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', 'W11016326', 'W11016326', 'WY01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016327', 'W11016327', 'WY01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016328', 'W11016328', 'WY01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016329', 'W11016329', 'WY01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', NULL, '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016330', 'W11016330', 'WY01', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 42.7162, -110.931, NULL, NULL),
('942854057', 'W11016331', 'W11016331', 'UT01', 'Intermountain Utah Heart Group', NULL, NULL, 'Intermountain Utah Heart Group', 'Group', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5169 S Cottonwood', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006865', 0, 'N', 0, '2009-02-02', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016332', 'W11016332', 'UT01', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016333', 'W11016333', 'UT01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016334', 'W11016334', 'UT01', 'Intermountain Heart Rhythm Specialists', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016335', 'W11016335', 'UT01', 'Intermountain Heart Rhythm Specialists', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965122', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W11016336', 'W11016336', 'UT01', 'Intermountain Utah Heart Group', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016337', 'W11016337', 'UT01', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016338', 'W11016338', 'UT01', 'Utah Heart', 'Dean', 'A', 'Mayer', 'MD', 'Hospitalist', '', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915432', 0, 'N', 0, '2011-09-26', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016339', 'W11016339', 'UT01', 'Intermountain Heart Rhythm Specialists', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016340', 'W11016340', 'UT01', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016341', 'W11016341', 'UT01', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016342', 'W11016342', 'UT01', 'Intermountain Heart Rhythm Specialists', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', '5169 S Cottonwood St Ste B-510', 'Murray', 'Salt Lake', 'UT', '84157', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528036654', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W11016343', 'W11016343', 'UT01', 'Intermountain Utah Heart Group', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W11016344', 'W11016344', 'UT01', 'Intermountain Utah Heart Group', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2012-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016345', 'W11016345', 'UT01', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016346', 'W11016346', 'UT01', 'Intermountain Utah Heart Group', 'Peter', 'J', 'Casterella', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063480655', 0, 'N', 0, '2009-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016347', 'W11016347', 'UT01', 'Intermountain Heart Rhythm Specialists', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016348', 'W11016348', 'UT01', 'Intermountain Heart Rhythm Specialists', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965122', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016349', 'W11016349', 'UT01', 'Intermountain Utah Heart Group', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016350', 'W11016350', 'UT01', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016351', 'W11016351', 'UT01', 'Intermountain Utah Heart Group', 'Dean', 'A', 'Mayer', 'MD', 'Hospitalist', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915432', 0, 'N', 0, '2011-09-26', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016352', 'W11016352', 'UT01', 'Intermountain Heart Rhythm Specialists', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2010-08-06', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016353', 'W11016353', 'UT01', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016354', 'W11016354', 'UT01', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016355', 'W11016355', 'UT01', 'Utah Heart Clinic', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528036654', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016356', 'W11016356', 'UT01', 'Intermountain Utah Heart Group', 'Brian', 'K', 'Whisenant', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', '9844 S 1300 E Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84094', '8013070893', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750359253', 0, 'N', 0, '2014-06-20', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('942854057', 'W11016357', 'W11016357', 'UT01', 'Intermountain Utah Heart Group', 'Ruben', 'Alberto', 'Zito', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', '324 10th Ave Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083900', '8014083909', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811907397', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.7808, -111.88, NULL, NULL),
('870395551', 'W11016358', 'W11016358', 'UT01', NULL, 'Aaron', 'M', 'Nelson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3360 S 1500 E', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085220300', '2085246097', NULL, NULL, 'Bonneville', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-11-18', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013076355', 0, 'N', 0, '2009-02-04', NULL, NULL, 0, 0, NULL, NULL),
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('680493661', 'W11016395', 'W11016395', 'UTDT01', 'Zion Dental Care', 'Chad', NULL, 'Booth', 'DMD', 'Dentist', '', '', NULL, 'O', '82 S 700 W', 'Hurricane', 'Washington', 'UT', '84737', '4356354333', NULL, '82 S 700 W', 'Hurricane', 'Washington', 'UT', '84737', '4356354333', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005357', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870511191', 'W11016396', 'W11016396', 'UTDT01', '', 'Jerald', NULL, 'Boseman', 'DDS', 'Dentist', '', '', NULL, 'O', '4190 S Highland Dr Ste 106', 'Salt Lake City', '', 'UT', '84124', '8012780840', NULL, '4190 S Highland Dr Ste 106', 'Salt Lake City', '', 'UT', '84124', '8012780840', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005366', 0, 'N', 0, '2009-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870542115', 'W11016397', 'W11016397', 'UTDT01', '', 'Gary', '', 'Clark', 'DMD', 'Dentist', '', '', NULL, 'O', '9730 S 700 E Ste 106', 'Sandy', 'Salt Lake', 'UT', '84070', '8015721130', NULL, '9730 S 700 E Ste 106', 'Sandy', 'Salt Lake', 'UT', '84070', '8015721130', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005722', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870567253', 'W11016398', 'W11016398', 'UTDT01', 'Dental Works', 'Ronald', NULL, 'Cohn', 'DMD', 'Dentist', NULL, NULL, NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000005754', 0, 'N', 0, '2009-02-11', NULL, NULL, 0, 0, NULL, NULL),
('529627214', 'W11016399', 'W11016399', 'UTDT01', '', 'Steven', '', 'Curtis', 'DMD', 'Dentist', '', '', NULL, 'O', '1320 N 600 E Ste 4', 'Logan', 'Cache', 'UT', '84341', '4357531690', NULL, '1320 N 600 E Ste 4', 'Logan', 'Cache', 'UT', '84341', '4357531690', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005867', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('394482862', 'W11016400', 'W11016400', 'UTDT01', '', 'Mark', '', 'Eggert', 'DDS', 'Dentist', '', '', NULL, 'O', '1435 S 1350 E', 'Clearfield', 'Davis', 'UT', '84015', '8017736170', NULL, '1435 S 1350 E', 'Clearfield', 'Davis', 'UT', '84015', '8017736170', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006098', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('200427348', 'W11016401', 'W11016401', 'UTDT01', '', 'Brandon', '', 'Fairbanks', 'DMD', 'Orthodontist', '', '', NULL, 'O', '3300 N Running Creek Way Ste F-102', 'Lehi', 'Utah', 'UT', '84043', '8017664660', NULL, '3300 N Running Creek Way Ste F-102', 'Lehi', 'Utah', 'UT', '84043', '8017664660', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006189', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870549520', 'W11016402', 'W11016402', 'UTDT01', 'Willow Creek Dental', 'Danny', NULL, 'Harris', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '8757 Highland Dr', 'Sandy', NULL, 'UT', '84093', '8019470505', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-01', '2010-02-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006592', 0, 'N', 0, '2009-02-11', NULL, NULL, 0, 0, NULL, NULL),
('611438956', 'W11016403', 'W11016403', 'UTDT01', '', 'Clint', '', 'Iverson', 'DMD', 'Dentist', '', '', NULL, 'O', '1770 E 5625 S Ste B', 'Ogden', 'Weber', 'UT', '84403', '8014751999', NULL, '1770 E 5625 S Ste B', 'Ogden', 'Weber', 'UT', '84403', '8014751999', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006884', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('263762308', 'W11016404', 'W11016404', 'UTDT01', '', 'Robert', '', 'Johnson', 'DDS', 'Dentist', '', '', NULL, 'O', '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', NULL, '6017 Fashion Point Dr', 'Ogden', 'Weber', 'UT', '84403', '8014755155', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006975', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870621575', 'W11016405', 'W11016405', 'UTDT01', '', 'Samuel', '', 'Knight', 'DDS', 'Dentist', '', '', NULL, 'O', '1761 N 2000 W', 'Far West', '', 'UT', '84404', '8017313200', NULL, '1761 N 2000 W', 'Far West', '', 'UT', '84404', '8017313200', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '1083705149', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('263812607', 'W11016406', 'W11016406', 'UTDT01', 'Iverson & Larsen Dental', 'Paul', '', 'Larsen', 'DMD', 'Dentist', '', '', NULL, 'O', '2627 N Hwy 162', 'Eden', 'Weber', 'UT', '84310', '8017453882', NULL, '2627 N Hwy 162', 'Eden', 'Weber', 'UT', '84310', '8017453882', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'DEN|', '1184742264', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('263903795', 'W11016407', 'W11016407', 'UTDT01', 'Oral & Maxillofacial Surgeons of Utah', 'Todd', '', 'Liston', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '3590 Harrison Blvd Ste 2 Dental', 'Ogden', 'Weber', 'UT', '84403', '8013927176', NULL, '3590 Harrison Blvd Ste 2 Dental', 'Ogden', 'Weber', 'UT', '84403', '8013927176', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2009-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'DEN|', '1598835506', 0, 'N', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870353458', 'W11016408', 'W11016408', 'UTDT01', '', 'Thomas', '', 'Ludlow', 'DDS', 'Dentist', '', '', NULL, 'O', '850 E 300 S Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013550380', NULL, '850 E 300 S Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013550380', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007353', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('263194321', 'W11016409', 'W11016409', 'UTDT01', '', 'David', '', 'McGowen', 'DDS', 'Dentist', '', '', NULL, 'O', '154 E Myrtle Ave Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8015908786', NULL, '154 E Myrtle Ave Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8015908786', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007517', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('263163065', 'W11016410', 'W11016410', 'UTDT01', '', 'Adam', '', 'McLachlan', 'DDS', 'Dentist', '', '', NULL, 'O', '154 E Myrtle Ave Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8015908150', NULL, '154 E Myrtle Ave Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8015908150', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007526', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('528399714', 'W11016411', 'W11016411', 'UTDT01', '', 'Jonathan', '', 'Miles', 'DDS', 'Dentist', '', '', NULL, 'O', '510 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633266', NULL, '510 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633266', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007606', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870549520', 'W11016412', 'W11016412', 'UTDT01', 'Willow Creek Dental', 'Derek', NULL, 'Morris', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '8757 Highland Dr', 'Sandy', NULL, 'UT', '84093', '8019470505', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'UT000A', NULL, NULL, '0.00', '20.00', '0.00', 8, '2009-01-01', '2010-02-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000007702', 0, 'N', 0, '2009-07-09', NULL, NULL, 0, 0, NULL, NULL),
