'Iron', 'UT', '84720', '4355868336', NULL, '465 W 1600 N', 'Cedar City', 'Iron', 'UT', '84720', '4355868336', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730220971', 0, 'n', 0, '2013-01-14', NULL, NULL, 37.7062, -113.068, NULL, NULL),
('870639748', 'W11019673', 'W11019673', 'UT01', 'Hoopes Vision Correction Center', 'Renee', 'A', 'McIntosh', 'OD', 'Optometry', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2012-11-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003057894', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11019674', 'W11019674', 'UT01', 'Ogden Clinic', 'Dustin', 'A', 'Havey', 'PA', 'Pediatrics', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740416577', 0, 'y', 0, '2013-01-17', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('621801973', 'W11019675', 'W11019675', 'UT01', 'Comprehensive Neurology of Utah', 'Mohammad', '', 'Shoari', 'MD', 'Neurology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8013641117', NULL, '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8013641117', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-06-15', '2011-07-28', 0, 0, 0, 'Davis Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1740483395', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019676', 'W11019676', 'UT01', 'Comprehensive Neurology of Utah', 'Mary', 'Elena', 'James', 'MD', 'Neurology', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', NULL, '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710927975', 0, 'N', 0, '2011-10-04', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W11019677', 'W11019677', 'UT01', 'Comprehensive Neurology of Utah', 'Mohammad', '', 'Shoari', 'MD', 'Neurology', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', NULL, '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-06-15', NULL, 0, 0, 0, 'Davis Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1740483395', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('519211467', 'W11019678', 'W11019678', 'ID01', 'Life Counseling Center', 'Janelle', '', 'Stauffer-Boothby', 'LCSW', 'Mental Health', 'Social Worker', '', 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, '2009-08-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922247410', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019679', 'W11019679', 'UT01', 'Standard Optical', 'Ronald', 'S', 'Roper', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S Ste 64', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', NULL, '834 E 9400 S Ste 64', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2010-03-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447313416', 0, 'Y', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019680', 'W11019680', 'UT01', 'Standard Optical', 'Bernadette', 'N', 'Lynch', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2190 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014874138', NULL, '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014874138', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-18', '2010-04-09', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861640658', 0, 'N', 0, '2009-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019681', 'W11019681', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', NULL, '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'n', 0, '2013-06-04', NULL, NULL, 41.1734, -112.042, NULL, NULL),
('870179340', 'W11019686', 'W11019686', 'UT01', 'Standard Optical', 'Duane', 'C', 'Knowles', 'OD', 'Optometry', '', '', NULL, 'O', '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', NULL, '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306935523', 0, 'n', 0, '2013-07-11', NULL, NULL, 41.1734, -112.042, NULL, NULL),
('870179340', 'W11019682', 'W11019682', 'UT01', 'Standard Optical', 'Kendra', 'M', 'Halepaska', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '250 N Red Cliffs Dr Ste 7', 'Tooele', 'Tooele', 'UT', '84074', '4358824815', NULL, '1901 W Pkwy Blvd', 'Salt Lake City', 'Tooele', 'UT', '84119', '4358824815', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2009-08-15', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255575304', 0, 'N', 0, '2009-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019683', 'W11019683', 'UT01', 'Standard Optical', 'Curtis', 'S', 'Goodman', 'OD', 'Optometry', '', '', NULL, 'O', '4305 S Harrison Blvd Ste 9111', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4305 S Harrison Blvd Ste 9111', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2012-04-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497990642', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11019684', 'W11019684', 'UT01', 'Standard Optical', 'Michael', 'S', 'Marty', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497743942', 0, 'N', 0, '2013-03-26', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W11019685', 'W11019685', 'UT01', 'Standard Optical', 'Duane', 'G', 'Lund', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S Ste 64', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', NULL, '834 E 9400 S Ste 64', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2013-09-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932271244', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('262256160', 'W11019687', 'W11019687', 'UT01', 'Spectrum Eye Care', 'Ryan', 'S', 'Orgill', 'OD', 'Optometry', '', '', NULL, 'O', '225 W Main St Ste E', 'Grantsville', 'Tooele', 'UT', '84029', '4352490530', NULL, '225 W Main St Ste E', 'Grantsville', 'Tooele', 'UT', '84029', '4352490530', '          ', 'WUTALBERT5', '', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2009-08-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598962755', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W11019688', 'W11019688', 'UT01', 'Heart and Lung Institute', 'Jason', 'L', 'Davis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', NULL, '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-11-08', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861502783', 0, 'N', 0, '2009-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W11019689', 'W11019689', 'UT01', 'Heart and Lung Institute', 'Jason', 'L', 'Davis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2010-11-08', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861502783', 0, 'N', 0, '2009-08-20', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W11019690', 'W11019690', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Matthew', 'E', 'Dahl', 'MD', 'Ear, Nose and Throat', 'Neck Surgery', '', NULL, 'O', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', NULL, '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679666556', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.7689, -111.865, NULL, NULL),
('680562677', 'W11019691', 'W11019691', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Matthew', 'E', 'Dahl', 'MD', 'Ear, Nose and Throat', 'Neck Surgery', '', NULL, 'O', '7138 S 2000 E Ste 217', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013282522', NULL, '7138 S 2000 E Ste 217', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013282522', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679666556', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870284475', 'W11019692', 'W11019692', 'UT01', 'Granger Medical Clinic', 'Saudamini', '', 'Wadwekar', 'MD', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962613471', 0, 'N', 0, '2011-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11019693', 'W11019693', 'UT01', 'Granger Medical Clinic', 'Saudamini', '', 'Wadwekar', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653479', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653479', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962613471', 0, 'N', 0, '2011-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W11019694', 'W11019694', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', NULL, '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, 'N', 0, '2013-01-03', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('870373083', 'W11019695', 'W11019695', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, 'N', 0, '2013-01-03', NULL, NULL, 40.588, -111.975, NULL, NULL),
('202630141', 'W11019696', 'W11019696', 'ID02', 'Primary Health Medical Group', 'Gary', 'A', 'Luken', 'MD', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', NULL, '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-08-15', '2010-01-22', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760499412', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6199, -116.379, NULL, NULL),
('954893928', 'W11019697', 'W11019697', 'UT01', 'Exodus Healthcare Network', 'Carol', 'F', 'Rasmussen', 'FNP', 'Family Practice', '', '', NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-08-15', '2011-09-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1245397637', 0, 'N', 0, '2013-07-16', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W11019698', 'W11019698', 'WY01', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'n', 0, '2012-07-18', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('870479370', 'W11019699', 'W11019699', 'UT01', 'Mountain West Cardiovascular Associates', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', NULL, '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'W11019700', 'W11019700', 'UT01', 'Mountain West Cardiovascular Associates', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', NULL, '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('830216112', 'W11019701', 'W11019701', 'WY01', 'Lander Medical Clinic', 'Karla', '', 'Wagner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1942395652', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W11019715', 'W11019715', 'TX01', 'Health Texas Medical Group of San Antonio', '', '', 'Health Texas Medical Group of San Antonio', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006634', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019726', 'W11019726', 'UT01', 'University Health Care', 'Brent', 'D', 'Wilson', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831121938', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W11019702', 'W11019702', 'WY01', 'Sheridan Orthopaedic Assoc', 'Jeremy', 'P', 'Zebroski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-08-15', '2012-02-12', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497840318', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W11019703', 'W11019703', 'WY01', 'Sheridan Orthopaedic Assoc', 'Brian', '', 'Laman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-08-15', '2012-02-12', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396794152', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('200743054', 'W11019704', 'W11019704', 'UT01', 'Blue Mountain Hospital', NULL, NULL, 'Blue Mountain Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783993', NULL, NULL, NULL, 'San Juan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2009-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558513812', 0, 'n', 0, '2009-08-21', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('200743054', 'W11019705', 'W11019705', 'UT01', 'Blue Mountain Hospital', NULL, NULL, 'Blue Mountain Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 67', 'Sauk Rapids', 'Benton', 'MN', '56379', '4356784794', NULL, NULL, NULL, 'Benton', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2009-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558513812', 0, 'y', 0, '2009-08-21', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W11019706', 'W11019706', 'UTMH1', 'Alpine Center for Personal Growth', 'Michael', 'C', 'Desjardins', 'APRN', 'Mental Health', 'Adult Psychiatric Nurse Practitioner', 'Psychiatry', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', NULL, '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '          ', 'UTARNP', '', '', '0.00', '35.00', '0.00', 6, '2009-08-24', '2013-02-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801924766', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019707', 'W11019707', 'UTMH1', 'Valley Mental Health  Inc', 'Emily', NULL, 'Duffin', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033340674', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019708', 'W11019708', 'UTMH1', 'Valley Mental Health  Inc', 'Amanda', 'R', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386826030', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019709', 'W11019709', 'UTMH1', 'Valley Mental Health  Inc', 'Melanie', 'M', 'Jones', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225148372', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019710', 'W11019710', 'UTMH1', 'Valley Mental Health  Inc', 'Angela', NULL, 'Bowman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225000417', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019711', 'W11019711', 'UTMH1', 'Valley Mental Health  Inc', 'Amy', 'L', 'Fehlberg', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619108057', 0, 'Y', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019712', 'W11019712', 'UTMH1', 'Valley Mental Health  Inc', 'L', 'Dawn', 'Benson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124224043', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019713', 'W11019713', 'UTMH1', 'Valley Mental Health  Inc', 'Summer', 'L', 'Barnes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083844690', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11019714', 'W11019714', 'UTMH1', 'Valley Mental Health  Inc', 'Benjamin', 'T', 'Thatcher', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-20', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0184131095', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('030525123', 'W11019716', 'W11019716', 'UTMH1', '', 'Erin', 'E', 'Vasquez', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013778222', NULL, '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013778222', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-08-25', '2010-04-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003875725', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870626387', 'W11019717', 'W11019717', 'UTMH1', 'Comprehensive Treatment Clinic', 'A', 'T', 'Freestone', 'PSYD, LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', NULL, '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-08-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265556401', 0, 'n', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870626387', 'W11019718', 'W11019718', 'UTMH1', 'Comprehensive Treatment Clinic', 'Carl', 'J', 'Sorenson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', NULL, '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-08-26', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033349659', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('518476736', 'W11019719', 'W11019719', 'UTMH1', 'The Family Life Therapy Center', 'Brian', 'L', 'Parker', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1173 S 250 W Ste 203', 'St George', 'Washington', 'UT', '84770', '4356528585', NULL, '1173 S 250 W Ste 203', 'St George', 'Washington', 'UT', '84770', '4356528585', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-08-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962686105', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11019720', 'W11019720', 'UTMH1', 'Family Support & Treatment Center', 'Nevin', 'G', 'Alderman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013143668', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019721', 'W11019721', 'UT01', 'University Health Care', 'Brian', NULL, 'Snow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053536425', 0, 