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
('205633889', 'W12021407', 'W12021407', 'UTMH1', 'Center For Change', 'Delores', '', 'Stewart', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 970205', 'Orem', 'Utah', 'UT', '84097', '8012289900', '8012282550', 'PO Box 970205', 'Orem', 'Utah', 'UT', '84097', '8012289900', '8012282550', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659490795', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('205633889', 'W12021406', 'W12021406', 'UTMH1', 'Center For Change', 'Delores', '', 'Stewart', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '573 W 1830 N Ste 4', 'Orem', 'Utah', 'UT', '84057', '8012289900', '8012282550', '573 W 1830 N Ste 4', 'Orem', 'Utah', 'UT', '84057', '8012289900', '8012282550', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659490795', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.331, -111.71, NULL, NULL),
('455064842', 'W12021410', 'W12021410', 'UTMH1', 'Autism and Psychological Services for Children and Families, P LLC', 'Lori', '', 'Lichte-Brill', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2290 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017197036', NULL, '2290 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017197036', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902139603', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12021411', 'W12021411', 'UT01', 'Granger Medical West Jordan ', 'Jared', '', 'Mathis', 'PA', 'Pain Management', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497908008', 0, 'N', 0, '2013-04-02', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12021412', 'W12021412', 'UT01', 'Granger Medical Park City', 'Jared', '', 'Mathis', 'PA', 'Pain Management', '', '', NULL, 'O', '1600 Snow Creek Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', NULL, '1600 Snow Creek Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497908008', 0, 'N', 0, '2013-04-02', NULL, NULL, 40.662, -111.511, NULL, NULL),
('870284475', 'W12021413', 'W12021413', 'UT01', 'Granger Medical Tooele', 'Jared', '', 'Mathis', 'PA', 'Pain Management', '', '', NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', NULL, '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497908008', 0, 'N', 0, '2013-04-02', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870284475', 'W12021414', 'W12021414', 'UT01', 'Granger Medical West Jordan ', 'Jared', '', 'Mathis', 'PA', 'Pain Management', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497908008', 0, 'N', 0, '2013-04-02', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W12021419', 'W12021419', 'UT01', 'University of Utah General Pediatrics', '', '', 'University of Utah Dept of General Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812205', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812205', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009284', 0, 'N', 0, '2012-11-30', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870476269', 'W12021417', 'W12021417', 'UT01', 'Department of Pediatrics University of Utah', '', '', 'University of Utah Dept of Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009306', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W12021418', 'W12021418', 'UT01', 'Department of Pediatrics University of Utah', '', '', 'University of Utah Dept of Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '50 N Medical', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009306', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870645559', 'W12021420', 'W12021420', 'UT01', 'University of Utah General Pediatrics', '', '', 'University of Utah Dept of General Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812205', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812205', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009284', 0, 'N', 0, '2012-11-30', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12021421', 'W12021421', 'UT01', 'University Radiology Associates', '', '', 'University Radiology Associates', 'GROUP', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009332', 0, 'N', 0, '2012-08-02', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('237268471', 'W12021422', 'W12021422', 'UT01', 'University Radiology Associates', '', '', 'University Radiology Associates', 'GROUP', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009332', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W12021423', 'W12021423', 'UT01', 'U of U Pediatric Orthopedics', '', '', 'U of U pediatric Orthopedics', 'GROUP', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, '100 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009248', 0, 'N', 0, '2012-08-02', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870645895', 'W12021424', 'W12021424', 'ID01', 'U of U Pediatric Orthopedics', '', '', 'U of U pediatric Orthopedics', 'GROUP', 'Pediatric Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009248', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('452098247', 'W12021425', 'W12021425', 'UT01', 'University of Utah Neuro-Ophthalmology', '', '', 'University of Utah Neuro-Ophthalmology', 'Group', 'Clinics', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821380759', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('452098247', 'W12021426', 'W12021426', 'UT01', 'University Health Care', '', '', 'University of Utah Neuro-Ophthalmology', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821380759', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('800765107', 'W12021427', 'W12021427', 'UT01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('800765107', 'W12021428', 'W12021428', 'UT01', 'University of Utah Uveitis', '', '', 'University of Utah Uveitis', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235406372', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12021432', 'W12021432', 'UT01', 'Mountain Land Movement Specialists Salt Lake    ', 'Samuel', 'Andrew', 'Maw', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1153 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012626331', '8012623372', '1153 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012626331', '8012623372', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053670638', 0, 'N', 0, '2012-08-02', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870574059', 'W12021433', 'W12021433', 'UT01', 'Mountain Land Movement Specialists Salt Lake    ', 'Samuel', 'Andrew', 'Maw', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8012626331', '8012623372', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8012626331', '8012623372', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053670638', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('061655757', 'W12021436', 'W12021436', 'UT01', 'MountainTop Physical Therapy & Wellness Center Inc', 'Preston', 'B', 'Hall', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1794 Olympic Pkwy Ste 140', 'Park City', 'Summit', 'UT', '84098', '4355750345', '4355750346', '1794 Olympic Pkwy Ste 140', 'Park City', 'Summit', 'UT', '84098', '4355750345', '4355750346', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1386747707', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.723, -111.48, NULL, NULL),
('061655757', 'W12021437', 'W12021437', 'UT01', 'MountainTop Physical Therapy & Wellness Center Inc', 'Stacy', '', 'McCooey', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1794 Olympic Pkwy Ste 140', 'Park City', 'Summit', 'UT', '84098', '4355750345', '4355750346', '1794 Olympic Pkwy Ste 140', 'Park City', 'Summit', 'UT', '84098', '4355750345', '4355750346', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1841393295', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.723, -111.48, NULL, NULL),
('451683899', 'W12021439', 'W12021439', 'UT01', 'Orthopaedic Therapy and Sports Performance ', 'Marc', 'Shaw', 'Larson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1030 S Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4355385111', '4357871913', '1030 S Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4355385111', '4357871913', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093939761', 0, 'N', 0, '2012-08-03', NULL, NULL, 41.488, -112.027, NULL, NULL),