('611438956', 'W11016413', 'W11016413', 'UTDT01', '', 'Brett', '', 'Moyes', 'DDS', 'Dentist', '', '', NULL, 'O', '1770 E 5625 S Ste B', 'Ogden', 'Weber', 'UT', '84403', '8014751999', NULL, '1770 E 5625 S Ste B', 'Ogden', 'Weber', 'UT', '84403', '8014751999', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007751', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('470882266', 'W11016414', 'W11016414', 'UTDT01', '', 'Douglas', NULL, 'Petersen', 'DMD', 'Dentist', '', '', NULL, 'O', '310 N 400 E', 'Nephi', '', 'UT', '84648', '4356231918', NULL, '310 N 400 E', 'Nephi', '', 'UT', '84648', '4356231918', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000008151', 0, 'N', 0, '2009-02-11', NULL, NULL, 0, 0, NULL, NULL),
('680143975', 'W11016415', 'W11016415', 'UTDT01', '', 'Ashton', '', 'Prince', 'DMD', 'Dentist', '', '', NULL, 'O', '144 W Brigham Rd', 'St George', 'Washington', 'UT', '84790', '4356568003', NULL, '144 W Brigham Rd', 'St George', 'Washington', 'UT', '84790', '4356568003', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008263', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W11016416', 'W11016416', 'UTDT01', 'Monarch Dental', 'Tyler', '', 'Reading', 'DMD', 'Pedodontist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008337', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W11016417', 'W11016417', 'UTDT01', 'Monarch Dental', 'Tyler', '', 'Reading', 'DMD', 'Pedodontist', '', '', NULL, 'O', '5419 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008337', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('262785814', 'W11016418', 'W11016418', 'UTDT01', '', 'Jeffrey', '', 'Rupp', 'DMD', 'Pedodontist', '', '', NULL, 'O', '1955 S 1300 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014631900', NULL, '1955 S 1300 E Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014631900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008510', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870577275', 'W11016419', 'W11016419', 'UTDT01', 'Sorensen Dental Care', 'Terry', '', 'Sorensen', 'DMD', 'Dentist', '', '', NULL, 'O', '12569 S 2700 W Ste 100', 'Riverton', '', 'UT', '84065', '8012547272', NULL, '12569 S 2700 W Ste 100', 'Riverton', '', 'UT', '84065', '8012547272', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-02-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'DEN|', '0000008815', 0, 'N', 0, '2010-10-12', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W11016420', 'W11016420', 'UTDT01', 'Stonehaven Dental', 'Brett', NULL, 'Tobler', 'DMD', 'Dentist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000009112', 0, 'N', 0, '2009-02-11', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W11016421', 'W11016421', 'UTDT01', 'Stonehaven Dental', 'Eric', '', 'Tobler', 'DMD', 'Dentist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000009113', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W11016422', 'W11016422', 'UTDT01', 'Stonehaven Dental', 'Nathan', NULL, 'Tobler', 'DMD', 'Dentist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', '', 'UT', '84043', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000009114', 0, 'N', 0, '2009-02-11', 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
('870383546', 'W11016423', 'W11016423', 'UTDT01', '', 'Randy', '', 'Webb', 'DDS', 'Dentist', '', '', NULL, 'O', '1434 E 9400 S Ste 206', 'Sandy', 'Salt Lake', 'UT', '84093', '8015710063', NULL, '1434 E 9400 S Ste 206', 'Sandy', 'Salt Lake', 'UT', '84093', '8015710063', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2009-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000009546', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('201943877', 'W11016424', 'W11016424', 'WY01', 'Sheridan Neurology', 'Thomas', 'O', 'Mayer', 'MD', 'Neurology', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2009-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813930', 0, 'N', 0, '2013-06-17', NULL, NULL, 44.8106, -106.988, NULL, NULL),
('201943877', 'W11016425', 'W11016425', 'WY01', 'Sheridan Neurology', 'Thomas', 'O', 'Mayer', 'MD', 'Neurology', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076736300', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076736300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2009-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813930', 0, 'N', 0, '2013-06-17', NULL, NULL, 44.3496, -106.705, NULL, NULL),
('261739588', 'W11016426', 'W11016426', 'WY01', 'Cloud Peak Sleep Specialist ', '', '', 'Cloud Peak Sleep Specialist LLC', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2009-02-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003029', 0, 'n', 0, '2011-06-10', NULL, NULL, 44.8106, -106.988, NULL, NULL),
('510511480', 'W11016427', 'W11016427', 'UTMH1', 'PATHWAYS . . . A Counseling and Learning Center, Inc.', 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1104 E Ashton St Ste  114', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015588650', NULL, '1104 E Ashton St Ste  114', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015588650', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('261636582', 'W11016428', 'W11016428', 'UT01', 'Mt View Foot Clinic', 'Steven', 'P', 'Royall', 'DPM', 'Podiatry', '', '', NULL, 'O', '3900 S 617 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013646444', NULL, '3900 S 617 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013646444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-12', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962442822', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('263647055', 'W11016432', 'W11016432', 'ID02', 'Embrace Wellness', 'Tammy', 'L', 'Hadfield', 'NP', 'Gynecology', '', '', NULL, 'B', 'PO Box 819', 'Eagle', 'Ada', 'ID', '83616', '2082878400', NULL, 'PO Box 819', 'Eagle', 'Ada', 'ID', '83616', '2082878400', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-15', '2013-07-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1457456022', 0, 'N', 0, '2013-10-01', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'W11016501', 'W11016501', 'UT01', '', 'Corey', '', 'Bowden', 'DC', 'Chiropractic', '', '', NULL, 'O', '938 S University Park Blvd', 'Clearfield', 'Davis', 'UT', '84015', '8017734130', NULL, '938 S University Park Blvd', 'Clearfield', 'Davis', 'UT', '84015', '8017734130', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-01-14', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063639359', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11016502', 'W11016502', 'UT01', '', 'John', 'Robert', 'Sorenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', NULL, '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-01-12', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918686', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016504', 'W11016504', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Gregory', 'H', 'Bean', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-02-06', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629069695', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016505', 'W11016505', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Robert', '', 'Aagard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1477661379', 0, 'N', 0, '2012-03-08', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016506', 'W11016506', 'UT01', 'Valley Obstetrics & Gynecology PC', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2012-03-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016507', 'W11016507', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Brent', '', 'Lind', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184732018', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016508', 'W11016508', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2012-03-08', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016509', 'W11016509', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Ryan', 'C', 'Ollerton', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528275898', 0, 'N', 0, '2012-03-12', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11016510', 'W11016510', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Kelli', '', 'Parker', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861615296', 0, 'Y', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016511', 'W11016511', 'ID02', 'Valley Family Health Care', 'Shirley', 'M', 'Murata', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-02-02', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639108350', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016512', 'W11016512', 'ID02', 'Valley Family Health Care', 'Shirley', 'M', 'Murata', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1441 NE 10th Ave', 'Payette', 'Payette', 'ID', '83661', '2086429376', NULL, '1441 NE 10th Ave', 'Payette', 'Payette', 'ID', '83661', '2086429376', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-02-02', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639108350', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11016513', 'W11016513', 'UT01', 'University Health Care', 'Christopher', 'B', 'Dechet', 'MD', 'Urology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538271861', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11016514', 'W11016514', 'UT01', 'University Health Care', 'James', 'B', 'Meeks', 'PA', 'Urology', 'Emergency Medicine', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '8015883307', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '8015883307', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-24', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023057460', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11016515', 'W11016515', 'UT01', 'University Health Care', 'James', 'B', 'Meeks', 'PA', 'Urology', 'Emergency Medicine', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016625555', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016625555', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-24', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023057460', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11016516', 'W11016516', 'UT01', 'University Health Care', 'Christopher', 'B', 'Dechet', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016625555', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8016625555', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538271861', 0, 'Y', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('262388378', 'W11016517', 'W11016517', 'UT01', 'Utah Endocrinology Associates PLLC', 'Tausha', 'M', 'Jensen', 'APRN', 'Endocrinology', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225297542', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('262388378', 'W11016518', 'W11016518', 'UT01', 'Utah Endocrinology Associates PLLC', 'Alireza', '', 'Falahati-Nini', 'MD', 'Endocrinology', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', '470 E 3900 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417989971', 0, 'n', 0, '2012-04-16', NULL, NULL, 40.6871, -111.878, NULL, NULL),