'N', 0, '2009-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019722', 'W11019722', 'UT01', 'University Health Care', 'Brian', NULL, 'Snow', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053536425', 0, 'N', 0, '2009-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11019723', 'W11019723', 'ID02', NULL, 'Wendell', NULL, 'Nelson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1012 12th Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084669249', NULL, '867 E 9400 S', 'Sandy', 'Canyon', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-06-19', '2010-10-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497785679', 0, 'N', 0, '2009-08-24', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11019724', 'W11019724', 'UT01', 'University Health Care', 'Christopher', 'A', 'Naun', 'MD', 'Pediatrics', 'Pediatric Critical Care', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215101936', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11019725', 'W11019725', 'UT01', 'University Health Care', 'Christopher', 'A', 'Naun', 'MD', 'Pediatrics', 'Pediatric Critical Care', '', 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, '2009-07-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215101936', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019727', 'W11019727', 'UT01', 'University Radiology Associates', 'Brent', 'D', 'Wilson', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', 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, '2009-08-03', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831121938', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019728', 'W11019728', 'UT01', 'University Radiology Associates', 'Brent', 'D', 'Wilson', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817533', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817533', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831121938', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019729', 'W11019729', 'UT01', 'University Radiology Associates', 'Jack', 'H', 'Morshedzadeh', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', 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, '2009-08-10', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381447', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11019730', 'W11019730', 'UT01', 'University Radiology Associates', 'Jack', 'H', 'Morshedzadeh', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '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, '2009-08-10', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381447', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019731', 'W11019731', 'UT01', 'U-U Cardiology Division', 'Jack', 'H', 'Morshedzadeh', 'MD', 'Cardiovascular Disease', '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', '', '0.00', '25.00', '0.00', 3, '2009-08-10', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381447', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019732', 'W11019732', 'UT01', 'University Health Care', 'Jack', 'H', 'Morshedzadeh', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-10', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381447', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019733', 'W11019733', 'UT01', 'University Health Care', 'Jack', 'H', 'Morshedzadeh', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139910', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139910', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-10', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381447', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019734', 'W11019734', 'UT01', 'University Health Care', 'Mark', 'T', 'Evans', 'PA', 'Family Practice', '', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-04', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861606154', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019735', 'W11019735', 'UT01', 'University Health Care', 'Mark', 'T', 'Evans', 'PA', 'Family Practice', '', '', 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', '', '0.00', '35.00', '0.00', 6, '2009-08-04', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861606154', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019736', 'W11019736', 'UT01', 'University Health Care', 'Sunil', NULL, 'Sharma', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', 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', '', '0.00', '25.00', '0.00', 3, '2009-08-11', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699775767', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019737', 'W11019737', 'UT01', 'University Health Care', 'Sunil', NULL, 'Sharma', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', 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', '', '0.00', '25.00', '0.00', 3, '2009-08-11', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699775767', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11019738', 'W11019738', 'UT01', 'University Health Care', 'Richard', 'D', 'King', 'MD', 'Neurology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093830572', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11019739', 'W11019739', 'UT01', 'University Health Care', 'Richard', 'D', 'King', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093830572', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019740', 'W11019740', 'UT01', 'University Health Care', 'Clint', 'D', 'Barnett', 'MD', 'Orthopedic Surgery', '', '', NULL, 'o', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164453916', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019741', 'W11019741', 'UT01', 'University Health Care', 'Clint', 'D', 'Barnett', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2010-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164453916', 0, 'N', 0, '2009-08-25', NULL, NULL, 0, 0, NULL, NULL),
('743134251', 'W11019742', 'W11019742', 'UT01', 'University Health Care', 'Steven', 'S', 'Wu', 'MD', 'Pediatric Gastroenterology', '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, '2009-08-14', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0102311743', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134251', 'W11019743', 'W11019743', 'UT01', 'University Health Care', 'Steven', 'S', 'Wu', 'MD', 'Pediatric Gastroenterology', 'Pediatrics', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622912', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622912', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-08-14', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0102311743', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W11019744', 'W11019744', 'UT01', 'U-U Dermatology Division', 'Mark', 'J', 'Eliason', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', NULL, 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891990156', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W11019745', 'W11019745', 'UT01', 'University Health Care', 'Mark', 'J', 'Eliason', 'MD', 'Dermatology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891990156', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019746', 'W11019746', 'UT01', 'ARUP Pathology Associates', 'Rosemary', 'C', 'Bender', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-12', '2010-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548411259', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11019747', 'W11019747', 'UT01', 'University Pathology Associates', 'Rosemary', 'C', 'Bender', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-12', '2010-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548411259', 0, 'N', 0, '2012-03-06', 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
('870659348', 'W11019748', 'W11019748', 'UT01', 'University Pathology Associates', 'Rosemary', 'C', 'Bender', 'MD', 'Pathology', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-12', '2010-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548411259', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019749', 'W11019749', 'UT01', 'University Health Care', 'Rosemary', 'C', 'Bender', 'MD', 'Pathology', '', '', NULL, 'B', '500 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', NULL, '500 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-12', '2010-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548411259', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019750', 'W11019750', 'UT01', 'University Health Care', 'Keri', 'L', 'Gibson', 'MD', 'Obstetrics and Gynecology', '', '', 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', '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457548430', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019751', 'W11019751', 'UT01', 'University Health Care', 'Keri', 'L', 'Gibson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457548430', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019752', 'W11019752', 'UT01', 'University Health Care', 'Kenneth', 'F', 'Grossmann', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', 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', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083827455', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11019753', 'W11019753', 'UT01', 'University Health Care', 'Kenneth', 'F', 'Grossmann', 'MD', 'Hematology and Oncology', 'Internal Medicine', 'Oncology', 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', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083827455', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11019754', 'W11019754', 'UT01', 'U Dept of Family & Preventative Medicine', 'Karly', 'A', 'Pippitt', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619155637', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11019755', 'W11019755', 'UT01', 'University Health Care', 'Karly', 'A', 'Pippitt', 'MD', 'Family Practice', '', '', NULL, 'O', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-03', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619155637', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019756', 'W11019756', 'UT01', 'U-U Cardiology Division', 'LeeAnn', NULL, 'Spencer', 'APRN', 'Cardiovascular Disease', '', '', 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', '', '0.00', '25.00', '0.00', 3, '2009-08-04', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508009226', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11019757', 'W11019757', 'UT01', 'University Health Care', 'LeeAnn', NULL, 'Spencer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-04', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508009226', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019758', 'W11019758', 'UT01', 'University of Utah Orthopedic Consultants', 'Brandon', 'D', 'Lawrence', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2010-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659555670', 0, 'N', 0, '2010-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11019759', 'W11019759', 'UT01', 'University Health Care', 'Brandon', 'D', 'Lawrence', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659555670', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11019760', 'W11019760', 'UT01', 'University Pathology Associates', 'Barbara', 'E', 'Chadwick', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521734', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11019761', 'W11019761', 'UT01', 'University Health Care', 'Barbara', 'E', 'Chadwick', 'MD', 'Pathology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521734', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11019762', 'W11019762', 'WYBILLINGS', 'Sheridan Memorial Hospital ', 'Alan', NULL, 'Thometz', 'DO', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1333 W 5h St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721083', NULL, NULL, NULL, 'Sheridan', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000013015', 0, 'N', 0, '2009-08-28', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019763', 'W11019763', 'UT01', 'ARUP Pathology Associates', 'Barbara', 'E', 'Chadwick', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521734', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019764', 'W11019764', 'UT01', 'University Health Care', 'Barbara', 'E', 'Chadwick', 'MD', 'Pathology', '', '', NULL, 'O', '500 S Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', NULL, '500 S Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521734', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('841488548', 'W11019765', 'W11019765', 'UTPEHP', 'Western Colorado Lung Center', 'Stephan', '', 'Lillard', 'MD', 'Pulmonary', 'Critical Care', '', NULL, 'O', '1050 Wellington Ave', 'Grand Junction', 'Mesa', 'CO', '81501', '9702454810', '          ', '1050 Wellington Ave', 'Grand Junction', 'Mesa', 'CO', '81501', '9702454810', '          ', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2009-08-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285625749', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019766', 'W11019766', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', NULL, '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-18', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952556235', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'W11019767', 'W11019767', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', NULL, '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-18', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952556235', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'W11019768', 'W11019768', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Weber', 'UT', '84403', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Weber', 'UT', '84403', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-18', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952556235', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11019769', 'W11019769', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-18', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952556235', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W11019770', 'W11019770', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', NULL, '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491222', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'W11019771', 'W11019771', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491222', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11019772', 'W11019772', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491222', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W11019773', 'W11019773', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', NULL, '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491222', 0, 'Y', 0, '2013-10-23', NULL, NULL, 41.0825, -111.993, NULL, NULL),