('451683899', 'W12021440', 'W12021440', 'UT01', 'Orthopaedic Therapy and Sports Performance ', 'Marc', 'Shaw', 'Larson', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 739', 'Brigham City', 'Box Elder', 'UT', '84302', '4355385111', '4357871913', 'PO Box 739', 'Brigham City', 'Box Elder', 'UT', '84302', '4355385111', '4357871913', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093939761', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('454102852', 'W12021445', 'W12021445', 'UTDT01', 'Family Smiles Dental', 'Lance D', '', 'Crowther', 'DDS', 'Dentist', '', '', NULL, 'O', '1148 E Hwy 193', 'Layton', 'Davis', 'UT', '84040', '8017714505', NULL, '1148 E Hwy 193', 'Layton', 'Davis', 'UT', '84040', '8017714505', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005846', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('452163028', 'W12021446', 'W12021446', 'WY01', 'Rocky Mountain Womens Health ', 'John', 'W', 'Mercer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1205988540', 0, 'N', 0, '2012-08-06', NULL, NULL, 43.0307, -108.417, NULL, NULL),
('452163028', 'W12021447', 'W12021447', 'WYT2', 'Rocky Mountain Womens Health ', 'John', 'W', 'Mercer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1205988540', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006344', 'W12006344', 'UT01', 'Now Care Clinic', 'Shiloh', 'D', 'Manning', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739386', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739386', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972536001', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006343', 'W12006343', 'UT01', 'Now Care Clinic', 'Shiloh', 'D', 'Manning', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972536001', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006345', 'W12006345', 'UT01', 'Now Care Clinic', 'Shiloh', 'D', 'Manning', 'NP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972536001', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12020775', 'W12020775', 'ID02', 'Primary Health Medical Group', 'Matthew', 'J', 'May', 'MD', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-09-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1255387908', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('202630141', 'W12020776', 'W12020776', 'ID02', 'Primary Health Medical Group', 'Matthew', 'J', 'May', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-09-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1255387908', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12021449', 'W12021449', 'UT01', 'West Valley Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2013-07-31', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12021450', 'W12021450', 'UT01', 'West Valley Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021452', 'W12021452', 'WY01', 'Wyoming Cardiopulmonary Services ', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.8501, -106.309, NULL, NULL),
('830238247', 'W12021453', 'W12021453', 'WYT1', 'Wyoming Cardiopulmonary Services', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021454', 'W12021454', 'WY01', 'Family Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021455', 'W12021455', 'WYT1', 'Family Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021456', 'W12021456', 'WY01', 'Converse County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('830238247', 'W12021457', 'W12021457', 'WYT1', 'Converse County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12021458', 'W12021458', 'IDREC', 'St Lukes Pediatric Cardiology', 'Gregory', 'G', 'Janos', '', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '', '', '', '0.00', '0.00', '0.00', 8, '2012-07-01', '2012-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1336133776', 0, 'N', 1, '2012-08-07', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W12021451', 'W12021451', 'IDREC', 'St Lukes Pediatric Cardiology', 'Diana', '', 'Alexander', '', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '', '', '', '0.00', '0.00', '0.00', 8, '2012-07-01', '2012-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528004702', 0, 'N', 1, '2014-05-22', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('830238247', 'W12021459', 'W12021459', 'WY01', 'Family Health Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830335677', 'W12047442', 'W12047442', 'WY01', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021460', 'W12021460', 'WYT1', 'Family Health Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021461', 'W12021461', 'WY01', 'Lander Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830238247', 'W12021462', 'W12021462', 'WYT1', 'Lander Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021463', 'W12021463', 'WY01', 'Rawhide Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.7626, -104.452, NULL, NULL),
('830238247', 'W12021464', 'W12021464', 'WYT1', 'Rawhide Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021465', 'W12021465', 'WY01', 'Wind River Medical Building', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('830238247', 'W12021466', 'W12021466', 'WYT1', 'Wind River Medical Building', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021468', 'W12021468', 'WY01', 'Carbon County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 41.7866, -107.261, NULL, NULL),
('830238247', 'W12021469', 'W12021469', 'WYT1', 'Caron County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021470', 'W12021470', 'WY01', 'Gottsche Rehabilitation Center', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830238247', 'W12021471', 'W12021471', 'WYT1', 'Gottsche Rehabilitation Center', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021472', 'W12021472', 'WY01', 'Platte County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.0498, -104.96, NULL, NULL),
('830238247', 'W12021473', 'W12021473', 'WYT1', 'Platte County Memorial Hospital', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021474', 'W12021474', 'WY01', 'Worland Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.0168, -107.954, NULL, NULL),
('830238247', 'W12021475', 'W12021475', 'WYT1', 'Worland Medical Clinic', 'Adrian', '', 'Fluture', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1982729802', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('451447444', 'W12021478', 'W12021478', 'UTDT01', 'Bountiful Dental', 'Benjamin', '', 'Hadfield', 'DDS', 'Dentist', '', '', NULL, 'O', '1480 S Orchard Dr Ste 102', 'Bountiful', 'Davis', 'UT', '84010', '8012954551', NULL, '1480 S Orchard Dr Ste 102', 'Bountiful', 'Davis', 'UT', '84010', '8012954551', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009903', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('364712022', 'W12021479', 'W12021479', 'UTDT01', 'West Jordan Modern Dentistry and Orthodontics', 'Dustin', '', 'Hopkins', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '7632 S Campus View Dr', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012824142', NULL, '7632 S Campus View Dr', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012824142', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009811', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('900809888', 'W12021481', 'W12021481', 'UTDT01', 'Midvale Modern Dentistry and Orthodontics', 'Dustin', '', 'Hopkins', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '1144 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015663118', NULL, '1144 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015663118', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009811', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12021489', 'W12021489', 'UTDT01', 'Monarch Dental', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12021488', 'W12021488', 'UTDT01', 'Monarch Dental', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', 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, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12021484', 'W12021484', 'UTDT01', 'Monarch Dental', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12021490', 'W12021490', 'UTDT01', 'Monarch Dental', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12021486', 'W12021486', 'UTDT01', 'Monarch Dental', 'Joshua', '', 'Jeppson', 'DDS', 'Endodontist', '', '', NULL, 'O', '4645 S 4000 W Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019551900', NULL, '4645 S 4000 W Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019551900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578710331', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12021529', 'W12021529', 'WYT1', 'Rawhide Clinic', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021530', 'W12021530', 'WY01', 'Wind River Medical Building', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('830238247', 'W12021531', 'W12021531', 'WYT1', 'Wind River Medical Building', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021532', 'W12021532', 'WY01', 'Carbon County Memorial Hospital', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 41.7866, -107.261, NULL, NULL),