('800223062', 'W11016519', 'W11016519', 'UT01', 'Brigham Center for Womens Health', 'Daniel', 'R', 'Ferguson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', NULL, '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2010-08-31', 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194802991', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('800223062', 'W11016520', 'W11016520', 'UT01', 'Brigham Center for Womens Health', 'Daniel', 'R', 'Ferguson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', NULL, 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2010-08-31', 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194802991', 0, 'y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820423387', 'W11016521', 'W11016521', 'ID02', 'MRI Mobile', '', '', 'MRI Mobile', 'GROUP', 'Imaging Center', 'Diagnostic Radiology', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728105', '          ', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728105', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881649234', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W11016522', 'W11016522', 'UT01', 'Utah State University for Persons with Disabilities Biomedic', 'Stephen', 'D', 'Schneider', 'MD', 'Pediatrics', '', '', NULL, 'O', '6802 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357972750', NULL, '6802 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357972750', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-02-20', '2013-10-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962412353', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('565910003', 'W11016523', 'W11016523', 'UTMH1', 'Counseling & Assessments', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', NULL, '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-13', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'n', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('565910003', 'W11016524', 'W11016524', 'UTMH1', 'Counseling & Assessments', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', NULL, 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-13', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'y', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('204009858', 'W11016525', 'W11016525', 'UT01', 'Aspen Dermatology', 'Chad', 'R', 'Peterson', 'DO', 'Dermatology', NULL, NULL, NULL, 'O', '114 E 800 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941490', NULL, '114 E 800 N', 'Spanish Fork', 'Utah', 'UT', '84660', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-20', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821299751', 0, 'N', 0, '2009-02-20', NULL, NULL, 40.1201, -111.653, NULL, NULL),
('382084239', 'W11016526', 'W11016526', 'TX01', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3338 Oakwell Ct Ste 208', 'San Antonio', 'Bexar', 'TX', '78218', '2018828636', NULL, '3338 Oakwell Ct Ste 208', 'San Antonio', 'Bexar', 'TX', '78218', '2018828636', '', 'WUQUEST5', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008294', 0, 'N', 0, '2013-10-15', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('382084239', 'W11016527', 'W11016527', 'TX01', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7579 N Loop 1604 W Ste 200', 'San Antonio', 'Bexar', 'TX', '78249', '2106952093', NULL, '7579 N Loop 1604 W Ste 200', 'San Antonio', 'Bexar', 'TX', '78249', '2106952093', '', 'WUQUEST5', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008294', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'W11016528', 'W11016528', 'TX01', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11212 State Hwy 151 Medical Plaza 1 Ste 210', 'San Antonio', 'Bexar', 'TX', '78251', '2106802248', NULL, '11212 State Hwy 151 Medical Plaza 1 Ste 210', 'San Antonio', 'Bexar', 'TX', '78251', '2106802248', '', 'WUQUEST5', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008294', 0, 'N', 0, '2013-10-15', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('870281028', 'W11016529', 'W11016529', 'UT01', 'Cascade Family Medicine', 'Steven', 'L', 'Berry', 'MD', 'Family Practice', '', '', NULL, 'O', '137 N 400 W Ste C11', 'Orem', 'Utah', 'UT', '84057', '8018027373', NULL, '137 N 400 W Ste C11', 'Orem', 'Utah', 'UT', '84057', '8018027373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-02-06', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528095312', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('043742679', 'W11016530', 'W11016530', 'ID02', NULL, 'Russell', 'H', 'Griffiths', 'MD', 'Pediatric Plastic Surgery', 'Plastic Surgery', '', NULL, 'O', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083812222', NULL, '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083812222', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-02-01', '2009-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326079609', 0, 'n', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('043742679', 'W11016531', 'W11016531', 'ID02', NULL, 'Russell', 'H', 'Griffiths', 'MD', 'Pediatric Plastic Surgery', 'Plastic Surgery', '', NULL, 'O', '100 E Idaho St Ste 303', 'Boise', 'Ada', 'ID', '83712', '2084331736', NULL, '100 E Idaho St Ste 303', 'Boise', 'Ada', 'ID', '83712', '2084331736', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-02-01', '2009-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326079609', 0, 'n', 0, '2012-02-13', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('043742679', 'W11016532', 'W11016532', 'ID02', NULL, 'Russell', 'H', 'Griffiths', 'MD', 'Pediatric Plastic Surgery', 'Plastic Surgery', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2084331736', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2084331736', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-02-01', '2009-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326079609', 0, 'n', 0, '2012-02-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('261747001', 'W11016533', 'W11016533', 'ID02', 'Jon R Gray Chiropractic Center', 'Jon', 'R', 'Gray', 'DC', 'Chiropractic', '', '', NULL, 'O', '13125 Persimmion Ln Ste 175', 'Boise', 'Ada', 'ID', '83713', '2088540600', NULL, '13125 Persimmion Ln Ste 175', 'Boise', 'Ada', 'ID', '83713', '2088540600', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-02-06', '2010-07-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558377168', 0, 'N', 0, '2013-05-21', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W11016534', 'W11016534', 'WY01', 'Yellowstone Behavioral Health Center', 'Christine', '', 'Esposito', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-02-06', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013157197', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('830216112', 'W11016537', 'W11016537', 'WY01', 'Lander Medical Clinic', 'Jan', '', 'Siebersma', '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', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-03-06', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952303216', 0, 'n', 0, '2012-02-08', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('263770372', 'W11016538', 'W11016538', 'ID02', '', 'Amy', 'E', 'Latta', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '7154 W State St Ste 106', 'Boise', 'Ada', 'ID', '83714', '2082508939', '2082293099', '7154 W State St Ste 106', 'Boise', 'Ada', 'ID', '83714', '2082508939', '2082293099', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2009-02-06', '2012-02-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750536264', 0, 'Y', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11016577', 'W11016577', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'David', 'W', 'Agler', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', NULL, '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-02-01', '2009-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1427109321', 0, 'n', 0, '2009-02-25', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('943459248', 'W11016539', 'W11016539', 'UT01', 'Fox Therapy LLC', 'Heidi', 'S', 'Fox', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '901 S Orem Blvd', 'Orem', 'Utah', 'UT', '84058', '8013108342', NULL, '304 Elmwood', 'Orem', 'Utah', 'UT', '84057', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245290345', 0, 'n', 0, '2009-02-23', NULL, NULL, 0, 0, NULL, NULL),
('943459248', 'W11016540', 'W11016540', 'UT01', 'Fox Therapy LLC', 'Heidi', 'S', 'Fox', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', 'PO Box 50356', 'Provo', 'Utah', 'UT', '84605', '8013108342', NULL, '304 Elmwood', 'Orem', 'Utah', 'UT', '84057', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245290345', 0, 'y', 0, '2009-02-23', NULL, NULL, 0, 0, NULL, NULL),
('481299019', 'W11016541', 'W11016541', 'ID01', 'Cornerstone Psychological Associates PLLC', 'Terrie', 'J', 'Towle', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', NULL, '1755 Westgate Dr Ste 260', 'Boise', 'Ada', 'ID', '83704', '2083730790', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-02-06', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689656308', 0, 'n', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870552351', 'W11016542', 'W11016542', 'UTMH1', '', 'Eva', '', 'Beatty', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '115 W 200 S Ste 7', 'Moab', 'Grand', 'UT', '84532', '4352602324', NULL, '115 W 200 S Ste 7', 'Moab', 'Grand', 'UT', '84532', '4352602324', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-02-06', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346462363', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'W11016543', 'W11016543', 'UT01', 'Millcreek Womens Center', 'Camille', '', 'Stevenson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659522472', 0, 'N', 0, '2012-02-14', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('742719352', 'W11016544', 'W11016544', 'TX01', 'Urology of San Antonio', 'George', 'D', 'Case', 'MD', 'Urology', '', '', NULL, 'O', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', NULL, '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-02-06', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639267867', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
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('742719352', 'W11016550', 'W11016550', 'TX01', 'Urology of San Antonio', 'Lewis', 'F', 'Russell', 'MD', 'Urology', '', '', NULL, 'O', '128 W Bandera', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', NULL, '128 W Bandera', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-02-06', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1760596415', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.7807, -98.7308, NULL, NULL),
('742719352', 'W11016551', 'W11016551', 'TX01', 'Urology of San Antonio', 'Lewis', 'F', 'Russell', 'MD', 'Urology', '', '', NULL, 'B', '7909 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', NULL, '7909 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-02-06', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1760596415', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