('870639098', 'W11019774', 'W11019774', 'UT01', 'After Hours Medical Company', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', NULL, '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'W11019775', 'W11019775', 'UT01', 'After Hours Medical Company', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', NULL, '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'W11019776', 'W11019776', 'UT01', 'After Hours Medical Company', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11019777', 'W11019777', 'UT01', 'After Hours Medical Company', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W11019778', 'W11019778', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', NULL, 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720268204', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11019779', 'W11019779', 'UT01', 'After Hours Medical Company', 'Michael', 'J', 'Lemperle', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, 'PO Box 708757', 'Sandy', 'Utah', 'UT', '84070', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720268204', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('518507993', 'W11019781', 'W11019781', 'UTMH1', NULL, 'Barbara', 'K', 'Iucker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '807 E S Temple Ste 370', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016474773', NULL, '807 E S Temple Ste 370', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016474773', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-29', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083860795', 0, 'n', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019780', 'W11019780', 'UTMH1', 'LDS Family Services Centerville', 'Steven', 'D', 'Titensor', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-01', '2012-09-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720120710', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019812', 'W11019812', 'UTMH1', 'LDS Family Services', 'Maurice', 'W', 'Harker', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '95 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '95 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-04', '2012-05-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265573661', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019784', 'W11019784', 'UT01', 'University Health Care', 'Terrence', 'S', 'Bjordahl', 'MD', 'Nephrology', '', '', 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', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-15', '2012-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710006408', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019787', 'W11019787', 'UT01', 'University Health Care', 'Christopher', 'E', 'Rich', 'MD', 'Nephrology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816709', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770545485', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019786', 'W11019786', 'UT01', 'U-U Division of Nephrology', 'Christopher', 'E', 'Rich', 'MD', 'Nephrology', '', '', 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', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770545485', 0, 'Y', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11019785', 'W11019785', 'UT01', 'University Health Care', 'Terrence', 'S', 'Bjordahl', 'MD', 'Nephrology', '', '', 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', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-15', '2012-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710006408', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W11019783', 'W11019783', 'UT01', 'University Health Care', 'Reid', 'J', 'Robison', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-06-19', '2011-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760539415', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W11019782', 'W11019782', 'UT01', 'U of U Medical Center - Psychiatry', 'Reid', 'J', 'Robison', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367790', NULL, 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367790', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-06-19', '2011-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760539415', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11019788', 'W11019788', 'UT01', 'U Of U Dialysis Program', 'Christopher', 'E', 'Rich', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', NULL, 'PO Box 27071', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770545485', 0, 'Y', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870576193', 'W11019789', 'W11019789', 'UT01', 'Lakeside Dialysis Center', 'Christopher', 'E', 'Rich', 'MD', 'Nephrology', '', '', NULL, 'O', '532 S 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012993470', NULL, '532 S 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012993470', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2009-07-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770545485', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11019790', 'W11019790', 'UT01', 'Pediatric Neonatology-Department of University of Utah', 'Shrena', '', 'Patel', 'MD', 'Pediatrics', 'Neonatal-Perinatal 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, '2009-07-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811164031', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11019791', 'W11019791', 'UT01', 'University Health Care', 'Shrena', '', 'Patel', 'MD', 'Pediatrics', 'Neonatal-Perinatal Medicine', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811164031', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('820301586', 'W11019792', 'W11019792', 'ID01', 'Cardiothoracic & Vascular Asso', 'Matthew', 'W', 'Schoolfield', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275758377', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('742083988', 'W11019793', 'W11019793', 'TX01', 'Renal Associates', 'Emmanuel', 'C', 'Anekwe', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-08-01', '2011-07-18', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1205871720', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'W11019794', 'W11019794', 'TX01', 'Renal Associates', 'Emmanuel', 'C', 'Anekwe', 'MD', 'Nephrology', '', '', NULL, 'O', '303 N Frio', 'San Antonio', 'Bexar', 'TX', '78207', '2104877827', NULL, '303 N Frio', 'San Antonio', 'Bexar', 'TX', '78207', '2104877827', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-08-01', '2011-07-18', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1205871720', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W11019795', 'W11019795', 'TX01', 'Urology of San Antonio', 'Samuel', '', 'Hakim', 'MD', 'Urology', '', '', NULL, 'O', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', NULL, '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-08-01', '2011-01-17', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669509006', 0, 'N', 0, '2014-04-08', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
('113676182', 'W11019796', 'W11019796', 'TX01', 'The Podiatry Group of South Texas', 'Jose', 'F', 'Hilario', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', NULL, 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-08-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700806866', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11019797', 'W11019797', 'TX01', 'The Podiatry Group of South Texas', 'Jose', 'F', 'Hilario', 'DPM', 'Podiatry', '', '', NULL, 'O', '14855 Blanco Rd Ste 212', 'San Antonio', 'Bexar', 'TX', '78216', '2105459100', NULL, '14855 Blanco Rd Ste 212', 'San Antonio', 'Bexar', 'TX', '78216', '2105459100', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-08-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700806866', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870708131', 'W11019798', 'W11019798', 'ID02', 'Advanced Open Imaging Boise', 'Steven', 'F', 'Merandi', 'MD', 'Radiology', 'Imaging Center', '', NULL, 'O', '3581 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088467494', NULL, '3581 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088467494', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962458000', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('870708131', 'W11019799', 'W11019799', 'ID02', 'Advanced Open Imaging Boise', 'Steven', 'F', 'Merandi', 'MD', 'Radiology', 'Imaging Center', '', NULL, 'B', '19401 40 Ave W', 'Lynnwood', 'Snohomish', 'WA', '98036', '2088467494', NULL, '19401 40 Ave W', 'Lynnwood', 'Snohomish', 'WA', '98036', '2088467494', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962458000', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('264660061', 'W11019800', 'W11019800', 'TX01', 'Mimari Surgery Associates', 'Damon', 'A', 'Mimari', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', NULL, '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1972787745', 0, 'n', 0, '2013-07-19', NULL, NULL, 29.5151, -98.5765, NULL, NULL),
('741654878', 'W11019801', 'W11019801', 'TX01', 'Neurosurgical Associates of San Antonio', 'George', 'M', 'Galvan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4410 Medical Dr Ste 610', 'San Antonio', 'Bexar', 'TX', '78229', '2106142462', NULL, '4410 Medical Dr Ste 610', 'San Antonio', 'Bexar', 'TX', '78229', '2106142462', '', 'TXNEURO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-26', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1255512539', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5101, -98.5712, NULL, NULL),
('741654878', 'W11019802', 'W11019802', 'TX01', 'Neurosurgical Associates of San Antonio', 'George', 'M', 'Galvan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1303 McCullough Ave Ste 264', 'San Antonio', 'Bexar', 'TX', '78212', '2106142453', NULL, '1303 McCullough Ave Ste 264', 'San Antonio', 'Bexar', 'TX', '78212', '2106142453', '', 'TXNEURO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-26', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1255512539', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4412, -98.4924, NULL, NULL),
('741654878', 'W11019803', 'W11019803', 'TX01', 'Neurosurgical Associates of San Antonio', 'George', 'M', 'Galvan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104771956', NULL, '18626 Hardy Oak Blvd Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104771956', '', 'TXNEURO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-08-26', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1255512539', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6139, -98.4774, NULL, NULL),
('752630583', 'W11019804', 'W11019804', 'TX01', 'Sleep Centers of Texas', NULL, NULL, 'Sleep Centers of Texas', 'GROUP', 'Sleep Medicine', NULL, NULL, NULL, 'O', '6001 Callaghan Rd Ste 105', 'San Antonio', 'Bexar', 'TX', '78228', '2105208333', NULL, '3604 N Preston', 'Plano', 'Bexar', 'TX', '75093', NULL, NULL, 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346474640', 0, 'n', 0, '2009-09-01', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019805', 'W11019805', 'UT01', 'Physican Group of Utah Inc', 'Nancy', 'E', 'Gundersen', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504602', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504602', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609080720', 0, 'y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019806', 'W11019806', 'ID01', NULL, 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-08-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019807', 'W11019807', 'ID02', '', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-15', '2012-08-20', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019808', 'W11019808', 'ID03', 'West Dermatology of Idaho', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-15', '2012-08-20', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019809', 'W11019809', 'ID03', '', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-15', '2010-12-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2011-06-29', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('953134847', 'W11019810', 'W11019810', 'ID02', '', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-15', '2010-12-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2011-06-29', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('953134847', 'W11019811', 'W11019811', 'ID01', '', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-15', '2010-12-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2011-06-29', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('203184995', 'W11019813', 'W11019813', 'UTMH1', 'Life Changing Services', 'Maurice', 'W', 'Harker', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '722 Shepard Ln Ste 108', 'Farmington', 'Davis', 'UT', '84025', '8016356474', NULL, '722 Shepard Ln Ste 108', 'Farmington', 'Davis', 'UT', '84025', '8016356474', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265573661', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('203184995', 'W11019814', 'W11019814', 'UTMH1', 'LDS Family Services', 'Maurice', 'W', 'Harker', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '95 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '95 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265573661', 0, 'Y', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019815', 'W11019815', 'UTMH1', 'LDS Family Services', 'Sondra', 'J', 'Southers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008168', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019816', 'W11019816', 'UTMH1', 'LDS Family Services', 'Shannon', 'E', 'Landheim', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-04', '2010-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770520777', 0, 'N', 0, '2012-06-19', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019819', 'W11019819', 'UTMH1', 'Resilient Solutions Inc', 'Trisha', 'T', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861533465', 0, 'N', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019817', 'W11019817', 'UTMH1', 'LDS Family Services', 'Michael', 'L', 'Van Dam', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-04', '2011-09-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386729994', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019818', 'W11019818', 'UTMH1', 'LDS Family Services', 'Trisha', 'T', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-04', '2011-10-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861533465', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019820', 'W11019820', 'UTMH1', 'Resilient Solutions Inc', 'Trisha', 'T', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '904 S Main St', 'Clearfield', 'Davis', 'UT', '84015', '8012593883', NULL, '904 S Main St', 'Clearfield', 'Davis', 'UT', '84015', '8012593883', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861533465', 0, 'y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019821', 'W11019821', 'UTMH1', 'Resilient Solutions Inc', 'Lisa', 'M', 'Steed', 'LCSW', 'Mental Health', '', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164562328', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019822', 'W11019822', 'UTMH1', 'Resilient Solutions Inc', 'Lisa', 'M', 'Steed', 'LCSW', 'Mental Health', '', '', NULL, 'B', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164562328', 0, 'y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019823', 'W11019823', 'UTMH1', 'LDS Family Services', 'Lisa', 'M', 'Steed', 'LCSW', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164562328', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019824', 'W11019824', 'UTMH1', 'LDS Family Services', 'Rocio', 'F', 'Paredes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265681860', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019825', 'W11019825', 'ID03', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-06-30', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'Y', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019826', 'W11019826', 'ID01', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'ID', '92373', '9097986642', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-06-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'Y', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'W11019827', 'W11019827', 'ID01', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-06-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('953134847', 'W11019828', 'W11019828', 'ID03', '', 'Heather', 'N', 'Knutson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', NULL, '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-08-01', '2012-06-30', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215936034', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6891, -116.342, NULL, NULL),