('830238247', 'W12021533', 'W12021533', 'WYT1', 'Carbon County Memorial Hospital', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047444', 'W12047444', 'WY01', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021534', 'W12021534', 'WY01', 'Gottsche Rehabilitation Center', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830238247', 'W12021535', 'W12021535', 'WYT1', 'Gottsche Rehabilitation Center', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021536', 'W12021536', 'WY01', 'Platte County Memorial Hospital', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.0498, -104.96, NULL, NULL),
('830238247', 'W12021537', 'W12021537', 'WYT1', 'Platte County Memorial Hospital', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021538', 'W12021538', 'WY01', 'Worland Medical Clinic', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.0168, -107.954, NULL, NULL),
('830238247', 'W12021539', 'W12021539', 'WYT1', 'Worland Medical Clinic', 'Wesley', 'W', 'Hiser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1760429799', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021540', 'W12021540', 'WY01', 'Wyoming Cardiopulmonary Services, PC', 'Jane ', '', 'Cassel', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072263174', '3072663177', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072263174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-14', '2012-07-14', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1124072616', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021541', 'W12021541', 'WY01', 'Wyoming Cardiopulmonary Services', 'Jane ', '', 'Cassel', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072263174', '3072663177', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072263174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1124072616', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.8501, -106.309, NULL, NULL),
('870550275', 'W12020388', 'W12020388', 'UT01', 'Grow Up Great', 'Jonathan', '', 'Tew', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205977188', 0, 'N', 0, '2012-08-07', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870550275', 'W12020390', 'W12020390', 'UT01', 'Wasatch Pediatrics Inc', 'Jonathan', '', 'Tew', 'MD', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205977188', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12020389', 'W12020389', 'UT01', 'Wasatch Pediatrics, Inc.', 'Jonathan', '', 'Tew', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205977188', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021542', 'W12021542', 'WY01', 'Wyoming Cardiopulmonary Services', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', '2013-12-31', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021544', 'W12021544', 'WY01', 'Family Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021543', 'W12021543', 'WYT1', 'Wyoming Cardiopulmonary Services', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', '2013-12-31', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021545', 'W12021545', 'WYT1', 'Family Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021546', 'W12021546', 'WY01', 'Converse County Memorial Hospital', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('830238247', 'W12021547', 'W12021547', 'WYT1', 'Converse County Memorial Hospital', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021548', 'W12021548', 'WYT1', 'Family Health Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021549', 'W12021549', 'WY01', 'Family Health Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830238247', 'W12021550', 'W12021550', 'WYT1', 'Lander Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021551', 'W12021551', 'WY01', 'Lander Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830238247', 'W12021552', 'W12021552', 'WYT1', 'Rawhide Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021553', 'W12021553', 'WY01', 'Rawhide Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7626, -104.452, NULL, NULL),
('830238247', 'W12021554', 'W12021554', 'WY01', 'Wind River Medical Building', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'Y', 0, '2014-04-01', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('830238247', 'W12021555', 'W12021555', 'WYT1', 'Wind River Medical Building', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021556', 'W12021556', 'WY01', 'Carbon County Memorial Hospital', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 41.7866, -107.261, NULL, NULL),
('830238247', 'W12021557', 'W12021557', 'WYT1', 'Carbon County Memorial Hospital', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021558', 'W12021558', 'WY01', 'Gottsche Rehabilitation Center', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.6474, -108.2, NULL, NULL),
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('830238247', 'W12021560', 'W12021560', 'WYT1', 'Platte County Memorial Hospital', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12021562', 'W12021562', 'WYT1', 'Worland Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021563', 'W12021563', 'WY01', 'Worland Medical Clinic', 'Michael ', 'D', 'Eisenhauer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821064510', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.0168, -107.954, NULL, NULL),
('870526396', 'W12021564', 'W12021564', 'UTMH1', '', 'Joan', 'B', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', NULL, '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730278631', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870526396', 'W12021565', 'W12021565', 'UTMH1', '', 'Joan', 'B', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '672 Bonita Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', NULL, '672 Bonita Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730278631', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12021566', 'W12021566', 'UT01', 'Jordan Parkway Medical Clinic ', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1325 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015083111', '8015083105', '1325 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015083111', '8015083105', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12021567', 'W12021567', 'UT01', 'Physician Group of Utah', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12021570', 'W12021570', 'WYT1', 'Family Medical Clinic', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('270806125', 'W12021571', 'W12021571', 'NM01', 'Breathe America Albuquerque Inc', 'Christopher', 'L', 'Gray', 'PA', 'Allergy and Immunology', '', '', NULL, 'O', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', 'NMALLERGY', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144285065', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('830335677', 'W12047446', 'W12047446', 'WYT1', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12021589', 'W12021589', 'WY01', 'Worland Medical Clinic', 'John ', 'W', 'Pickrell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891748703', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.0168, -107.954, NULL, NULL),
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('830238247', 'W12021592', 'W12021592', 'WY01', 'Wyoming Cardiopulmonary Services', 'Arianne ', 'E', 'Staffileno', 'FNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1184677023', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.8501, -106.309, NULL, NULL),