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('528624487', 'W11016555', 'W11016555', 'UTMH1', 'Alternate Billing c/o Mary Bybe', 'M', 'M', 'Green', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014768885', NULL, 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014768885', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-02-23', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780771147', 0, 'Y', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
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('800239738', 'W11016557', 'W11016557', 'UT01', 'Jordan Family Health LLC', 'Caryn', 'M', 'Slack', 'MD', '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, '2009-02-06', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'y', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11016558', 'W11016558', 'UT01', 'Jordan Family Health LLC', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11016559', 'W11016559', 'UT01', 'Jordan Family Health LLC', 'Judith', 'L', 'Kirstein', 'MD', '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, '2009-02-06', '2010-08-31', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11016560', 'W11016560', 'UT01', 'Jordan Family Health LLC', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', '2010-08-31', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('721545000', 'W11016561', 'W11016561', 'UT01', 'Dinosaurland Pediatrics', 'Willis', 'Manford', 'Gooch', 'MD', 'Pediatrics', '', '', NULL, 'O', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-02-24', '2010-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508040015', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11016562', 'W11016562', 'UT01', 'Mountain Land Salt Lake Downtown', 'Oryslava', '', 'Sorensen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '508 E S Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015219222', '8015720696', '508 E S Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015219222', '8015720696', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-12-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881859767', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11016564', 'W11016564', 'UT01', 'Physical Therapy @ Kilmball Junction', 'Dan', 'S', 'Ivie', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6531 N Landmark Dr Ste E', 'Kimball Junction', 'Summit', 'UT', '84098', '4356497335', '8015720696', '6531 N Landmark Dr Ste E', 'Kimball Junction', 'Summit', 'UT', '84098', '4356497335', '8015720696', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-01-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861484131', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11016565', 'W11016565', 'UT01', 'MLR Medical Park', 'Quinn', '', 'Christensen', 'OT', 'Physical Therapy', '', '', NULL, 'O', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4353732781', '8015720696', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4353732781', '8015720696', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-12-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972691749', 0, 'N', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'W11016602', 'W11016602', 'UT01', 'Ogden Clinic', 'Kimberly', 'E', 'Beck', 'MD', 'Family Practice', '', '', NULL, 'O', '6112 S 1550 E', 'South Ogden', 'Weber', 'UT', '84405', '8014753800', NULL, '6112 S 1550 E', 'South Ogden', 'Weber', 'UT', '84405', '8014753800', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-03-01', '2012-10-12', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1700814803', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('432051652', 'W11016603', 'W11016603', 'ID02', 'Idaho Spine and Sports Chiropractic', 'Kendrick', 'L', 'Tweedt', 'DC', 'Chiropractic', '', '', NULL, 'O', '8725 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', NULL, '8725 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-02-11', '2012-02-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528142007', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11016604', 'W11016604', 'UTMH1', 'LDS Family Services', 'Karson', 'S', 'Kinikini', 'LCSW', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396896858', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11016605', 'W11016605', 'UTMH1', 'LDS Family Services', 'Karson', 'S', 'Kinikini', 'LCSW', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', NULL, '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396896858', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11016606', 'W11016606', 'UTMH1', 'LDS Family Services', 'Marilyn', '', 'Stephens-Burton', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013160860', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('320271992', 'W11016607', 'W11016607', 'UTMH1', '', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015015444', NULL, '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015015444', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2012-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('820558600', 'W11016608', 'W11016608', 'ID02', 'The Eye Site', 'Ana', 'D', 'Nielson', 'OD', 'Optometry', '', '', NULL, 'O', '2320 E Gala St Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2088980304', NULL, '2320 E Gala St Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2088980304', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2013-08-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972547503', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('742358801', 'W11016609', 'W11016609', 'TX01', 'Childrens Heart Network', 'Christopher', 'L', 'Curzon', 'DO', '', '', '', NULL, 'B', 'PO Box 2137', 'San Antonio', 'Bexar', 'TX', '78297', '2103417722', NULL, 'PO Box 2137', 'San Antonio', 'Bexar', 'TX', '78297', '2103417722', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-03-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952582074', 0, 'Y', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
('742358801', 'W11016610', 'W11016610', 'TX01', 'Childrens Heart Network', 'Christopher', 'L', 'Curzon', 'DO', '', '', '', NULL, 'O', '1901 Babcock Rd Ste 301', 'San Antonio', 'Bexar', 'TX', '78229', '2103417722', NULL, '1901 Babcock Rd Ste 301', 'San Antonio', 'Bexar', 'TX', '78229', '2103417722', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-03-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952582074', 0, 'N', 0, '2011-07-14', 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
('742358801', 'W11016611', 'W11016611', 'TX01', 'Childrens Heart Network', 'Christopher', 'L', 'Curzon', 'DO', '', '', '', NULL, 'O', '333 N Santa Rosa St', 'San Antonio', 'Bexar', 'TX', '78207', '2103417722', NULL, '333 N Santa Rosa St', 'San Antonio', 'Bexar', 'TX', '78207', '2103417722', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-03-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952582074', 0, 'N', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
('820558600', 'W11016612', 'W11016612', 'ID02', 'The Eye Site', 'Ryan', 'E', 'Nielson', 'OD', 'Optometry', '', '', NULL, 'O', '2320 E Gala St Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2088980304', NULL, '2320 E Gala St Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2088980304', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2013-08-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538103148', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W11016613', 'W11016613', 'UT01', 'Mountain Star Pediatrics', 'Jan', 'M', 'Castro', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235335944', 0, 'N', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W11016614', 'W11016614', 'UT01', 'Mountain Star Pediatrics', 'David', 'F', 'Castro', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427254135', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('510557896', 'W11016615', 'W11016615', 'ID02', 'Idaho Spine & Sports Chiropractic', 'Stephen', 'K', 'Burtenshaw', 'DC', 'Chiropractic', '', '', NULL, 'O', '8752 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', NULL, '8752 W Overland Rd Ste 110', 'Boise', 'Ada', 'ID', '83709', '2083232833', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2011-04-20', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386652691', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('481297403', 'W11016616', 'W11016616', 'UT01', 'Mountain West Family Practice', 'Melinda', NULL, 'Powell', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', NULL, '1929 N Aaron Dr', 'Tooele', 'Tooele', 'UT', '84074', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336385707', 0, 'N', 0, '2009-03-03', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870290108', 'W11016617', 'W11016617', 'UT01', 'St George Clinic', 'Curtis', '', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356746065', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356746065', '4356738557', 'WUSTGEIPA', 'WUSTDHCPC', NULL, '0.00', '25.00', '0.00', 3, '2009-03-01', '2010-02-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245225325', 0, 'N', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('820466781', 'W11016618', 'W11016618', 'ID02', 'Mountain States Counseling', 'Mark', 'E', 'Snow', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', NULL, '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023162682', 0, 'n', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W11016619', 'W11016619', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'O', '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', NULL, '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2010-08-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W11016620', 'W11016620', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'B', 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', NULL, 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2010-08-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'y', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830260066', 'W11016621', 'W11016621', 'WY01', NULL, 'Vernon', 'W', 'Miller', 'MD', 'General Surgery', '', '', NULL, 'O', '112 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642141', NULL, '112 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642141', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447256888', 0, 'n', 0, '2012-02-14', NULL, NULL, 43.6474, -108.201, NULL, NULL),
('760843953', 'W11016622', 'W11016622', 'UT01', 'Seraphine Medical', 'Robert', 'W', 'Gneiting', 'NP', 'Family Practice', '', '', NULL, 'O', '6216 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84125', '8019636966', NULL, '6216 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84125', '8019636966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2011-06-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225105919', 0, 'N', 0, '2012-03-02', NULL, NULL, 0, 0, NULL, NULL),
('760843953', 'W11016623', 'W11016623', 'UT01', 'Seraphine Medical', 'John', 'M', 'Menello', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019636966', NULL, 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019636966', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2009-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013084789', 0, 'y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('760843953', 'W11016624', 'W11016624', 'UT01', 'Seraphine Medical', 'Robert', 'W', 'Gneiting', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019636966', NULL, 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019636966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2011-06-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225105919', 0, 'N', 0, '2012-03-02', NULL, NULL, 0, 0, NULL, NULL),