('621801973', 'W11019829', 'W11019829', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Andrea', 'J', 'Matich', 'MD', 'Family Practice', 'Orthopedic Surgery', NULL, NULL, 'O', '3580 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902092133', 0, 'N', 0, '2009-09-02', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('621801973', 'W11019830', 'W11019830', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Andrea', 'J', 'Matich', 'MD', 'Family Practice', 'Orthopedic Surgery', NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015683480', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Fulton', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902092133', 0, 'y', 0, '2009-09-02', NULL, NULL, 0, 0, NULL, NULL),
('870656518', 'W11019831', 'W11019831', 'UT01', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', 'Phone Number Only', '', NULL, 'UT', NULL, '8007754372', NULL, 'Phone Number Only', '', '', 'UT', '', '8007754372', '', 'WCSTDSC', NULL, NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('870656518', 'W11019832', 'W11019832', 'WY01', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', 'Phone Number Only', '', '', 'WY', '', '8007754372', NULL, 'Phone Number Only', '', '', 'WY', '', '8007754372', '          ', 'WCSTDSC', '', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019833', 'W11019833', 'UT01', 'Davis Hospital', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2010-07-20', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11019834', 'W11019834', 'UT01', 'Davis Hospital', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2010-07-20', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11019835', 'W11019835', 'UTMH1', 'LDS Family Services Centerville', 'Becky', 'P', 'Andrews', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-09-01', '2011-09-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730239534', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W11019836', 'W11019836', 'UTMH1', 'LDS Family Services Centerville', 'Becky', 'P', 'Andrews', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-01', '2009-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730239534', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11019837', 'W11019837', 'UTMH1', 'Childrens Justice Center', 'Mary', 'A', 'Carter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013188634', NULL, '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013188634', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518926880', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11019838', 'W11019838', 'UTMH1', 'Childrens Justice Center', 'Mary', 'A', 'Carter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013188634', NULL, 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013188634', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2009-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518926880', 0, 'y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('542627466', 'W11019839', 'W11019839', 'ID02', 'Keeton Counseling Services', 'Nancy', 'E', 'Keeton', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '10259 W Landmark Ct', 'Boise', 'Ada', 'ID', '83704', '2087945349', NULL, '10259 W Landmark Ct', 'Boise', 'Ada', 'ID', '83704', '2087945349', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-08', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689884652', 0, 'n', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11019840', 'W11019840', 'UT01', 'U-U Gastroenterology Division', 'Caroline', 'R', 'Tadros', '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, '2009-08-10', '2010-08-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107770', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11019841', 'W11019841', 'UT01', 'University Health Care', 'Caroline', 'R', 'Tadros', '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, '2009-08-10', '2010-08-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107770', 0, 'N', 0, '2013-12-02', 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
('870446925', 'W11019842', 'W11019842', 'UT01', 'University Health Care', 'Caroline', 'R', 'Tadros', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-10', '2010-08-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107770', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11019843', 'W11019843', 'UT01', 'Pediatric Critical Care-Department of University of Utah', 'Anna', 'M', 'Maslach-Hubbard', 'MD', 'Pediatrics', 'Pediatric Critical Care', '', 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, '2009-08-11', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548385743', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11019844', 'W11019844', 'UT01', 'University Health Care', 'Anna', 'M', 'Maslach-Hubbard', 'MD', 'Pediatrics', 'Pediatric Critical Care', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-08-11', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548385743', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019845', 'W11019845', 'UT01', 'ARUP Pathology Associates', 'Katherine', 'B', 'Geiersbach', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-13', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811043425', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11019846', 'W11019846', 'UT01', 'University Health Care', 'Katherine', 'B', 'Geiersbach', 'MD', 'Pathology', '', '', NULL, 'O', '500 S Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', NULL, '500 S Chipeta Wy', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-13', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811043425', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11019847', 'W11019847', 'UT01', 'University Pathology Associates', 'Katherine', 'B', 'Geiersbach', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-13', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811043425', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11019848', 'W11019848', 'UT01', 'University Health Care', 'Katherine', 'B', 'Geiersbach', 'MD', 'Pathology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-08-13', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811043425', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019849', 'W11019849', 'UT01', 'University Health Care', 'Kelly', 'L', 'Thomas', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-09-01', '2009-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861667602', 0, 'y', 0, '2009-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11019850', 'W11019850', 'UT01', 'University Health Care', 'Kelly', 'L', 'Thomas', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-09-01', '2009-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861667602', 0, 'N', 0, '2009-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W11019851', 'W11019851', 'UT01', 'UNI Home Project', 'Paul', 'S', 'Carbone', 'MD', 'Mental Health', 'Pediatrics', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194796201', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019854', 'W11019854', 'UTIHCPHY', 'Holladay Pediatrics', 'Matthew', 'A', 'Carter', 'MD', 'Pediatrics', '', '', NULL, 'o', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-07-31', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548309552', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('161751617', 'W11019852', 'W11019852', 'TX01', 'Rheumatology Associates of South Texas', 'Thomas', '', 'Rennie', 'MD', 'Rheumatology', '', '', NULL, 'O', '11212 Hwy 151 Bld 1 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2106563926', NULL, '11212 Hwy 151 Bld 1 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2106563926', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-11-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008358', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('870542586', 'W11019853', 'W11019853', 'UT01', 'University Health Care', 'Arsalan', 'N', 'Habib', 'MD', 'Nephrology', 'Internal Medicine', '', 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', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-15', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942336938', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019855', 'W11019855', 'UTIHCPHY', 'Dixie Hospitalists', 'Jose', 'William', 'Convalecer', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'o', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, NULL, NULL, 'Washington', NULL, NULL, '4356886200', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-13', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1699794594', 0, 'n', 0, '2010-05-24', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11019856', 'W11019856', 'UTIHCPHY', 'Mountain View Pediatrics', 'Woodrow', 'Cannon', 'Marriott', 'MD', 'Pediatrics', NULL, NULL, NULL, 'o', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-31', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891997557', 0, 'n', 0, '2009-09-05', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W11019857', 'W11019857', 'UTIHCPHY', 'Dixie Hospitalists', 'Don', 'J', 'Neer', 'MD', 'Hospitalist', '', '', NULL, 'o', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-08-17', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104972819', 0, 'n', 0, '2011-09-26', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11019858', 'W11019858', 'UTIHCPHY', 'Bryner Clinic', 'Sierra', 'E', 'Pardey', 'MD', 'Pediatrics', '', '', NULL, 'o', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-31', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982885471', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11019859', 'W11019859', 'UT01', 'University Neurosurgery Associates', 'Corey', 'S', 'Ames', 'APRN', 'Neurology', 'Family Nurse Practitioner', NULL, NULL, 'B', 'PO Box 413030', '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, '2006-08-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427039114', 0, 'y', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11019860', 'W11019860', 'UT01', 'University Neurosurgery Associates', 'Corey', 'S', 'Ames', 'APRN', 'Neurology', 'Family Nurse Practitioner', NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857575', '8015814385', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427039114', 0, 'N', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019861', 'W11019861', 'UT01', 'UUMC Rehab Medicine', 'Colby', 'R', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', NULL, 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0124549018', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11019862', 'W11019862', 'UT01', 'University of Utah Hospital PM&R', 'Colby', 'R', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877109', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877109', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0124549018', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W11019863', 'W11019863', 'UT01', 'University Health Care', 'Eric', 'C', 'Yang', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817514', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817514', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376719054', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W11019864', 'W11019864', 'UT01', 'University Health Care', 'Eric', 'C', 'Yang', '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, '2009-07-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376719054', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'W11019865', 'W11019865', 'UT01', 'U-U Otolaryngology - Pediatrics', 'Eric', 'C', 'Yang', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016621740', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016621740', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-07-01', '2009-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376719054', 0, 'y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'W11019866', 'W11019866', 'UT01', 'Primary Childrens Medical Center', 'Eric', 'C', 'Yang', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-07-01', '2009-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376719054', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11019867', 'W11019867', 'UT01', 'University Health Care', 'Stephanie', 'B', 'Johnston', 'MD', 'Pediatrics', NULL, NULL, NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '8015813899', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801073812', 0, 'N', 0, '2009-09-05', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870645559', 'W11019868', 'W11019868', 'UT01', 'University Health Care', 'Stephanie', 'B', 'Johnston', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801073812', 0, 'y', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11019869', 'W11019869', 'UT01', 'U of U Emergency Physicians', 'Zachary', 'S', 'Sturges', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992980353', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11019870', 'W11019870', 'UT01', 'U of U Emergency Physicians', 'Zachary', 'S', 'Sturges', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992980353', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W11019871', 'W11019871', 'UT01', 'University Health Care', 'Gwen', 'A', 'Latendresse', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814014', '8015859345', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814014', '8015859345', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629226808', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W11019872', 'W11019872', 'UT01', 'University of Utah', 'Gwen', 'A', 'Latendresse', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629226808', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11019873', 'W11019873', 'UT01', 'University Health Care', 'Elizabeth', 'H', 'Doby', 'MD', 'Pediatrics', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '8015813899', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '8015813899', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2010-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932371358', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11019874', 'W11019874', 'UT01', 'University Health Care', 'Elizabeth', 'H', 'Doby', '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, '2009-07-01', '2010-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932371358', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019875', 'W11019875', 'UTPEHP', 'Park City Medical Center', NULL, NULL, 'Park City Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851530984', 0, 'N', 0, '2009-09-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019876', 'W11019876', 'UTPEHP', 'Park City Surgical Center', NULL, NULL, 'Park City Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538555284', 0, 'N', 0, '2009-09-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019877', 'W11019877', 'UTPEHP', 'Park City Medical Center', NULL, NULL, 'Park City Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356587000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851530984', 0, 'y', 0, '2009-09-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019878', 'W11019878', 'UTPEHP', 'Park City Medical Center', 'Gary', 'D', 'Hood', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306022603', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019879', 'W11019879', 'UTPEHP', 'Park City Medical Center', 'Rebecca', 'Lynn', 'McCollaum', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669658969', 0, 'N', 0, '2010-10-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019880', 'W11019880', 'UTPEHP', 'Park City Medical