('830216112', 'W12021593', 'W12021593', 'WY01', 'Lander Medical Clinic', 'Amy ', '', 'Hitshew ', 'PA', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245332337', 0, 'N', 0, '2013-11-14', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830216112', 'W12021594', 'W12021594', 'WY01', 'Lander Medical Clinic', 'Amy ', '', 'Hitshew ', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245332337', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021595', 'W12021595', 'WYT2', 'Lander Medical Clinic', 'Amy ', '', 'Hitshew ', 'PA', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245332337', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021596', 'W12021596', 'WYT2', 'Lander Medical Clinic', 'Amy ', '', 'Hitshew ', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245332337', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021598', 'W12021598', 'WY01', 'Lander Medical Clinic', 'Edward', '', 'Dowie', 'PA', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538969', 0, 'N', 0, '2013-10-30', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830216112', 'W12021599', 'W12021599', 'WY01', 'Lander Medical Clinic', 'Edward', '', 'Dowie', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538969', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('830216112', 'W12021600', 'W12021600', 'WYT2', 'Lander Medical Clinic', 'Edward', '', 'Dowie', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538969', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021604', 'W12021604', 'WY01', 'Lander Medical Clinic', 'Shirley', '', 'Schatza', 'NP', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073811584', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021601', 'W12021601', 'WY01', 'Lander Medical Clinic', 'Shirley', '', 'Schatza', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073811584', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021605', 'W12021605', 'WYT2', 'Lander Medical Clinic', 'Shirley', '', 'Schatza', 'NP', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073811584', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021603', 'W12021603', 'WYT2', 'Lander Medical Clinic', 'Shirley', '', 'Schatza', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', '2013-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073811584', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('270690153', 'W12021606', 'W12021606', 'UT01', 'Peak HealthCare Inc', 'Hollie', 'M', 'Stapley', 'PA-C', 'Family Practice', '', '', NULL, 'O', '590 E 100 N Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356372324', '4356372326', '590 E 100 N Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356372324', '4356372326', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891058061', 0, 'N', 0, '2012-10-12', NULL, NULL, 39.601, -110.8, NULL, NULL),
('202630141', 'W12021220', 'W12021220', 'ID02', 'Primary Health Medical Group ', 'Sonya', 'L', 'Crum', 'NP', 'Family Practice', '', '', NULL, 'O', '435 Eagle Rd Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089398200', NULL, '435 Eagle Rd Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-01', '2013-02-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720341456', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6915, -116.355, NULL, NULL),
('202630141', 'W12021221', 'W12021221', 'ID02', 'Primary Health Medical Group ', 'Sonya', 'L', 'Crum', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089398200', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089398200', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-09-01', '2013-02-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720341456', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021607', 'W12021607', 'WY01', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.8501, -106.309, 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
('830238247', 'W12021608', 'W12021608', 'WYT1', 'Wyoming Cardiopulmonary Services', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021609', 'W12021609', 'WYT1', 'Family Medical Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021610', 'W12021610', 'WY01', 'Family Medical Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021611', 'W12021611', 'WYT1', 'Converse County Memorial Hospital', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021612', 'W12021612', 'WY01', 'Converse County Memorial Hospital', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('830238247', 'W12021613', 'W12021613', 'WY01', 'Family Health Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830238247', 'W12021614', 'W12021614', 'WYT1', 'Family Health Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021615', 'W12021615', 'WYT1', 'Lander Medical Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021616', 'W12021616', 'WY01', 'Lander Medical Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830238247', 'W12021617', 'W12021617', 'WYT1', 'Rawhide Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047447', 'W12047447', 'WYT1', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021618', 'W12021618', 'WY01', 'Rawhide Clinic', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7626, -104.452, NULL, NULL),
('830238247', 'W12021619', 'W12021619', 'WYT1', 'Wind River Medical Building', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021620', 'W12021620', 'WY01', 'Wind River Medical Building', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('830238247', 'W12021621', 'W12021621', 'WY01', 'Carbon County Memorial Hospital', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 41.7866, -107.261, NULL, NULL),
('830238247', 'W12021622', 'W12021622', 'WYT1', 'Carbon County Memorial Hospital', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021623', 'W12021623', 'WYT1', 'Gottsche Rehabilitation Center', 'Robert ', 'A', 'Novick', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1538106554', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
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('830216112', 'W12021710', 'W12021710', 'WY01', 'Lander Medical Clinic', 'Patricia ', '', 'DeClue', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', NULL, 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1467499244', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('830216112', 'W12021711', 'W12021711', 'WYT2', 'Lander Medical Clinic', 'Patricia ', '', 'DeClue', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', NULL, 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1467499244', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('453579890', 'W12021713', 'W12021713', 'Sinclair', 'Lukes Family Pharmacy', '', '', 'Lukes Family Pharmacy ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '21 E Maple St Ste B', 'Hailey', 'Blaine', 'ID', '83333', '2087884970', '2087885791', '21 E Maple St Ste B', 'Hailey', 'Blaine', 'ID', '83333', '2087884970', '2087885791', 'DME9512', '', '', '0.00', '40.00', '0.00', 3, '2012-10-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083985766', 0, 'Y', 0, '2012-10-11', NULL, NULL, 43.5143, -114.31, NULL, NULL),
('383809303', 'W12021720', 'W12021720', 'SACN', 'Serenity Neuropsychology & Counseling', 'Melody', 'L', 'Snider', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088935484', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088935484', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982734984', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12021714', 'W12021714', 'WY01', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'Y', 0, '2013-06-28', NULL, NULL, 43.0337, -108.418, NULL, NULL),
('911753075', 'W12021716', 'W12021716', 'WY01', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'M', '5000 Hopyard Rd Ste 100', 'Pleasanton', 'Alameda', 'CA', '94588', '3078564161', NULL, '5000 Hopyard Rd Ste 100', 'Pleasanton', 'Alameda', 'CA', '94588', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('911753075', 'W12021718', 'W12021718', 'WY01', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12021715', 'W12021715', 'WYT1', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12021717', 'W12021717', 'WYT1', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'M', '5000 Hopyard Rd Ste 100', 'Pleasanton', 'Alameda', 'CA', '94588', '3078564161', NULL, '5000 Hopyard Rd Ste 100', 'Pleasanton', 'Alameda', 'CA', '94588', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('911753075', 'W12021719', 'W12021719', 'WYT1', 'Northwest Emergency Physicians', '', '', 'Northwest Emergency Physicians', '', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', NULL, 'PO Box 634720', 'Cincinnati', 'Hamilton', 'OH', '45263', '3078564161', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235172370', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870638577', 'W12021721', 'W12021721', 'UT01', 'University of Utah Pediatric Ophthalmology', '', '', 'University of Utah Pediatric Ophthalmology', 'GROUP', 'Pediatric Ophthalmology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812352', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812352', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009316', 0, 'N', 0, '2012-08-10', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870638577', 'W12021722', 'W12021722', 'UT01', 'University of Utah Pediatric Ophthalmology', '', '', 'University of Utah Pediatric Ophthalmology', 'GROUP', 'Pediatric Ophthalmology', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009316', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W12021723', 'W12021723', 'UT01', 'John A Moran Eye Center', '', '', 'University of Utah Dept of Ophthalmology', 'GROUP', 'Ophthalmology', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009291', 0, 'N', 0, '2013-02-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876151902', 'W12021724', 'W12021724', 'UT01', 'University of Utah Dept of Ophthalmology', '', '', 'University of Utah Dept of Ophthalmology', 'GROUP', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413075', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009291', 0, 'N', 0, '2012-12-07', NULL, NULL, 0, 0, NULL, NULL),