('760843953', 'W11016625', 'W11016625', 'UT01', 'Seraphine Medical', 'John', 'M', 'Menello', 'MD', 'Family Practice', '', '', NULL, 'O', '6216 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8019636966', NULL, '6216 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8019636966', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2009-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013084789', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('542387570', 'W11016626', 'W11016626', 'UTMH1', NULL, 'Clyde', 'D', 'Elliott', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', NULL, '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2013-02-14', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124138631', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('542387570', 'W11016627', 'W11016627', 'UTMH1', NULL, 'Clyde', 'D', 'Elliott', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 3163', 'Ogden', 'Weber', 'UT', '84409', '8014750712', NULL, 'PO Box 3163', 'Ogden', 'Weber', 'UT', '84409', '8014750712', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-03-01', '2013-02-14', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124138631', 0, 'y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('260018312', 'W11016628', 'W11016628', 'UT01', '', 'Gilbert', 'R', 'Escandon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '620 S 400 E Ste 201', 'St George', 'Washington', 'UT', '84770', '4356562995', NULL, '620 S 400 E Ste 201', 'St George', 'Washington', 'UT', '84770', '4356562995', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2011-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194760769', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016629', 'W11016629', 'UTPEHP', 'IHC Life Flight', NULL, NULL, 'IHC Life Flight', 'GROUP', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '2086784444', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '12.00', '0.00', 8, '2008-07-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006846', 0, 'Y', 0, '2009-11-17', NULL, NULL, 0, 0, NULL, NULL),
('731631366', 'W11016640', 'W11016640', 'WY01', 'Rehab Authority', 'Heather', 'J', 'Martinson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', NULL, '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-06', '2010-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366630402', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('731631366', 'W11016639', 'W11016639', 'WY01', 'Rehab Authority', 'Dustin', 'D', 'Martinson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', NULL, '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-06', '2010-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073701116', 0, 'N', 0, '2011-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W11016638', 'W11016638', 'WY01', 'Lander Medical Clinic', 'Douglas', '', 'Phipps', '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, '2009-03-06', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1508952276', 0, 'N', 0, '2014-04-11', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830317319', 'W11016637', 'W11016637', 'WY01', 'Fremont Pediatrics', 'Richard', '', 'Barnes', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-03-06', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1174616122', 0, 'n', 0, '2012-06-04', NULL, NULL, 42.8233, -108.73, NULL, NULL),
('830219655', 'W11016636', 'W11016636', 'WY01', 'Gem City Bone and Joint', 'William', 'S', 'Bodemer', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3076325889', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3076325889', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2009-03-06', '2009-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497705370', 0, 'y', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'w11016709', 'w11016709', 'UTIHC03', 'Maternal Fetal Medicine', 'Donna', 'S', 'Dizon-Townson', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811918097', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'w11016710', 'w11016710', 'UTIHC03', 'Genetics', 'Katherine', 'R', 'Dunn', 'PA', 'Mental Health', 'Genetic Counseling', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659534394', 0, 'Y', 0, '2011-01-05', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'w11016712', 'w11016712', 'UTIHC03', 'Physical Therapy', 'Stephanie', NULL, 'Heinhold', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-12-28', '2010-01-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760629836', 0, 'Y', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
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('721528517', 'W11016718', 'W11016718', 'ID02', 'Pioneer Family Medicine', 'Aaron', 'D', 'Moorhouse', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', '2089383663', NULL, '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-03-13', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689602914', 0, 'n', 0, '2009-03-13', NULL, NULL, 0, 0, NULL, NULL),
('721528517', 'W11016719', 'W11016719', 'ID02', 'Pioneer Family Medicine', 'Jason', 'S', 'Ludwig', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', '2089383663', NULL, '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-03-13', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144258534', 0, 'n', 0, '2009-03-13', NULL, NULL, 0, 0, NULL, NULL),
('330239910', 'W11016720', 'W11016720', 'WY01', 'Alliance Healthcare Services', '', '', 'Alliance Healthcare Services ', 'GROUP', 'Imaging Center', '', '', NULL, 'O', '625 E Broadway St', 'Jackson', 'Teton', 'WY', '83001', '8005300912', NULL, '625 E Broadway St', 'Jackson', 'Teton', 'WY', '83001', '8005300912', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134303845', 0, 'N', 0, '2013-06-18', NULL, NULL, 43.48, -110.765, NULL, NULL),
('264071234', 'W11016721', 'W11016721', 'UTMH1', 'Harmony Family Therapy', 'Nancy', 'M', 'Sutton', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '90 W 200 S Ste 2', 'Heber City', 'Wasatch', 'UT', '84032', '4356544406', NULL, '90 W 200 S Ste 2', 'Heber City', 'Wasatch', 'UT', '84032', '4356544406', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2009-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962554154', 0, 'n', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11016723', 'W11016723', 'ID02', 'Primary Health Medical Group', 'Duard', 'P', 'Spruce', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-03-15', '2012-04-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912952730', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11016722', 'W11016722', 'ID02', 'Primary Health Medical Group', 'Duard', 'P', 'Spruce', 'MD', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', NULL, '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-03-15', '2012-04-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912952730', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('942854057', 'W11016724', 'W11016724', 'UTIHCPHY', 'Southwest Neurology Associates', 'Luciana', NULL, 'De Saibro', 'MD', 'Neurology', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-02-17', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033175765', 0, 'N', 0, '2009-05-15', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W11016725', 'W11016725', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Evan', 'T', 'Excell', 'PA-C', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-09-29', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932359569', 0, 'N', 0, '2011-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016726', 'W11016726', 'UTIHCPHY', 'Dixie Hospitalists', 'Sarah', 'West', 'Wu', 'MD', '', 'Hospitalists', '', 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, '2009-02-02', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285773218', 0, 'N', 0, '2011-09-26', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11016727', 'W11016727', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', 'Ernest', 'Brett', 'Horsley', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003826439', 0, 'N', 0, '2010-04-23', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W11016728', 'W11016728', 'UTPEHP', 'Avenues Midwifery', 'Sandae', NULL, 'Bonare', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-08-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841363306', 0, 'N', 0, '2009-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016729', 'W11016729', 'UTPEHP', 'Southwest Neurology Associates', 'Luciana', NULL, 'De Saibro', 'MD', 'Neurology', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84709', '4352513950', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84709', '4352513950', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-02-17', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033175765', 0, 'N', 0, '2012-10-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016730', 'W11016730', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Evan', 'T', 'Excell', 'PA-C', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-09-29', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932359569', 0, 'N', 0, '2011-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016731', 'W11016731', 'UTPEHP', 'Avenues Midwifery', 'Gretchen', 'Thorn', 'Faucett', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', NULL, '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477647741', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016732', 'W11016732', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Deborah', 'Ruth', 'Flansburg', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-09-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538231808', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016733', 'W11016733', 'UTPEHP', 'Avenues Midwifery', 'Diane', 'D', 'Heubusch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', NULL, '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962449306', 0, 'N', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016734', 'W11016734', 'UTPEHP', 'Avenues Midwifery', 'Nancy', 'Jaye', 'Mooy', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '324 10th Ave Ste 184', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014081440', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-08-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013902212', 0, 'N', 0, '2009-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016735', 'W11016735', 'UTPEHP', 'Dixie Hospitalists', 'Sarah', 'West', 'Wu', 'MD', '', 'Hospitalists', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-02-02', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285773218', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W11016736', 'W11016736', 'IDREC', 'St Lukes Pediatrics Endocrinology (Recognized PPO but not contracted pre-auth required)', 'Mike', 'T', 'Swinyard', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817340', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817340', '', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1245222819', 0, 'N', 0, '2014-07-02', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('870384752', 'W11016737', 'W11016737', 'UTPEHP', 'Central Utah Physical Therapy', 'Daniel', 'J', 'Bruse', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '80 E 1000 N Ste A', 'Richfield', NULL, 'UT', '84701', '4358966653', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, 'PEHPPREF2', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-03-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861406514', 0, 'N', 0, '2009-03-19', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W11016749', 'W11016749', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8014921611', NULL, 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491222', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11016748', 'W11016748', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '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, 40.5602, -111.939, NULL, NULL),