Center', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019881', 'W11019881', 'UTPEHP', 'Park City Medical Center', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019882', 'W11019882', 'UTPEHP', 'Park City Medical Center', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019883', 'W11019883', 'UTPEHP', 'Park City Medical Center', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019884', 'W11019884', 'UTPEHP', 'Park City Medical Center', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019885', 'W11019885', 'UTPEHP', 'Park City Medical Center', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019886', 'W11019886', 'UTPEHP', 'Park City Medical Center', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019887', 'W11019887', 'UTPEHP', 'Park City Medical Center', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019888', 'W11019888', 'UTPEHP', 'Park City Medical Center', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019889', 'W11019889', 'UTPEHP', 'Park City Medical Center', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019890', 'W11019890', 'UTPEHP', 'Park City Medical Center', 'Geoffrey', 'Matthew', 'Crockett', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780645697', 0, 'N', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019891', 'W11019891', 'UTPEHP', 'Park City Medical Center', 'Kristian', 'R', 'Kemp', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1154381689', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019892', 'W11019892', 'UTPEHP', 'Park City Medical Center', 'Ryan', '', 'Sipherd', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477748002', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019893', 'W11019893', 'UTPEHP', 'Park City Medical Center', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'N', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019894', 'W11019894', 'UTPEHP', 'Park City Medical Center', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019895', 'W11019895', 'UTPEHP', 'Park City Medical Center', 'Joseph', 'H', 'Berman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780772624', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019896', 'W11019896', 'UTPEHP', 'Park City Medical Center', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019897', 'W11019897', 'UTPEHP', 'Park City Medical Center', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019898', 'W11019898', 'UTPEHP', 'Park City Medical Center', 'Heather', 'D', 'Thoerner', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528103314', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019899', 'W11019899', 'UTPEHP', 'Park City Medical Center', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019900', 'W11019900', 'UTPEHP', 'Park City Medical Center', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019901', 'W11019901', 'UTPEHP', 'Park City Medical Center', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019902', 'W11019902', 'UTPEHP', 'Park City Medical Center', 'Gregory', 'D', 'Iverson', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962469395', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019903', 'W11019903', 'UTPEHP', 'Park City Medical Center', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019904', 'W11019904', 'UTPEHP', 'Park City Medical Center', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019905', 'W11019905', 'UTPEHP', 'Park City Medical Center', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019906', 'W11019906', 'UTPEHP', 'Park City Medical Center', 'Erin', 'M', 'Scales', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851484174', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019907', 'W11019907', 'UTPEHP', 'Park City Medical Center', 'Robert', 'L', 'Speakman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417047044', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019908', 'W11019908', 'UTPEHP', 'Park City Medical Center', 'Michele', '', 'Labree-Berg', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942344429', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019909', 'W11019909', 'UTPEHP', 'Park City Medical Center', 'Megan', 'B', 'Williams', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1093860405', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019910', 'W11019910', 'UTPEHP', 'Park City Medical Center', 'S', 'Marlene', 'Hatch', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205918240', 0, 'N', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019911', 'W11019911', 'UTPEHP', 'Park City Medical Center', 'Beau', 'Q', 'Johnson', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316029358', 0, 'N', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019912', 'W11019912', 'UTPEHP', 'Park City Medical Center', 'Lynn', '', 'Margolis', 'PT', 'Physical Therapy', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487827093', 0, 'N', 0, '2010-07-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019913', 'W11019913', 'UTPEHP', 'Park City Medical Center', 'Jan', NULL, 'Watts', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790867737', 0, 'N', 0, '2009-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019914', 'W11019914', 'UTPEHP', 'Park City Medical Center', 'James', 'L', 'Snyder', 'PHD', 'Psychology', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669493185', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019915', 'W11019915', 'UTPEHP', 'Park City Medical Center', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019916', 'W11019916', 'UTPEHP', 'Park City Medical Center', 'Barry', 'M', 'Birkin', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144289521', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019917', 'W11019917', 'UTPEHP', 'Park City Medical Center', 'Carl', 'M', 'Black', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891737094', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019918', 'W11019918', 'UTPEHP', 'Park City Medical Center', 'Gordon', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598710162', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019919', 'W11019919', 'UTPEHP', 'Park City Medical Center', 'Stephen', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336185784', 0, 'N', 0, '2010-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019920', 'W11019920', 'UTPEHP', 'Park City Medical Center', 'John', 'S', 'Collins', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215974266', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019921', 'W11019921', 'UTPEHP', 'Park City Medical Center', 'David', 'R', 'Cottam', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356309512', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019922', 'W11019922', 'UTPEHP', 'Park City Medical Center', 'Tyler', 'L', 'Crawford', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629029319', 0, 'N', 0, '2009-11-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019923', 'W11019923', 'UTPEHP', 'Park City Medical Center', 'Val', 'D', 'Dunn', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215975552', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019924', 'W11019924', 'UTPEHP', 'Park City Medical Center', 'William', 'B', 'Hale', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689625097', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019925', 'W11019925', 'UTPEHP', 'Park City Medical Center', 'Roy', 'C', 'Hammond', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235183781', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019926', 'W11019926', 'UTPEHP', 'Park City Medical Center', 'Daniel', 'J', 'Hatch', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588608582', 0, 'N', 0, '2010-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019927', 'W11019927', 'UTPEHP', 'Park City Medical Center', 'Dennis', 'K', 'Heaston', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1548214224', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019928', 'W11019928', 'UTPEHP', 'Park City Medical Center', 'Kurtis', 'R', 'Kendell', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427092469', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019929', 'W11019929', 'UTPEHP', 'Park City Medical Center', 'Jeffrey', 'S', 'McClellan', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518910108', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019930', 'W11019930', 'UTPEHP', 'Park City Medical Center', 'Matthew', 'A', 'McNairy', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265404834', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019931', 'W11019931', 'UTPEHP', 'Park City Medical Center', 'Ryan', 'B', 'Nielsen', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1821032863', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019932', 'W11019932', 'UTPEHP', 'Park City Medical Center', 'Matthew', 'E', 'Nokes', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1528280385', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019933', 'W11019933', 'UTPEHP', 'Park City Medical Center', 'John', 'C', 'Olson', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169604', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019934', 'W11019934', 'UTPEHP', 'Park City Medical Center', 'Rodney', 'C', 'Petersen', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548216765', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019935', 'W11019935', 'UTPEHP', 'Park City Medical Center', 'Joseph', 'D', 'Rasband', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922059542', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019936', 'W11019936', 'UTPEHP', 'Park City Medical Center', 'Kimball', 'Bruce', 'Taylor', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Drive', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760420996', 0, 'N', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019937', 'W11019937', 'UTPEHP', 'Park City Medical Center', 'Gary', 'M', 'Watts', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528014792', 0, 'N', 0, '2010-01-12', 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
('876151902', 'W11019938', 'W11019938', 'UT01', 'University Health Care', 'Craig', 'J', 'Chaya', '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, '2009-07-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275508160', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11019939', 'W11019939', 'UT01', 'University Health Care', 'Karyn', 'E', 'Bourke', '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, '2009-07-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073771697', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11019940', 'W11019940', 'UT01', 'University Health Care', 'Kenneth', 'S', 'Yonemura', 'MD', 'Neurosurgery', 'Pediatric Neurosurgery', '', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336239920', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('204914710', 'W11019941', 'W11019941', 'ID02', 'Harrisons Hope', '', '', 'Harrisons Hope', 'GROUP', 'Hospice', '', '', NULL, 'O', '1979 N Locust Grove', 'Meridian', 'Ada', 'ID', '83646', '2089476800', NULL, '1979 N Locust Grove', 'Meridian', 'Ada', 'ID', '83646', '2089476800', '          ', '', '', 'IDHOSP03', '0.00', '35.00', '0.00', 3, '2009-09-10', '2012-02-24', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1255368619', 0, 'N', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11019942', 'W11019942', 'UT01', NULL, 'Theron', 'B', 'Hall', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3630 W S Jordan Parkway Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020301', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-09-09', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376768432', 0, 'N', 0, '2009-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W11019943', 'W11019943', 'UT01', 'Utah County Surgical Associates', 'Karl', 'M', 'Francis', '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, '2009-09-11', '2012-09-30', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669521571', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'W11019944', 'W11019944', 'UT01', 'Circle of Life Womens Center', 'Wesley', 'B', 'Davis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003892480', 0, 'N', 0, '2012-06-20', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870617263', 'W11019945', 'W11019945', 'UT01', 'St Marks Family Medicine', 'Karl', 'A', 'Kirby', 'MD', 'Family Practice', '', '', NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-09-11', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912955402', 0, 'N', 0, '2013-06-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('270437667', 'W11019946', 'W11019946', 'UT01', 'New Horizon Medical Care', 'Marcella (Marcy)', 'B', 'Rowley', 'FNP', 'Family Practice', '', '', NULL, 'O', '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', NULL, '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740301837', 0, 'n', 0, '2013-06-17', NULL, NULL, 40.5223, -111.928, NULL, NULL),
('270437667', 'W11019947', 'W11019947', 'UT01', 'New Horizon Medical Care', 'Judith', 'S', 'Moore', 'DO', 'Family Practice', '', '', NULL, 'O', '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '', '1273 W 12600 S Ste 402', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', '2011-09-28', 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1659443539', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('820487790', 'W11019948', 'W11019948', 'ID01', 'Selah Medical Center', 'Cherish', 'L', 'Estep', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', NULL, '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', '          ', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-11', '2009-11-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134199631', 0, 'N', 0, '2009-09-11', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('820487790', 'W11019949', 'W11019949', 'ID01', 'Selah Medical Center', 'Cherish', 'L', 'Estep', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '          ', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-11', '2009-11-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134199631', 0, 'N', 0, '2009-09-11', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('208089778', 'W11019950', 'W11019950', 'UT01', '', 'Mette', 'V', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', 'Physiatry', '', NULL, 'O', '235 E Tabernacle St', 'St George', 'Washington', 'UT', '84770', '4356681294', NULL, '235 E Tabernacle St', 'St George', 'Washington', 'UT', '84770', '4356681294', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063445682', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('208089778', 'W11019951', 'W11019951', 'UT01', 'Kane County Clinic', 'Mette', 'V', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', 'Physiatry', '', NULL, 'O', '255 N Main St', 'Kanab', 'Kane', 'UT', '84741', '4356444100', NULL, '255 N Main St', 'Kanab', 'Kane', 'UT', '84741', '4356444100', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', '2011-09-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063445682', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('208089778', 'W11019952', 'W11019952', 'UT01', '', 'Mette', 'V', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', 'Physiatry', '', NULL, 'B', '620 S 400 E Ste 208', 'St George', 'Washington', 'UT', '84770', '4356289393', NULL, '620 S 400 E Ste 208', 'St George', 'Washington', 'UT', '84770', '4356289393', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063445682', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('870544114', 'W11019953', 'W11019953', 'UT01', 'Delta Chiropractic Center', 'Rendon', 'J', 'Hughes', 'DC', 'Chiropractic', '', '', NULL, 'O', '58 E Main St Ste 1', 'Delta', 'Millard', 'UT', '84624', '4358641833', NULL, '58 E Main St Ste 1', 'Delta', 'Millard', 'UT', '84624', '4358641833', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003959081', 0, 'n', 0, '2014-05-16', NULL, NULL, 39.3524, -112.573, NULL, NULL),