('529963974', 'W12021725', 'W12021725', 'UT01', 'Richard L Glines MD', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '', '52.50', '35.00', '0.00', 3, '2012-08-15', '2013-06-14', 0, 12, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('529963974', 'W12021726', 'W12021726', 'UT01', 'Richard L Glines MD', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'UTHCAPS', '', '', '54.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 12, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('526714520', 'W12021727', 'W12021727', 'UTMH1', 'Counseling Center of Park City ', 'Leah', 'M', 'Harter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1283 Deer Valley', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', '1283 Deer Valley', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', '', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2014-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760511455', 0, 'N', 0, '2014-06-19', NULL, NULL, 40.6568, -111.504, NULL, NULL),
('526714520', 'W12021728', 'W12021728', 'UTMH1', 'Counseling Center of Park City ', 'Leah', 'M', 'Harter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 683480', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', 'PO Box 683480', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', '', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2014-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760511455', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12021729', 'W12021729', 'UT01', 'Dept of Neurology School of Medicine U of U', '', '', 'Dept of Neurology School of Medicine U of U', 'GROUP', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005954', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12021730', 'W12021730', 'UT01', 'Dept of Neurology School of Medicine U of U', '', '', 'Dept of Neurology School of Medicine U of U', 'GROUP', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005954', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('454855728', 'W12021993', 'W12021993', 'UT01', 'Eastern Idaho Regional Medical Center', 'Andrew', 'H', 'Spencer', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '8017434700', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1467647537', 0, 'N', 0, '2012-09-04', NULL, NULL, 43.4696, -111.99, NULL, NULL),
('455396661', 'W12021733', 'W12021733', 'UTMH1', 'Aspire ', 'Jonathan', 'A', 'Selden', 'NP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', 'MD-3', '', '', '0.00', '35.00', '0.00', 3, '2012-08-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1417199506', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('455396661', 'W12021734', 'W12021734', 'UTMH1', 'Aspire ', 'Jonathan', 'A', 'Selden', 'NP', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 150501', 'Ogden', 'Weber', 'UT', '84415', '8015254645', '8017797808', 'PO Box 150501', 'Ogden', 'Weber', 'UT', '84415', '8015254645', '8017797808', 'MD-3', '', '', '0.00', '35.00', '0.00', 3, '2012-08-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1417199506', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('010885716', 'W12021735', 'W12021735', 'UTMH1', 'Riley Individual Family and Marriage Counseling LLC ', 'James ', 'G', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336317650', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
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('455145519', 'W12021737', 'W12021737', 'WY01', '', 'Cory', 'J', 'Lamblin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '815 E Main', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '3073328206', '815 E Main', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '3073328206', 'WYORTHO2', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396857108', 0, 'N', 0, '2013-06-18', NULL, NULL, 42.8241, -108.718, NULL, NULL),
('455145519', 'W12021738', 'W12021738', 'WYT1', '', 'Cory', 'J', 'Lamblin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '815 E Main', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '3073328206', '815 E Main', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '3073328206', 'WYORTHO2', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396857108', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('271365684', 'W12021741', 'W12021741', 'UTMH1', 'Salt Lake Behavioral Health', 'Kathleen', 'M', 'Acree', 'NP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646070', '3802 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012646000', '8012646070', 'SLBEHAVE', '', '', '0.00', '100.00', '0.00', 8, '2012-10-01', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295066116', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12021739', 'W12021739', 'UTMH1', 'Centered Approach Counseling ', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '4055 S 700 E Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8014507658', '8019055394', '4055 S 700 E Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8014507658', '8019055394', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-06-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12021740', 'W12021740', 'UTMH1', 'Centered Approach Counseling ', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014507658', '8019055394', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014507658', '8019055394', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-06-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006850', 'W40006850', 'UTMH1', 'Valley Mental Health  Inc', 'PAUL C', NULL, 'RASMUSSEN', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760462006', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006849', 'W40006849', 'UTMH1', 'Valley Mental Health  Inc', 'RYAN', 'C', 'RANDALL', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730106212', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('820503498', 'W12021747', 'W12021747', 'ID02', 'Craniofacial  Pain Center of Idaho ', 'Keith', 'L', 'Stucki', 'DMD', 'Sleep Disorders', '', '', NULL, 'O', '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2084639600', '2084613156', '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2084639600', '2084613156', '', '', '', '0.00', '20.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053686485', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('742412898', 'W12021749', 'W12021749', 'UT01', 'Stephen D. Ratcliffe', 'Brian', 'J', 'Sullivan', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8013285750', '8015217463', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8013285750', '8015217463', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-09-03', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1306088943', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12021764', 'W12021764', 'ID01', '', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-06-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