('870639098', 'W11016747', 'W11016747', 'UT01', 'After Hours Medical Company', 'Jamie', 'L', 'Rosquist', 'PA', 'Urgent Care', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8014921611', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '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, 40.5284, -111.859, NULL, NULL),
('870639098', 'W11016746', 'W11016746', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', 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', 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, 40.5284, -111.859, NULL, NULL),
('870639098', 'W11016745', 'W11016745', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', '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', 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, 41.0825, -111.993, NULL, NULL),
('870639098', 'W11016744', 'W11016744', 'UT01', 'After Hours Medical Company', 'Tasha', 'E', 'Sabino', 'PA', 'Urgent Care', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', NULL, 'ME', '04915', '8015428222', NULL, 'PO Box 8476', 'Belfast', '', 'ME', '04915', '8015428222', '', '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, 0, 0, NULL, NULL),
('876114073', 'W11016750', 'W11016750', 'UTMH1', 'The Childrens Center', 'Jessica', 'L', 'Singleton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2009-02-02', '2012-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093831372', 0, 'N', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11016751', 'W11016751', 'UTMH1', 'The Childrens Center', 'Jessica', 'L', 'Singleton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019664251', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2009-02-02', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093831372', 0, 'N', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'W11016752', 'W11016752', 'UT01', 'OB/Gyn Associates LC', 'A', 'V', 'O''Neal', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', NULL, '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1639326119', 0, 'N', 0, '2009-03-19', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870618776', 'W11016753', 'W11016753', 'UT01', 'Gamma West Brachytherapy', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'N', 0, '2012-02-16', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870618776', 'W11016754', 'W11016754', 'UT01', 'Gamma West Brachytherapy', 'Mark', 'W', 'Reilly', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 30015 Dept 15', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013598956', NULL, 'PO Box 30015 Dept 15', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013598956', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1699799981', 0, 'y', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('263534210', 'W11016755', 'W11016755', 'UT01', 'Advanced Family Medicine', 'Robert', 'W', 'Welker', 'MD', 'Family Practice', '', '', NULL, 'O', '195 W Telegraph Ste 3', 'Washington', 'Washington', 'UT', '84780', '4356284444', NULL, '195 W Telegraph Ste 3', 'Washington', 'Washington', 'UT', '84780', '4356284444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-02-06', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1740278183', 0, 'N', 0, '2012-04-18', NULL, NULL, 37.1302, -113.513, NULL, NULL),
('870532738', 'W11016756', 'W11016756', 'UT01', 'Davis Family Physicians', 'Lane', 'O', 'Heder', 'PA', 'Family Practice', '', '', NULL, 'O', '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2011-03-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083641286', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'W11016757', 'W11016757', 'UT01', 'Davis Family Physicians', 'Gavin', 'N', 'Vanstaden', 'MD', 'Family Practice', '', '', NULL, 'O', '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', '2009-08-24', 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1841380433', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('870532738', 'W11016758', 'W11016758', 'UT01', 'Davis Family Physicians', 'Rohn', 'C', 'Rigby', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017737232', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2011-09-13', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437283553', 0, 'N', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'W11016759', 'W11016759', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Jennifer', '', 'Wright-Bennion', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', NULL, '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', '2009-12-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1982618559', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'W11016760', 'W11016760', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Jessica', 'L', 'Haddy', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', NULL, '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538894', 0, 'N', 0, '2010-07-06', NULL, NULL, 0, 0, NULL, NULL),
('611566873', 'W11016761', 'W11016761', 'ID02', 'Idaho Allergy', 'Stephen', 'B', 'Fritz', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '379 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089383443', NULL, '379 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089383443', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1881799963', 0, 'n', 0, '2012-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870674767', 'W11016762', 'W11016762', 'UT01', '', 'Gregory', 'E', 'Anderson', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1395 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357555000', NULL, '1395 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357555000', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-03-15', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1619192424', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7574, -111.824, NULL, NULL),
('870674767', 'W11016763', 'W11016763', 'UT01', '', 'Gregory', 'E', 'Anderson', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1335 S Main St Ste 102', 'Garland', 'Box Elder', 'UT', '84312', '4357555000', NULL, '1335 S Main St Ste 102', 'Garland', 'Box Elder', 'UT', '84312', '4357555000', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-03-15', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1619192424', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7273, -112.162, NULL, NULL),
('204572113', 'W11016764', 'W11016764', 'UT01', 'Dixie Opthalmic Specialists & Laser Eye Center', 'William', 'R', 'Barlow', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1085 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356882020', NULL, '1085 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356882020', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-03-15', '2010-02-22', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265534853', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('204572113', 'W11016765', 'W11016765', 'UT01', 'Dixie Opthalmic Specialists & Laser Eye Center', 'William', 'R', 'Barlow', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 11', 'Mesquite', 'Clark', 'NV', '89027', '4356882020', NULL, '1301 Bertha Howe Ave Ste 11', 'Mesquite', 'Clark', 'NV', '89027', '4356882020', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-03-15', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265534853', 0, 'N', 0, '2012-04-12', NULL, NULL, 36.8087, -114.115, NULL, NULL),
('870516264', 'W11016766', 'W11016766', 'UT01', 'Utah County Surgical Associates', 'Scott', '', 'Bramble', 'PA-C', '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, '2009-03-15', '2012-09-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598913022', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('412057748', 'W11016767', 'W11016767', 'UT01', 'Utah Pain and Rehab', 'Catherine', 'M', 'Harmston', 'NP', 'Pain Management', '', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639283302', 0, 'n', 0, '2012-05-24', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('412057748', 'W11016768', 'W11016768', 'UT01', 'Utah Pain and Rehab', 'Billi', NULL, 'Stephens', 'PA', 'Pain Management', NULL, NULL, NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851480982', 0, 'n', 0, '2009-03-20', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('412057748', 'W11016769', 'W11016769', 'UT01', 'Utah Pain and Rehab', 'Christian', 'C', 'Obah', 'MD', 'Pain Management', 'Anesthesiology', NULL, NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912959008', 0, 'n', 0, '2012-05-08', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('870676756', 'W11016770', 'W11016770', 'UT01', NULL, 'Sandra', 'L', 'Van Leuven', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 876', 'Price', 'Carbon', 'UT', '84501', '4356450800', NULL, 'PO Box 876', 'Price', 'Carbon', 'UT', '84501', '4356450800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1538109715', 0, 'Y', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870676756', 'W11016771', 'W11016771', 'UT01', '', 'Sandra', 'L', 'Van Leuven', 'MD', 'Family Practice', '', '', NULL, 'O', '1777 Sun Peak Dr Ste 150', 'Park City', 'Summit', 'UT', '84098', '4356450800', NULL, '1777 Sun Peak Dr Ste 150', 'Park City', 'Summit', 'UT', '84098', '4356450800', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2011-10-17', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1538109715', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870566422', 'W11016772', 'W11016772', 'UT01', NULL, 'Christine', 'S', 'Osborne', 'AUD', 'Audiology', '', '', NULL, 'O', '8017 Royal Ln', 'Sandy', 'Salt Lake', 'UT', '84093', '8016529854', NULL, '8017 Royal Ln', 'Sandy', 'Salt Lake', 'UT', '84093', '8016529854', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093880312', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.6046, -111.822, NULL, NULL),
('870566422', 'W11016773', 'W11016773', 'UT01', NULL, 'Christine', 'S', 'Osborne', 'AUD', 'Audiology', '', '', NULL, 'B', 'PO Box 971', 'Kaysville', 'Davis', 'UT', '84037', '8016529854', NULL, 'PO Box 971', 'Kaysville', 'Davis', 'UT', '84037', '8016529854', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093880312', 0, 'Y', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W11016774', 'W11016774', 'UT01', 'Stephen D Ratcliffe Clinic', 'Gabriela', 'V', 'Cetrola', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '          ', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2012-11-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962460790', 0, 'N', 0, '2014-04-11', NULL, NULL, 40.791, -111.931, NULL, NULL),
('742412898', 'W11016775', 'W11016775', 'UT01', 'Oquirrh View Clinic', 'Gabriela', 'V', 'Cetrola', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '          ', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2012-11-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962460790', 0, 'N', 0, '2014-04-11', NULL, NULL, 40.6664, -111.967, NULL, NULL),