('830236761', 'W11019954', 'W11019954', 'WY01', 'Fremont Orthopedics', 'John', '', 'Whipp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', '          ', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1649375502', 0, 'N', 0, '2013-09-27', NULL, NULL, 42.8241, -108.718, NULL, NULL),
('942854057', 'W11019955', 'W11019955', 'UTIHC04', 'Park City Medical Center', NULL, NULL, 'Park City Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851530984', 0, 'N', 0, '2009-09-14', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11019956', 'W11019956', 'UTIHC04', 'Park City Medical Center', NULL, NULL, 'Park City Medical Center', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851530984', 0, 'y', 0, '2009-09-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019957', 'W11019957', 'UTIHC04', 'Park City Surgical Center', NULL, NULL, 'Park City Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1820 Sidewinder Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356479100', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538555284', 0, 'Y', 0, '2009-09-14', NULL, NULL, 40.6637, -111.498, NULL, NULL),
('942854057', 'W11019958', 'W11019958', 'UTIHC04', 'Park City Surgical Center', NULL, NULL, 'Park City Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577475', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538555284', 0, 'Y', 0, '2009-09-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019959', 'W11019959', 'UTIHC04', 'Consult Liaison', 'P', 'Brent', 'Petersen', 'MD', 'Mental Health', 'Psychiatry', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306824628', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019960', 'W11019960', 'UTIHC04', 'Center for Counseling', 'P', 'Brent', 'Petersen', 'MD', 'Mental Health', 'Psychiatry', NULL, NULL, 'O', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306824628', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019961', 'W11019961', 'UTIHC04', 'Family Medicine', 'Tyson', 'B', 'Dekorse', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, NULL, NULL, 'Sanpete', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043421936', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019962', 'W11019962', 'UTIHC04', 'Pediatrics', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019963', 'W11019963', 'UTIHC04', 'DRMC Rehab Ctr', 'Erika', 'R', 'Snow', 'PT', 'Physical Therapy', 'Psychiatry', NULL, NULL, 'O', '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84770', '4356356480', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-01-20', '2009-08-04', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083795975', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019964', 'W11019964', 'UTIHC04', 'Summit After Hours Clinic', 'Joseph', 'J', 'Albano', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1003836636', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019965', 'W11019965', 'UTIHC04', 'Summit After Hours Clinic', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'Y', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019966', 'W11019966', 'UTIHC04', 'Emergency Room', 'D', 'Wain', 'Allen', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1942224050', 0, 'N', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019967', 'W11019967', 'UTIHC04', 'Summit After Hours Clinic', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019968', 'W11019968', 'UTIHC04', 'Emergency Room', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019969', 'W11019969', 'UTIHC04', 'Emergency Room', 'Joseph', 'H', 'Berman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780772624', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019970', 'W11019970', 'UTIHC04', 'Summit After Hours Clinic', 'Benjamin', 'B', 'Betteridge', 'MD', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-04-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225007388', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019971', 'W11019971', 'UTIHC04', 'Summit After Hours Clinic', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019972', 'W11019972', 'UTIHC04', 'Emergency Room', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019973', 'W11019973', 'UTIHC04', 'Summit After Hours Clinic', 'David', 'W', 'Brinton', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-07-01', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093820706', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019974', 'W11019974', 'UTIHC04', 'Radiology', 'Gordon', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598710162', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019975', 'W11019975', 'UTIHC04', 'Emergency Room', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019976', 'W11019976', 'UTIHC04', 'Summit After Hours Clinic', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019977', 'W11019977', 'UTIHC04', 'Emergency Room', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019978', 'W11019978', 'UTIHC04', 'Summit After Hours Clinic', 'Jill', 'B', 'Faatz', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356542500', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2006-06-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417981002', 0, 'Y', 0, '2010-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019979', 'W11019979', 'UTIHC04', 'Summit After Hours Clinic', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019980', 'W11019980', 'UTIHC04', 'Summit After Hours Clinic', 'Wayne', 'Richard', 'Graham', 'DO', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-08-30', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781054', 0, 'Y', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019981', 'W11019981', 'UTIHC04', 'Summit After Hours Clinic', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019982', 'W11019982', 'UTIHC04', 'Emergency Room', 'Gregory', 'D', 'Iverson', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962469395', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019983', 'W11019983', 'UTIHC04', 'Summit After Hours Clinic', 'R', 'Herbert', 'Lepley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611495', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019984', 'W11019984', 'UTIHC04', 'Physical Therapy', 'Lynn', '', 'Margolis', 'PT', 'Physical Therapy', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487827093', 0, 'N', 0, '2010-07-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019985', 'W11019985', 'UTIHC04', 'Summit After Hours Clinic', 'Debra', 'Sue', 'Martin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972543684', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019986', 'W11019986', 'UTIHC04', 'Summit After Hours Clinic', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019987', 'W11019987', 'UTIHC04', 'Emergency Room', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019988', 'W11019988', 'UTIHC04', 'Summit After Hours Clinic', 'June', 'E', 'Neeley', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508965369', 0, 'Y', 0, '2010-11-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019989', 'W11019989', 'UTIHC04', 'Radiology', 'Rodney', 'C', 'Petersen', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548216765', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019990', 'W11019990', 'UTIHC04', 'Summit After Hours Clinic', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-02-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019991', 'W11019991', 'UTIHC04', 'Summit After Hours Clinic', 'Jeffrey', 'S', 'Rasch', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-09-01', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598717662', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019992', 'W11019992', 'UTIHC04', 'Summit After Hours Clinic', 'Spencer', 'E', 'Richards', 'MD', 'Family Practice', 'Sports Medicine', NULL, NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609845775', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019993', 'W11019993', 'UTIHC04', 'Summit After Hours Clinic', 'Spencer', 'E', 'Richards', 'MD', 'Family Practice', 'Sports Medicine', NULL, NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609845775', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019994', 'W11019994', 'UTIHC04', 'Summit After Hours Clinic', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019995', 'W11019995', 'UTIHC04', 'Emergency Room', 'Erin', 'M', 'Scales', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851484174', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019996', 'W11019996', 'UTIHC04', 'Emergency Room', 'Robert', 'L', 'Speakman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417047044', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019997', 'W11019997', 'UTIHC04', 'Summit After Hours Clinic', 'Kathleen', 'W', 'Thomas', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356497640', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-01-01', '2009-09-15', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235290', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019998', 'W11019998', 'UTIHC04', 'Summit After Hours Clinic', 'Sandra', 'L', 'Van Leuven', 'MD', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1538109715', 0, 'Y', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11019999', 'W11019999', 'UTIHC04', 'Summit After Hours Clinic', 'Robert', 'T', 'Winn', 'MD', 'Family Practice', 'Pediatrics', 'Urgent Care', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2006-01-01', '2009-09-15', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1912951393', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020000', 'W11020000', 'UTIHC04', 'Summit After Hours Clinic', 'Eric', 'M', 'Wood', 'MD, MPH', 'Emergency Medicine', '', 'Occupational Therapy', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4356470700', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2007-04-01', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992719504', 0, 'Y', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020001', 'W11020001', 'UTIHC04', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W11020002', 'W11020002', 'UTIHC04', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11020003', 'W11020003', 'UTIHC04', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Highway 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W11020004', 'W11020004', 'UTIHC04', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W11020005', 'W11020005', 'UTIHC04', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W11020006', 'W11020006', 'UTIHC04', 'EKG', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'Y', 0, '2014-05-19', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020007', 'W11020007', 'UTIHC04', 'Colorectal / Spina Bifida', 'Patrick', 'C', 'Cartwright', 'MD', 'Pediatrics', 'Urology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467542050', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11020008', 'W11020008', 'UTIHC04', 'Family Medicine', 'Spencer', 'J', 'Chun', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-07-01', '2010-08-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205026556', 0, 'N', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020009', 'W11020009', 'UTIHC04', 'Anesthesia', 'Shaun', 'S', 'Evans', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, NULL, NULL, 'Wasatch', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649292897', 0, 'N', 0, '2009-09-10', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W11020010', 'W11020010', 'UTIHC04', 'Physical Therapy', 'Colby', 'Reed', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-31', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1245429018', 0, 'N', 0, '2010-07-13', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11020011', 'W11020011', 'UTIHC04', 'EKG', 'Gary', 'D', 'Hood', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306022603', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020012', 'W11020012', 'UTIHC04', 'EKG', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'Y', 0, '2014-05-19', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020013', 'W11020013', 'UTIHC04', 'Cardiology', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-08-28', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W11020014', 'W11020014', 'UTIHC04', 'EKG', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'Y', 0, '2014-05-22', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020015', 'W11020015', 'UTIHC04', 'Family Medicine', 'Brian', 'C', 'Lofgran', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074575', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074575', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-08-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518845', 0, 'N', 0, '2010-10-28', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W11020016', 'W11020016', 'UTIHC04', 'EKG', 'Rebecca', 'Lynn', 'McCollaum', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', '2009-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669658969', 0, 'Y', 0, '2010-10-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020017', 'W11020017', 'UTIHC04', 'Rehab', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11020018', 'W11020018', 'UTIHC04', 'EKG', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020019', 'W11020019', 'UTIHC04', 'EKG', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020020', 'W11020020', 'UTIHC04', 'Radiology', 'Matthew', 'E', 'Nokes', 'MD', 'Radiology', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-02-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1528280385', 0, 'N', 0, '2010-12-28', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11020021', 'W11020021', 'UTIHC04', 'Pediatrics', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-10', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, '2009-09-25', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11020022', 'W11020022', 'UTIHC04', 'EKG', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020023', 'W11020023', 'UTIHC04', 'Pediatrics', 'Thomas', 'A', 'Pilcher', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, '', '0.00', '10.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1437247582', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11020024', 'W11020024', 'UTIHC04', 'Radiation Oncology', 'Joseph', 'D', 'Rasband', 'MD', 'Radiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922059542', 0, 'Y', 0, '2014-03-18', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W11020025', 'W11020025', 'UTIHC04', 'EKG', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'Y', 0, '2014-05-19', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020026', 'W11020026', 'UTIHC04', 'EKG', 'James', 'L', 'Snyder', 'PHD', 'Psychology', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669493185', 0, 'Y', 0, '2009-09-10', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020027', 'W11020027', 'UTIHC04', 'Emergency Room', 'James', 'R', 'Stewart', 'DO', 'Family Practice', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457338220', 0, 'Y', 0, '2014-04-08', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W11020028', 'W11020028', 'UTIHC04', 'EKG', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'Y', 0, '2014-05-19', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020029', 'W11020029', 'UTIHC04', 'EKG', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'Y', 0, '2014-06-20', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11020030', 'W11020030', 'UTIHC04', 'Anesthesia', 'Bryan', 'G', 'Wright', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255288', 0, 'N', 0, '2013-08-23', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W11020031', 'W11020031', 'UTIHC04', 'EKG', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-09-15', '2012-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020032', 'W11020032', 'UTIHC01', 'Radiology', 'Mark', 'S', 'Asay', 'MD', 'Vascular Surgery', 'Radiologist', 'Radiology', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114962180', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020033', 'W11020033', 'UTIHC01', 'Pediatrics', 'Patrick', 'C', 'Cartwright', 'MD', 'Pediatrics', 'Urology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467542050', 0, 'N', 0, '2013-08-28', 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