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('820200895', 'W12021766', 'W12021766', 'ID01', '', 'Rhoda', '', 'Linch', 'PAC', 'Family Practice', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-01', '2013-01-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1700164092', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12021767', 'W12021767', 'ID01', '', 'Richard', '', 'Trump', 'PA-C', 'Urgent Care', 'Physician Assistant', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-01', '2012-09-19', 0, 0, 0, '', NULL, '', '', 'HCFA|', '1063601177', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12021768', 'W12021768', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary', 'Cary', '', 'Jackson', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1118 Nw 16th St Ste A', 'Boise', 'Ada', 'ID', '83706', '2084656952', '2084656449', '1118 Nw 16th St Ste A', 'Boise', 'Ada', 'ID', '83706', '2084656952', '2084656449', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12021777', 'W12021777', 'UT01', 'Davis Orthopedics &Sports Medicine  ', 'Rodney', 'G', 'Jay', '', 'Sports Medicine', '', '', NULL, 'O', '2132 N 1700 W Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017733900', '8017733902', '2132 N 1700 W Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017733900', '8017733902', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225201148', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('942854057', 'W12023709', 'W12023709', 'UTIHCPHY', 'IHC Med Grp', '', '', 'IHC Med Grp', '', 'Master', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '          ', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009766', 0, 'Y', 1, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'W12021771', 'W12021771', 'WY01', 'South Lincoln Medical Clinic ', 'Chad', 'W', 'Seiler', 'MD', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '3078779769', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '3078779769', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2014-04-21', 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB', '1215170311', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7896, -110.54, NULL, NULL),
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('850248687', 'W12021774', 'W12021774', 'NM01', 'Dermatology Consultants of ABQ PC ', 'Pitiporn ', '', 'Suwatee', 'MD', 'Dermatology', '', '', NULL, 'O', '8316 Kaseman Ct NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052925850', '5052929724', '8316 Kaseman Ct NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052925850', '5052929724', 'NMSTD+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710073291', 0, 'N', 0, '2012-10-09', NULL, NULL, 35.0925, -106.552, NULL, NULL),
('621801973', 'W12021778', 'W12021778', 'UT01', 'Davis Orthopedics &Sports Medicine  ', 'Rodney', 'G', 'Jay', '', 'Sports Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225201148', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12021784', 'W12021784', 'UTIHC04', '', 'Darin', 'W', 'Bloomfield', '', 'Certified Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1760750368', 0, 'Y', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12021787', 'W12021787', 'UTIHC04', '', 'Scott', 'F', 'Hansen', '', 'Sports Medicine', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014421400', NULL, 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014421400', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1235212192', 0, 'N', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
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('453568119', 'W12021789', 'W12021789', 'ID02', 'Comprehensive Dermatology of Idaho', 'Ryan', 'S', 'Owsley', 'MD', 'Dermatology', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084677546', '2084677500', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084677546', '2084677500', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-02', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1659361681', 0, 'N', 0, '2014-03-26', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('453568119', 'W12021790', 'W12021790', 'ID02', 'Comprehensive Dermatology of Idaho', 'Thad', 'W', 'Wilkey', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '211 Forest St', 'Mccall', 'Valley', 'ID', '83638', '2084677546', '2084677500', '211 Forest St', 'Mccall', 'Valley', 'ID', '83638', '2084677546', '2084677500', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174513188', 0, 'N', 0, '2013-02-21', NULL, NULL, 44.9086, -116.11, NULL, NULL),
('453568119', 'W12021791', 'W12021791', 'ID02', 'Comprehensive Dermatology of Idaho', 'Thad', 'W', 'Wilkey', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084677546', '2084677500', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084677546', '2084677500', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174513188', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820309671', 'W12021793', 'W12021793', 'ID02', 'OB/GYN Associates PA', 'Bryan', '', 'Palmer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-08-02', '2014-07-14', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1730338161', 0, 'N', 0, '2014-07-14', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12021794', 'W12021794', 'ID02', 'OB/GYN Associates PA', 'Bryan', '', 'Palmer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084541065', '3520 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084541065', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-08-02', '2013-09-04', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1730338161', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12019540', 'W12019540', 'UT01', 'Urology Specialists of Utah', 'Ryan', 'D', 'Wight', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3336 S 4155 W Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019554685', '8019630981', '3336 S 4155 W Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019554685', '8019630981', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609028943', 0, 'N', 0, '2012-08-15', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('261891316', 'ELHCA0169', 'ELHCA0169', 'TXHOUSTD', 'Pediatric Heart Specialists of Houston', 'Jose', NULL, 'Quinones', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '450 Medical Ctr Blvd            Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', '450 Medical Ctr Blvd            Ste 600C', 'Webster', 'Harris', 'TX', '77598', '2815544300', '2815544355', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689611378', 0, 'Y', 0, '2014-04-02', NULL, NULL, 29.5413, -95.126, NULL, NULL),
('261891316', 'ELHCA0170', 'ELHCA0170', 'TXHOUSTD', 'Houston Pediatric Specialty Group PLLC', 'Jose', NULL, 'Quinones', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8664016413', 'PO Box 281009      ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8664016413', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689611378', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021798', 'W12021798', 'UTIHC04', 'Dixie Regional Health & Performance Center', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12021799', 'W12021799', 'UTIHC04', 'Dixie Regional Health & Performance Center', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352511000', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12021795', 'W12021795', 'ID02', 'St Lukes Clinic Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12021801', 'W12021801', 'SACN', 'St Lukes Clinic Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12021802', 'W12021802', 'SACN', 'St Lukes Clinic Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('452716222', 'W12021803', 'W12021803', 'SACN', 'St Lukes Clinic Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2084290300', '2084290305', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2084290300', '2084290305', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12021804', 'W12021804', 'ID02', 'St Lukes Clinic Endocrinology', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('452716222', 'W12021805', 'W12021805', 'ID02', 'St Lukes Physician Services', 'Richard', 'B', 'Christensen', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-06-12', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1346272127', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('270300360', 'ELHCA0166', 'ELHCA0166', 'TXHOUSTD', 'General Surgeons of Houston ', 'Don', 'Calfred', 'Quast', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 281527 ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 281527 ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1639164114', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021808', 'W12021808', 'UTIHC01', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021809', 'W12021809', 'UTIHC02', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', NULL, '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021810', 'W12021810', 'UTIHC02', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021811', 'W12021811', 'UTIHC03', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', NULL, '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021812', 'W12021812', 'UTIHC03', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021813', 'W12021813', 'UTIHC04', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021814', 'W12021814', 'UTIHC04', 'Childrens Justice Center', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', NULL, '125 S Main St', 'Farmington', 'Davis', 'UT', '84025', '8014513560', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 40.9783, -111.888, NULL, NULL),