('742412898', 'W11016776', 'W11016776', 'UT01', 'Community Health Centers', 'Gabriela', 'V', 'Cetrola', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-15', '2012-11-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962460790', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870217443', 'W11016802', 'W11016802', 'UT01', 'Carbon Medical Services', 'Glori', 'M', 'Allen', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'B', 'PO Box 930', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884441', NULL, 'PO Box 930', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-23', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1801824297', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870217443', 'W11016803', 'W11016803', 'UT01', 'Carbon Medical Services', 'Glori', 'M', 'Allen', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'O', '305 Ctr St', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884411', NULL, '305 Ctr St', 'East Carbon City', 'Carbon', 'UT', '84520', '4358884411', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-03-23', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1801824297', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870217443', 'W11016804', 'W11016804', 'UT01', 'Carbon Medical Services', 'Glori', 'M', 'Allen', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'O', '125 S Main St', 'Helper', 'Carbon', 'UT', '84526', '4354727000', NULL, '125 S Main St', 'Helper', 'Carbon', 'UT', '84526', '4354727000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-23', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1801824297', 0, 'N', 0, '2014-02-05', NULL, NULL, 39.6902, -110.855, NULL, NULL),
('481200844', 'W11016805', 'W11016805', 'WY01', 'Christian Counseling Center', 'Kay', '', 'Cartee', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '829 Belinda Dr', 'Riverton', 'Fremont', 'WY', '82501', '3076900661', NULL, '829 Belinda Dr', 'Riverton', 'Fremont', 'WY', '82501', '3076900661', '', 'WYPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-03-23', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508020553', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('826000428', 'W11016806', 'W11016806', 'UT01', 'Malad Valley Clinic Dept Oneida County Hospital', 'Stephen', 'C', 'Johnson', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 167', 'Malad City', 'Oneida', 'ID', '83252', '2087662267', NULL, 'PO Box 167', 'Malad City', 'Oneida', 'ID', '83252', '2087662267', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-01-01', '2010-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427041201', 0, 'Y', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('201896120', 'W11016808', 'W11016808', 'UT01', 'Medical Associates of Salt Lake', 'Nancy', 'L', 'McLaughlin', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-03-18', '2010-03-17', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1184633661', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11016827', 'W11016827', 'UT01', 'Davis Internal Medicine', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8017737500', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8017737500', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-02-03', '2009-01-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11016833', 'W11016833', 'UT01', 'Comprehensive Neurology of Utah', 'Mohammad', '', 'Shoari', 'MD', 'Neurology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013641117', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013641117', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-02-03', NULL, 0, 0, 0, 'Davis Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1740483395', 0, 'y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11016835', 'W11016835', 'UT01', 'South Valley Urology', 'Patrick', 'V', 'Hewitt', 'PA', 'Urology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015660204', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015660204', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-02-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1750360053', 0, 'y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W11016841', 'W11016841', 'UT01', 'Salt Lake Senior Clinic', 'Sonal', 'S', 'Thakur', 'MD', 'Geriatrics', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504602', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Fulton', 'UT', '84095', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-02-03', '2009-10-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831353226', 0, 'y', 0, '2009-03-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11016842', 'W11016842', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Stuart', 'Charles', 'Marshall', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-02-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447204821', 0, 'N', 0, '2011-10-11', NULL, NULL, 40.5879, -111.976, NULL, NULL),
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('742915297', 'W11016883', 'W11016883', 'TX01', 'South Texas Oncology and Hematology', 'Anthony', '', 'Tolcher', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184627663', 0, 'y', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'W11016888', 'W11016888', 'UT01', NULL, 'Christopher', 'E', 'Palmer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '124 W Main St', 'Enterprise', 'Washington', 'UT', '84725', '4355724977', '4357506290', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-02-02', '2009-02-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659539369', 0, 'N', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11016889', 'W11016889', 'UT01', 'Ogden Internal Medicine & Urology', 'Joseph', 'A', 'Conrad', 'MD', 'Geriatrics', 'Pulmonary', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-04-06', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164502662', 0, 'N', 0, '2010-11-19', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11016890', 'W11016890', 'UT01', 'Ogden Internal Medicine & Urology', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758686', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758686', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-04-06', '2009-09-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'n', 0, '2014-07-10', 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
('830317319', 'W11016891', 'W11016891', 'WY01', 'Fremont Pediatrics', 'Mary', '', 'Barnes', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '', '', NULL, '', '0.00', '10.00', '0.00', 3, '2009-03-31', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1679674246', 0, 'n', 0, '2014-05-14', NULL, NULL, 42.8233, -108.73, NULL, NULL),
('202099145', 'W11016892', 'W11016892', 'WY01', 'Worland Surgery Clinic', 'Gerald', 'E', 'Weaver', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'O', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472405', NULL, '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472405', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-03-31', '2012-11-30', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1952333221', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11016893', 'W11016893', 'WY01', 'Billings Clinic - Orthopedics & Sports Medicine', 'Blaine', NULL, 'Etzel', 'PA-C', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4066573782', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881686590', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11016894', 'W11016894', 'WY01', 'Billings Clinic - Peds', 'Kathryn', NULL, 'Lysinger', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154477750', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016895', 'W11016895', 'UT01', 'Intermountain Anesthesia', 'James', NULL, 'Harned', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006584', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016896', 'W11016896', 'UT01', 'Intermountain Anesthesia', 'Ronald', NULL, 'Yardley', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009699', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016897', 'W11016897', 'UT01', 'Intermountain Anesthesia', 'Sharon', NULL, 'Stewart', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215032081', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016898', 'W11016898', 'UT01', 'Intermountain Anesthesia', 'Matthew', NULL, 'Guercio', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982712709', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016899', 'W11016899', 'UT01', 'Intermountain Anesthesia', 'Andrew', NULL, 'Miller', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007612', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W11016900', 'W11016900', 'UT01', 'Intermountain Anesthesia', 'Brett', NULL, 'Hays', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '', NULL, '1000', '41.23', '0.00', '0.00', 6, '2007-12-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006624', 0, 'Y', 0, '2009-03-31', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11016901', 'W11016901', 'WY01', 'Billings Clinic - Peds', 'Karen', NULL, 'Breetz', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-07-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679778328', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11016902', 'W11016902', 'WY01', 'Billings Clinic - Radiology', 'Zachary', NULL, 'Bland', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467664235', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('621762468', 'W11016903', 'W11016903', 'WYWSBAIT', 'SageWest Health Care', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Rehabilitation Hospital', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2009-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295153591', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('621823043', 'W11016904', 'W11016904', 'WYPROMPT', 'Lander Valley Medical Center', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Hospital', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', '', '', '', '0.00', '5.00', '0.00', 3, '2009-04-15', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245337286', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('621762468', 'W11016905', 'W11016905', 'WYPROMPT', 'Riverton Memorial Hospital', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Rehabilitation Hospital', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '', '', '', '', '0.00', '5.00', '0.00', 3, '2009-04-15', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295153591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621823043', 'W11016906', 'W11016906', 'WYWSBAIT', 'Lander Valley Medical Center', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Hospital', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '          ', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-04-01', '2014-04-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245337286', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11016907', 'W11016907', 'WY01', 'Billings Clinic - Hospitalist', 'Shelly', '', 'Basye', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558569475', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11016908', 'W11016908', 'UT01', 'University Health Care', 'David', 'G', 'Owen', '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, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154411775', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11016909', 'W11016909', 'UT01', 'University Health Care', 'David', 'G', 'Owen', 'MD', 'Family Practice', '', '', NULL, 'o', '1138 E Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 E Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154411775', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11016910', 'W11016910', 'UT01', 'University Health Care', 'David', 'G', 'Owen', '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, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154411775', 0, 'Y', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11016985', 'W11016985', 'UTPEHP', 'Heart Failure Clinic', 'Abdallah', 'G', 'Kfoury', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014085319', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134132681', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016986', 'W11016986', 'UTPEHP', 'Adult Psychiatric', 'James', 'L', 'Kimball', 'MD', 'Psychiatry', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081038', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538211859', 0, 'N', 0, '2009-04-06', 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