('942854057', 'W11020034', 'W11020034', 'UTIHC01', 'Physical Therapy', 'Colby', 'Reed', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-31', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1245429018', 0, 'N', 0, '2010-07-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020035', 'W11020035', 'UTIHC01', 'Cardiology', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-08-28', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020036', 'W11020036', 'UTIHC01', 'Family Medicine', 'Brian', 'C', 'Lofgran', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074575', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074575', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-08-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518845', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020037', 'W11020037', 'UTIHC01', 'Rehab', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020038', 'W11020038', 'UTIHC01', 'Pediatrics', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-10', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, '2009-09-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020039', 'W11020039', 'UTIHC01', 'Pediatrics', 'Thomas', 'A', 'Pilcher', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-06-01', '2013-12-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1437247582', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020040', 'W11020040', 'UTIHC02', 'Pediatrics', 'Patrick', 'C', 'Cartwright', 'MD', 'Pediatrics', 'Urology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467542050', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020041', 'W11020041', 'UTIHC02', 'Physical Therapy', 'Colby', 'Reed', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-31', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1245429018', 0, 'N', 0, '2010-07-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020042', 'W11020042', 'UTIHC02', 'Rehab', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020043', 'W11020043', 'UTIHC02', 'Pediatrics', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-10', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, '2009-09-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020044', 'W11020044', 'UTIHC02', 'Pediatrics', 'Thomas', 'A', 'Pilcher', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-06-01', '2013-12-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1437247582', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020045', 'W11020045', 'UTIHC03', 'Pediatrics', 'Patrick', 'C', 'Cartwright', 'MD', 'Pediatrics', 'Urology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467542050', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020046', 'W11020046', 'UTIHC03', 'Physical Therapy', 'Colby', 'Reed', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-07-31', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1245429018', 0, 'N', 0, '2010-07-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020047', 'W11020047', 'UTIHC03', 'Cardiology', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-08-28', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020048', 'W11020048', 'UTIHC03', 'Rehab', 'Dawn', 'Ann', 'McNulty', 'MD', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235213984', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020049', 'W11020049', 'UTIHC03', 'Pediatrics', 'Allison', NULL, 'Oki', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-07-10', NULL, NULL, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1063689750', 0, 'N', 0, '2009-09-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020050', 'W11020050', 'UTIHC03', 'Pediatrics', 'Thomas', 'A', 'Pilcher', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-06-01', '2013-12-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1437247582', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('270212896', 'W11020051', 'W11020051', 'UT01', 'Northern Utah Dermatology', 'Daniel', 'J', 'Hansen', 'DO', 'Dermatology', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 102', 'South Ogden', 'Weber', 'UT', '84405', '8013993324', NULL, '6028 S Ridgeline Dr Ste 102', 'South Ogden', 'Weber', 'UT', '84405', '8013993324', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1114121217', 0, 'n', 0, '2013-06-19', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('208180338', 'W11020076', 'W11020076', 'UT01', '', 'Elizabeth', 'E', 'Auger', 'DPM', 'Podiatry', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8016192170', '8015539562', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8016192170', '8015539562', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679590558', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('270354831', 'W11020052', 'W11020052', 'UT01', 'Integrative Medical Associates', 'Stuart', 'B', 'Porter', 'DO', 'Family Practice', '', '', NULL, 'O', '3650 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013739920', NULL, '3650 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013739920', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-11', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1689612996', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('260168070', 'W11020053', 'W11020053', 'ID01', NULL, 'Louis', 'A', 'Burke', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', NULL, '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', '', 'IDORTHO2+5', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952518060', 0, 'n', 0, '2013-06-17', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('260168070', 'W11020054', 'W11020054', 'ID01', NULL, 'Kyle', 'L', 'Palmer', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', NULL, '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', '', 'IDORTHO2+5', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720027311', 0, 'n', 0, '2013-06-05', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('260168070', 'W11020055', 'W11020055', 'ID01', '', 'Kyle', 'L', 'Palmer', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1673 W Shoreline Dr Ste 101', 'Boise', 'Ada', 'ID', '83702', '2088848300', NULL, '1673 W Shoreline Dr Ste 101', 'Boise', 'Ada', 'ID', '83702', '2088848300', '          ', 'IDORTHO2+5', '', '', '0.00', '30.00', '0.00', 3, '2009-09-01', '2011-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720027311', 0, 'N', 0, '2013-06-05', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('943468694', 'W11020056', 'W11020056', 'UT01', NULL, 'Merwin', NULL, 'Rasmussen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939500', '8017335623', '1954 E Fort Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2009-02-25', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497770978', 0, 'Y', 0, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11020057', 'W11020057', 'UT01', '', 'Jared', NULL, 'Hoyt', 'DC', 'Chiropractic', '', '', NULL, 'O', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-08-17', '2010-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306075833', 0, 'N', 0, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11020058', 'W11020058', 'UT01', NULL, 'Justin', 'K', 'Poppe', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '720 S River Rd Ste B110', 'St George', 'Washington', 'UT', '84790', '4356562888', '4356562999', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-08-20', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700040292', 0, 'N', 0, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W11020059', 'W11020059', 'UT01', 'USU Speech Language Hearing Center', 'Chad', 'S', 'Bingham', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275750440', 0, 'n', 0, '2013-09-23', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W11020060', 'W11020060', 'UT01', 'USU Speech Language Hearing Center', 'Anne', '', 'Elsweiler', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972790129', 0, 'n', 0, '2013-12-02', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W11020061', 'W11020061', 'UT01', 'USU Speech Language Hearing Center', 'Kim', '', 'Corbin-Lewis', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750403523', 0, 'n', 0, '2013-12-02', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W11020062', 'W11020062', 'UT01', 'USU Speech Language Hearing Center', 'Jill', 'R', 'Andrus', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971375', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497198592', 0, 'n', 0, '2013-06-17', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('203407058', 'W11020063', 'W11020063', 'UTMH1', 'Life Matters Counseling & Health Center', 'Robert', 'P', 'Butters', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '740 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013130555', NULL, '740 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013130555', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639359615', 0, 'n', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('200979627', 'W11020064', 'W11020064', 'ID02', 'The Talk Shoppe', 'Amy', 'P', 'Morehead', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', NULL, '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-09', '2011-06-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043442429', 0, 'N', 0, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11020065', 'W11020065', 'UTMH1', 'Valley Mental Health  Inc', 'Kelly A', NULL, 'Bullaro-Pecora', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-09-15', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982815858', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529379607', 'W11020066', 'W11020066', 'UTMH1', NULL, 'Darlene', '', 'Horton', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '415 N Main Ste 104', 'Cedar City', 'Iron', 'UT', '84720', '4358676471', NULL, '415 N Main Ste 104', 'Cedar City', 'Iron', 'UT', '84720', '4358676471', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609065044', 0, 'n', 0, '2014-02-02', NULL, NULL, 0, 0, NULL, NULL),
('529379607', 'W11020067', 'W11020067', 'UTMH1', NULL, 'Darlene', '', 'Horton', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '4778 W 2100 N', 'Cedar City', 'Iron', 'UT', '84721', '4358676471', NULL, '4778 W 2100 N', 'Cedar City', 'Iron', 'UT', '84721', '4358676471', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609065044', 0, 'y', 0, '2014-02-02', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W11020068', 'W11020068', 'TX01', '', 'Randall', '', 'McGibeny', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', NULL, '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '          ', 'TXMA', '', '', '0.00', '100.00', '0.00', 6, '2009-09-11', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477729705', 0, 'N', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('528065332', 'W11020069', 'W11020069', 'UTMH1', 'Life Matters Counseling & Health Center', 'Victor', 'M', 'Zizumbo', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '740 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013130555', NULL, '740 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013130555', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235267667', 0, 'n', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11020070', 'W11020070', 'UTMH1', 'LDS Family Services', 'Kathryn', 'M', 'Hampton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-09-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721260', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('153448606', 'W11020071', 'W11020071', 'UTMH1', NULL, 'Kathryn', 'M', 'Hampton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '725 N 300 E', 'Bountiful', 'Davis', 'UT', '84010', '8016986079', NULL, '725 N 300 E', 'Bountiful', 'Davis', 'UT', '84010', '8016986079', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721260', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870626387', 'W11020072', 'W11020072', 'UTMH1', 'Comprehensive Treatment Clinic', 'Matthew', 'T', 'Hedelius', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', NULL, '40 W Cache Valley Blvd Ste 10A', 'Logan', 'Cache', 'UT', '84341', '4357872272', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053435289', 0, 'n', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W11020073', 'W11020073', 'UT01', 'USU Speech Language Hearing Center', 'K', 'Todd', 'Houston', 'PHD', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971374', NULL, '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971374', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-10-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407097694', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('900448097', 'W11020074', 'W11020074', 'UT01', 'Lakeview Urology & General Surgery LLC', 'Jon', 'C', 'Oberg', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'B', 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-08-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1316035942', 0, 'y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('900448097', 'W11020075', 'W11020075', 'UT01', 'Lakeview Urology & General Surgery LLC', 'Jon', 'C', 'Oberg', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'O', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', NULL, '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-08-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1316035942', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870477339', 'W11020077', 'W11020077', 'UT01', 'Service Drug', '', '', 'Service Drug', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358642545', '          ', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358642545', '          ', 'DME80', '', '', '0.00', '40.00', '0.00', 3, '2009-09-15', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528089570', 0, 'N', 0, '2014-05-02', NULL, NULL, 39.3524, -112.58, NULL, NULL),