('942854057', 'W12021815', 'W12021815', 'UTIHC01', 'Safe and Healthy Families', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021816', 'W12021816', 'UTIHC02', 'Safe and Healthy Families', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021817', 'W12021817', 'UTIHC03', 'Safe and Healthy Families', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021818', 'W12021818', 'UTIHC04', 'Safe and Healthy Families', 'Karen', 'R', 'Stilling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623601', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1821002262', 0, 'N', 0, '2012-08-15', NULL, NULL, 40.7585, -111.872, NULL, NULL),
('942854057', 'W12021820', 'W12021820', 'UTIHC04', '', 'Critt', 'F', 'Aardema', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891003265', 0, 'N', 0, '2014-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021821', 'W12021821', 'UTIHC04', '', 'Critt', 'F', 'Aardema', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891003265', 0, 'N', 0, '2014-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021823', 'W12021823', 'UTIHC04', '', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578889465', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021824', 'W12021824', 'UTIHC04', '', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'O', '126 S White Sage Ave ', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '126 S White Sage Ave ', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578889465', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021825', 'W12021825', 'UTIHC04', '', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'O', '674 S Hwy 99 ', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99 ', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578889465', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021826', 'W12021826', 'UTIHC04', '', 'Sarah', 'M', 'Andrews', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-07-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578889465', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021828', 'W12021828', 'UTIHC01', '', 'Stefanie', 'M', 'Azevedo', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780939744', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021829', 'W12021829', 'UTIHC02', '', 'Stefanie', 'M', 'Azevedo', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780939744', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021830', 'W12021830', 'UTIHC03', '', 'Stefanie', 'M', 'Azevedo', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780939744', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12021831', 'W12021831', 'UTIHC04', '', 'Stefanie', 'M', 'Azevedo', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780939744', 0, 'N', 0, '2012-08-17', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('830238247', 'W12021877', 'W12021877', 'WY01', 'Family Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021883', 'W12021883', 'WY01', 'Converse County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7594, -105.381, NULL, NULL),
('830238247', 'W12021884', 'W12021884', 'WYT1', 'Converse County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '111 S 5th', 'Douglas', 'Converse', 'WY', '82633', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021885', 'W12021885', 'WY01', 'Family Health Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.29, -105.521, NULL, NULL),
('830238247', 'W12021886', 'W12021886', 'WYT1', 'Family Health Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '407 S Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021887', 'W12021887', 'WY01', 'Lander Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.8251, -108.73, NULL, NULL),
('830238247', 'W12021888', 'W12021888', 'WYT1', 'Lander Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021889', 'W12021889', 'WY01', 'Rawhide Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.7626, -104.452, NULL, NULL),
('830238247', 'W12021890', 'W12021890', 'WYT1', 'Rawhide Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '921 S Ballancee Ave', 'Lusk', 'Niobrara', 'WY', '82225', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021891', 'W12021891', 'WY01', 'Wind River Medical Building', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('830238247', 'W12021892', 'W12021892', 'WYT1', 'Wind River Medical Building', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '1005 College View Dr Ste 9', 'Riverton', 'Fremont', 'WY', '82501', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021893', 'W12021893', 'WY01', 'Carbon County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 41.7866, -107.261, NULL, NULL),
('830238247', 'W12021894', 'W12021894', 'WYT1', 'Carbon County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021895', 'W12021895', 'WY01', 'Gottsche Rehabilitation Center', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830238247', 'W12021896', 'W12021896', 'WYT1', 'Gottsche Rehabilitation Center', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '148 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021897', 'W12021897', 'WY01', 'Platte County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.0498, -104.96, NULL, NULL),
('830238247', 'W12021898', 'W12021898', 'WYT1', 'Platte County Memorial Hospital', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '1356 Shiek St', 'Wheatland', 'Platte', 'WY', '82201', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021899', 'W12021899', 'WY01', 'Worland Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 44.0168, -107.954, NULL, NULL),
('830238247', 'W12021900', 'W12021900', 'WYT1', 'Worland Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '1106 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021775', 'W12021775', 'WY01', 'Wyoming Cardiopulmonary Services ', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82604', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82604', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 42.8501, -106.309, NULL, NULL),
('830238247', 'W12021776', 'W12021776', 'WYT1', 'Wyoming Cardiopulmonary Services ', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82604', '3072663174', '3072663177', '1230 E 1st St', 'Casper', 'Natrona', 'WY', '82604', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830238247', 'W12021878', 'W12021878', 'WYT1', 'Family Medical Clinic', 'Oleg', '', 'Ivanov', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '497 W Lott', 'Sheridan', 'Sheridan', 'WY', '82801', '3072663174', '3072663177', '', '', '', '0.00', '25.