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('942854057', 'W11016988', 'W11016988', 'UTPEHP', 'N/A', 'Bert', 'K', 'Lopansri', 'MD', 'Infectious Diseases', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014425228', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538261292', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016989', 'W11016989', 'UTPEHP', 'Adult Psychiatric', 'Louis', 'Alan', 'Moench', 'MD', 'Psychiatry', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081038', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154419083', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016990', 'W11016990', 'UTPEHP', '', 'Mary', 'G', 'Mooers', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014425228', NULL, '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014425228', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609823889', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016991', 'W11016991', 'UTPEHP', 'Cardiology', 'Margaret', 'G', 'Moses', 'APRN', 'Advanced Practice Registered Nurse', NULL, NULL, NULL, 'O', '8th Ave C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386691434', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016992', 'W11016992', 'UTPEHP', NULL, 'James', 'E', 'Pearl', 'MD', 'Internal Medicine', 'Pulmonary', 'Emergency Medicine', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', NULL, '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1417959206', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016993', 'W11016993', 'UTPEHP', 'Bone Marrow', 'Finn', 'B', 'Petersen', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', NULL, '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225164114', 0, 'N', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016994', 'W11016994', 'UTPEHP', 'Adult Psychiatric', 'Daniel', 'C', 'Rapp', 'MD', 'Psychiatry', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081038', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265528723', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016995', 'W11016995', 'UTPEHP', 'N/A', 'Brad', 'Y', 'Rasmusson', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346254091', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016996', 'W11016996', 'UTPEHP', 'Heart Failure Clinic', 'Kismet', 'D', 'Rasmusson', 'APRN', 'Advanced Practice Registered Nurse', NULL, NULL, NULL, 'O', '324 10th Ave Ste 218', 'Salt Lake City', NULL, 'UT', '84103', '8014088128', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265441059', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016997', 'W11016997', 'UTPEHP', 'Heart Failure Clinic', 'Dale', 'G', 'Renlund', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014085319', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508873209', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016998', 'W11016998', 'UTPEHP', 'N/A', 'Hildegard', 'K', 'Smith', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003820754', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016999', 'W11016999', 'UTPEHP', 'Trauma', 'Mark', 'H', 'Stevens', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770504953', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017000', 'W11017000', 'UTPEHP', 'Liver Transplant', 'I', 'R', 'Thomason', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', NULL, '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014081100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1649282542', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017001', 'W11017001', 'UTPEHP', 'Heart Failure Clinic', 'KayeLynn', NULL, 'VanWagenen', 'APRN', 'Advanced Practice Registered Nurse', NULL, NULL, NULL, 'O', '324 10th Ave Ste 218', 'Salt Lake City', NULL, 'UT', '84103', '8014088128', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215944913', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017002', 'W11017002', 'UTPEHP', 'Adult Psychiatric', 'Alisa', 'B', 'Von Riotte', 'MD', 'Psychiatry', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081038', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932201670', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017003', 'W11017003', 'UTPEHP', 'Inpatient Psych', 'Theodore', 'J', 'Wander', 'MD', 'Psychiatry', NULL, NULL, NULL, 'O', '8th Ave & C St Ste 5 North', 'Salt Lake City', NULL, 'UT', '84103', '8014081038', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730281478', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017004', 'W11017004', 'UTPEHP', 'EKG', 'Larry', 'J', 'Wright', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'O', '8th Ave & C St', 'Salt Lake City', NULL, 'UT', '84143', '8014081100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447270541', 0, 'N', 0, '2009-04-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017008', 'W11017008', 'UTIHC04', NULL, 'Stephen', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'o', '1000 N Mail St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, '1000 N Mail St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336185784', 0, 'Y', 0, '2010-08-21', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W11017007', 'W11017007', 'UTIHC04', NULL, 'Stephen', 'D', 'Brown', 'MD', 'Radiologist', '', '', 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, '2008-12-31', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336185784', 0, 'Y', 0, '2010-08-21', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W11017009', 'W11017009', 'UTIHC04', 'Neuropsychology', 'Robert', 'B', 'Burr', 'PhD', 'Psychology', 'Neuropsychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306895677', 0, 'Y', 0, '2014-06-18', NULL, NULL, 40.7585, -111.872, NULL, NULL),
('942854057', 'W11017010', 'W11017010', 'UTIHC04', NULL, 'Paul', 'David', 'Colte', 'PsyD', 'Mental Health', 'Psychology', NULL, NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624552', 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|', '1912055229', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017011', 'W11017011', 'UTIHC04', NULL, 'Tyler', 'L', 'Crawford', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, NULL, NULL, 'Millard', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629029319', 0, 'Y', 0, '2009-11-16', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11017012', 'W11017012', 'UTIHC04', NULL, 'Tyler', 'L', 'Crawford', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, NULL, NULL, 'Sanpete', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629029319', 0, 'Y', 0, '2009-11-16', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W11017013', 'W11017013', 'UTIHC04', NULL, 'Tyler', 'L', 'Crawford', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629029319', 0, 'Y', 0, '2009-11-16', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W11017014', 'W11017014', 'UTIHC04', NULL, 'Ronald', 'W', 'Day', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780763359', 0, 'N', 0, '2013-07-08', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11017015', 'W11017015', 'UTIHC04', '', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012653092', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012653092', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'Y', 0, '2014-06-18', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('942854057', 'W11017019', 'W11017019', 'UTIHC04', NULL, 'Theresa', 'A', 'Golley', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'o', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2009-03-02', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558502385', 0, 'Y', 0, '2009-04-15', NULL, NULL, 40.6675, -111.983, NULL, NULL),
('942854057', 'W11017020', 'W11017020', 'UTIHC04', NULL, 'Marsha', '', 'Hardman-Lundell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2006-01-01', '2008-05-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245248368', 0, 'Y', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11017022', 'W11017022', 'UTIHC04', '', 'William', 'Daniel', 'Jackson', 'MD', 'Pediatric Gastroenterology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622900', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', '2013-08-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417036088', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W11017078', 'W11017078', 'ID01', 'Saint Alphonsus Employee Assistance Program', 'Kevin', '', 'Geraghty', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '6140 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673300', '          ', '6140 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673300', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-03-10', '2015-03-10', 0, 0, 0, '', '', '', '', 'HCFA|', '1710900949', 0, 'Y', 0, '2014-04-15', NULL, NULL, 43.6118, -116.258, NULL, NULL),
('942854057', 'W11017079', 'W11017079', 'UTIHC01', '', 'Deborah', 'A', 'Bilder', 'MD', 'Mental Health', 'Psychiatry', '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', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', '2013-04-25', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427084615', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017080', 'W11017080', 'UTIHC01', NULL, 'Stephen', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'o', '1000 N Mail St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, '1000 N Mail St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336185784', 0, 'Y', 0, '2010-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017081', 'W11017081', 'UTIHC01', '', 'Robert', 'B', 'Burr', 'PhD', 'Psychology', 'Neuropsychology', '', NULL, 'o', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2009-03-05', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306895677', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11017083', 'W11017083', 'UTIHC01', NULL, 'Tyler', 'L', 'Crawford', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968271', NULL, NULL, NULL, 'Sevier', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629029319', 0, 'Y', 0, '2009-11-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017084', 'W11017084', 'UTIHC01', '', 'Ronald', 'W', 'Day', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780763359', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017085', 'W11017085', 'UTIHC01', '', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012653092', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012653092', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11017086', 'W11017086', 'UTIHC01', '', 'Richard', 'C', 'Ferre', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012705100', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012705100', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-05-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548283302', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL);