('870639098', 'W11020078', 'W11020078', 'UT01', 'After Hours Medical Company', 'Amy', 'L', 'Whipple', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', '', 'ME', '04915', '8014921611', NULL, 'PO Box 8476', 'Belfast', '', 'ME', '04915', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-03-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871751297', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11020079', 'W11020079', 'UT01', 'After Hours Medical Company', 'Amy', 'L', 'Whipple', 'FNP', 'Family Practice', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-03-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871751297', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11020080', 'W11020080', 'UT01', 'After Hours Medical Company', 'Amy', 'L', 'Whipple', 'FNP', 'Family Practice', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015450600', NULL, '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-03-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871751297', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11020081', 'W11020081', 'UT01', 'Granger Medical Clinic', 'Charles', 'D', 'Mallender', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653419', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653419', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2011-10-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942261037', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11020082', 'W11020082', 'UT01', 'Granger Medical Clinic', 'Charles', 'D', 'Mallender', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2011-10-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942261037', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('205321371', 'W11020083', 'W11020083', 'UTMH1', 'Adolescent Childs & Family Therapy Inc', 'Rose', 'B', 'Olds', 'ARNP', 'Mental Health', 'Psychiatry', NULL, NULL, 'O', '370 E S Temple Ste 550', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015377070', NULL, '370 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84111', NULL, NULL, 'ARNP', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619927795', 0, 'n', 0, '2009-09-16', NULL, NULL, 0, 0, NULL, NULL),
('820452136', 'W11020084', 'W11020084', 'ID01', 'McKim Chiropractic', 'Joshua', 'K', 'McKim', 'DC', 'Chiropractic', '', '', NULL, 'O', '2023 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084675756', NULL, '2023 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084675756', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538345525', 0, 'n', 0, '2012-10-29', NULL, NULL, 43.5492, -116.573, NULL, NULL),
('820452136', 'W11020085', 'W11020085', 'ID01', 'McKim Chiropractic', 'Joshua', 'K', 'McKim', 'DC', 'Chiropractic', '', '', NULL, 'O', '7149 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2089556606', NULL, '7149 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2089556606', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538345525', 0, 'n', 0, '2012-10-29', NULL, NULL, 43.6122, -116.271, NULL, NULL),
('820492308', 'W11020086', 'W11020086', 'ID02', 'Idaho Gastroenterology Associates', 'Matthew', 'R', 'Sericati', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', NULL, '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '          ', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-15', '2011-06-30', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194871871', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W11020087', 'W11020087', 'ID02', 'Idaho Gastroenterology Associates', 'Matthew', 'R', 'Sericati', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088843724', NULL, '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088843724', '          ', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-15', '2011-06-30', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194871871', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11020088', 'W11020088', 'ID02', 'Primary Health Medical Group', 'Steven', 'A', 'Smith', 'MD', 'Pediatrics', '', '', NULL, 'O', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-15', '2013-02-28', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861681611', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6122, -116.26, NULL, NULL),
('870281028', 'W11020089', 'W11020089', 'UT01', 'Central Utah Clinic', 'Matthew', 'S', 'Frazier', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598977944', 0, 'Y', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11020090', 'W11020090', 'UT01', 'Central Utah Clinic', 'Matthew', 'S', 'Frazier', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 207', 'Provo', 'Utah', 'UT', '84604', '8013737350', NULL, '1055 N 500 W Ste 207', 'Provo', 'Utah', 'UT', '84604', '8013737350', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598977944', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11020091', 'W11020091', 'UT01', 'Central Utah Clinic', 'Matthew', 'S', 'Frazier', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598977944', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W11020092', 'W11020092', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'B', 'PO Box 15109', 'Springfield', '', 'MA', '01115', '8013566100', NULL, 'PO Box 15109', 'Springfield', '', 'MA', '01115', '8013566100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'Y', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W11020093', 'W11020093', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', NULL, '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W11020094', 'W11020094', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber', 'Wasatch', 'UT', '84032', '4356029259', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W11020095', 'W11020095', 'UT01', 'American Fork Clinic', 'Tauaina', 'J', 'Ngatuvai', 'MD', 'Sports Medicine', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1003992470', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W11020096', 'W11020096', 'UT01', 'Lehi Medical Clinic', 'Tauaina', 'J', 'Ngatuvai', 'MD', 'Sports Medicine', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', NULL, '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1003992470', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11020097', 'W11020097', 'UT01', 'Central Utah Clinic', 'Sanford', 'T', 'Hamilton', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1356488126', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11020098', 'W11020098', 'UT01', 'Central Utah Clinic', 'Sanford', 'T', 'Hamilton', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1175 E 50 S Ste 161', 'American Fork', 'Utah', 'UT', '84003', '8014654805', NULL, '1175 E 50 S Ste 161', 'American Fork', 'Utah', 'UT', '84003', '8014654805', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-09-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1356488126', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'W11020099', 'W11020099', 'UT01', 'Mt Timpanogos Womens Healthcare', 'David', 'B', 'Young', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', '2009-12-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1679756852', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('270671464', 'W11020100', 'W11020100', 'UT01', 'Castle Valley Foot & Ankle Specialists', 'Brian', 'J', 'Griffeth', 'DPM', 'Podiatry', '', '', NULL, 'O', '250 N Fairgrounds Rd Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356376797', '4356376799', '250 N Fairgrounds Rd Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356376797', '4356376799', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1487833406', 0, 'N', 0, '2013-06-19', NULL, NULL, 39.6058, -110.835, NULL, NULL),
('562577913', 'W11020101', 'W11020101', 'UT01', 'Spine Care Center LLC', 'Sami', 'K', 'Weese', 'APRN', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6321 S Redwood Rd Ste 102', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016857246', '8017475487', '6321 S Redwood Rd Ste 102', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016857246', '8017475487', 'WCSTSCC5', '', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508017021', 0, 'N', 0, '2009-09-17', NULL, NULL, 0, 0, NULL, NULL),
('263094136', 'W11020102', 'W11020102', 'TX01', 'IMED Internal Medicine', 'Samuel', 'C', 'Danna', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405458', 'Atlanta', 'Fulton', 'GA', '30384', '2104040000', NULL, 'PO Box 405458', 'Atlanta', 'Fulton', 'GA', '30384', '2104040000', '          ', 'TXINTB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-09-15', '2011-07-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659575215', 0, 'Y', 0, '2009-09-17', NULL, NULL, 0, 0, NULL, NULL),
('263094136', 'W11020103', 'W11020103', 'TX01', 'IMED Internal Medicine', 'Samuel', 'C', 'Danna', 'MD', 'Internal Medicine', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104040000', NULL, '255 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104040000', '          ', 'TXINTB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-09-15', '2011-07-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659575215', 0, 'N', 0, '2009-09-17', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('870411148', 'W11020104', 'W11020104', 'UTMH1', 'Child & Family Psychology', 'Robert', 'F', 'Williams', 'PHD', 'Mental Health', 'Pediatric Psychology', '', NULL, 'O', '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', NULL, '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598808842', 0, 'n', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870499792', 'W11020105', 'W11020105', 'UT01', 'Southwest Surgical Associates', 'Amy', 'J', 'Benedict', 'APRN', 'General Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-15', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144467010', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11020106', 'W11020106', 'UT01', 'Tanner Memorial Clinic', 'Scott', 'R', 'Bishop', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962493486', 0, 'Y', 0, '2013-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11020107', 'W11020107', 'UT01', 'Tanner Memorial Clinic', 'Scott', 'R', 'Bishop', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962493486', 0, 'N', 0, '2013-04-29', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'W11020108', 'W11020108', 'UT01', 'Tanner Memorial Clinic', 'Scott', 'R', 'Bishop', 'MD', 'Family Practice', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '8017749219', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962493486', 0, 'N', 0, '2013-04-29', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'W11020109', 'W11020109', 'UT01', 'Tanner Memorial Clinic', 'Scott', 'R', 'Bishop', 'MD', 'Family Practice', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962493486', 0, 'N', 0, '2013-04-29', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870499792', 'W11020110', 'W11020110', 'UT01', 'Southwest Surgical Associates', 'Autum', '', 'Christensen', 'APRN', 'General Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-15', '2013-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669619466', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W11020111', 'W11020111', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Alfredo', '', 'Espinoza', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2009-09-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1629185616', 0, 'N', 0, '2012-10-23', NULL, NULL, 29.5159, -98.5758, NULL, NULL),
('741967809', 'W11020112', 'W11020112', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Alfredo', '', 'Espinoza', 'MD', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', NULL, '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2009-09-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1629185616', 0, 'N', 0, '2012-10-23', NULL, NULL, 29.6127, -98.4809, NULL, NULL),
('870780366', 'W11020113', 'W11020113', 'UT01', 'Obstetrics and Gynecology Clinic Inc', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223613', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2009-09-15', '2009-09-15', 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'n', 0, '2009-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870280366', 'W11020114', 'W11020114', 'UT01', 'Obstetrics and Gynecology Clinic', 'Jonathan', 'P', 'Daniels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223613', NULL, '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223613', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1043214935', 0, 'N', 0, '2013-04-11', NULL, NULL, 40.7628, -111.867, NULL, NULL),
('743003947', 'W11020115', 'W11020115', 'TX01', 'The San Antonio Orthopaedic Group', 'Billy', 'K', 'Parsley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255544904', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11020116', 'W11020116', 'TX01', 'The San Antonio Orthopaedic Group', 'Billy', 'K', 'Parsley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', NULL, '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897220', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255544904', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('743003947', 'W11020117', 'W11020117', 'TX01', 'The San Antonio Orthopaedic Group', 'Billy', 'K', 'Parsley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', NULL, '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045400', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255544904', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('264480825', 'W11020118', 'W11020118', 'ID01', 'Thomas Hammer Pediatrics', 'Thomas', 'J', 'Hammer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1209 N  Jacob Allcott Way', 'Nampa', 'Canyon', 'ID', '83687', '2084618700', NULL, '1209 N  Jacob Allcott Way', 'Nampa', 'Canyon', 'ID', '83687', NULL, NULL, 'IDPED', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1053301911', 0, 'n', 0, '2009-09-18', NULL, NULL, 43.595, -116.519, NULL, NULL),
('264480825', 'W11020119', 'W11020119', 'ID01', 'Thomas Hammer Pediatrics', 'Thomas', 'J', 'Hammer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2084618700', NULL, '1209 N  Jacob Allcott Way', 'Nampa', 'Ada', 'ID', '83687', NULL, NULL, 'IDPED', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1053301911', 0, 'y', 0, '2009-09-18', NULL, NULL, 0, 0, NULL, NULL),
('201928266', 'W11020120', 'W11020120', 'ID02', 'Spine & Physical Medicine', 'James', 'H', 'Bates', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2020 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2084011000', '          ', '2020 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2084011000', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-09-15', '2014-06-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821092412', 0, 'N', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('742855569', 'W11020121', 'W11020121', 'TX01', 'San Antonio Preventive & Diagnostic Medicine', 'Patrice', NULL, 'Alves', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8401 Datapoint Ste 401', 'San Antonio', 'Bexar', 'TX', '78229', '2109492200', NULL, '8401 Datapoint Ste 401', 'San Antonio', 'Bexar', 'TX', '78229', '2109492200', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-09-15', '2010-10-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437132966', 0, 'Y', 0, '2009-09-18', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020122', 'W11020122', 'UT01', 'Prorehab Physical Therapy', 'David', '', 'Hume', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357811502', '4357811505', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357811502', '4357811505', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184686404', 0, 'N', 0, '2011-04-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020123', 'W11020123', 'UT01', 'Mountain Land Mendenhall', 'Michael', NULL, 'Palmieri', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '754 S Main Ste 4', 'St George', 'Washington', 'UT', '84770', '4356730191', '4356730192', NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0222229954', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020124', 'W11020124', 'UT01', 'Mountain Land South Valley', 'Benjamin', NULL, 'Gubler', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '11333 S 1000 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713318', '8015713319', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942435730', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020125', 'W11020125', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Todd', '', 'Schwartz', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124291570', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL);