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1437311222', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021908', 'W12021908', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021905', 'W12021905', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'Y', 0, '2012-10-04', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021906', 'W12021906', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4353577688', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4353577688', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021909', 'W12021909', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'N', 0, '2012-08-17', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12021911', 'W12021911', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'N', 0, '2012-08-17', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12021910', 'W12021910', 'UTIHC04', '', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'N', 0, '2012-08-17', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12021914', 'W12021914', 'UTIHC01', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021915', 'W12021915', 'UTIHC02', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021916', 'W12021916', 'UTIHC03', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021917', 'W12021917', 'UTIHC04', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St ', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12021918', 'W12021918', 'UTIHC01', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021920', 'W12021920', 'UTIHC02', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021921', 'W12021921', 'UTIHC03', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021922', 'W12021922', 'UTIHC04', 'PCMC Rehab Bountiful', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021923', 'W12021923', 'UTIHC01', '', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', 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, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12021926', 'W12021926', 'UTIHC04', '', 'Erika', 'L', 'Cornella', 'OT', 'Occupational Therapy', '', '', 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, '2012-06-11', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1184985004', 0, 'Y', 0, '2012-08-17', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12021928', 'W12021928', 'UTIHC04', '', 'Ron', '', 'Ellsworth', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1100 S Medical Dr ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1245556141', 0, 'Y', 0, '2012-08-17', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021929', 'W12021929', 'UTIHC04', '', 'Ron', '', 'Ellsworth', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1245556141', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021930', 'W12021930', 'UTIHC04', '', 'Ron', '', 'Ellsworth', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1245556141', 0, 'Y', 0, '2012-08-17', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021931', 'W12021931', 'UTIHC04', '', 'Ron', '', 'Ellsworth', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1245556141', 0, 'Y', 0, '2012-08-17', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12021934', 'W12021934', 'UTIHC01', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021935', 'W12021935', 'UTIHC02', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021936', 'W12021936', 'UTIHC03', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021937', 'W12021937', 'UTIHC04', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12021938', 'W12021938', 'UTIHC01', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021939', 'W12021939', 'UTIHC02', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021940', 'W12021940', 'UTIHC03', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021941', 'W12021941', 'UTIHC04', '', 'Jason', 'M', 'Garnreiter', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013877696', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1790988962', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021942', 'W12021942', 'UTIHC04', '', 'Samuel', '', 'Inouye', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1700102696', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021943', 'W12021943', 'UTIHC04', '', 'Samuel', '', 'Inouye', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1700102696', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021944', 'W12021944', 'UTIHC04', '', 'Samuel', '', 'Inouye', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1700102696', 0, 'N', 0, '2012-08-17', NULL, NULL, 38.9534, -112.34, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12021945', 'W12021945', 'UTIHC04', '', 'Samuel', '', 'Inouye', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4357435591', '0000000000', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1700102696', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021947', 'W12021947', 'UTIHC04', '', 'Scott', 'R', 'Larsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1982913679', 0, 'Y', 0, '2012-08-17', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12021948', 'W12021948', 'UTIHC04', '', 'Scott', 'R', 'Larsen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1982913679', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021950', 'W12021950', 'UTIHC01', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021951', 'W12021951', 'UTIHC02', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021952', 'W12021952', 'UTIHC03', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021953', 'W12021953', 'UTIHC04', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 40.7585, -111.872, NULL, NULL),
('942854057', 'W12021954', 'W12021954', 'UTIHC01', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021955', 'W12021955', 'UTIHC02', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021956', 'W12021956', 'UTIHC03', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021957', 'W12021957', 'UTIHC04', 'Safe and Healthy Families', 'Antoinette', 'L', 'Laskey', 'MD', 'Pediatric Abuse & Neglect', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-08-12', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053427617', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021959', 'W12021959', 'UTIHC01', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021960', 'W12021960', 'UTIHC02', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021961', 'W12021961', 'UTIHC03', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021962', 'W12021962', 'UTIHC04', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', NULL, '280 N Main St Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2014-01-15', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12021963', 'W12021963', 'UTIHC01', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180  ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021964', 'W12021964', 'UTIHC02', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021965', 'W12021965', 'UTIHC03', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180    ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021966', 'W12021966', 'UTIHC04', 'PCMC Rehab Bountiful', 'Erin', '', 'McQuivey', 'SLP', 'Speech Language Pathology', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', NULL, 'PO Box 30180     ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8003081910', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053675066', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021967', 'W12021967', 'UTIHC04', '', 'Nathan', '', 'Nielson', 'DO', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr  ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Fillmore Community Medical Center', 'Delta Community Medical Center', '', 'HCFA|UB|', '1659697555', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021968', 'W12021968', 'UTIHC04', '', 'Nathan', '', 'Nielson', 'DO', 'Urgent Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Fillmore Community Medical Center', 'Delta Community Medical Center', '', 'HCFA|UB|', '1659697555', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021969', 'W12021969', 'UTIHC04', '', 'Nathan', '', 'Nielson', 'DO', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99   ', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Fillmore Community Medical Center', 'Delta Community Medical Center', '', 'HCFA|UB|', '1659697555', 0, 'N', 0, '2012-08-17', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12021970', 'W12021970', 'UTIHC04', '', 'Nathan', '', 'Nielson', 'DO', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '126 S White Sage Ave    ', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Fillmore Community Medical Center', 'Delta Community Medical Center', '', 'HCFA|UB|', '1659697555', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021972', 'W12021972', 'UTIHC04', '', 'Bryce', 'K', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'San Juan Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932417300', 0, 'Y', 0, '2012-08-17', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12021973', 'W12021973', 'UTIHC04', '', 'Bryce', 'K', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', NULL, 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'San Juan Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932417300', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021974', 'W12021974', 'UTIHC04', '', 'Isaac', 'R', 'Rasmussen', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr  ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1548586431', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021975', 'W12021975', 'UTIHC04', '', 'Isaac', 'R', 'Rasmussen', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1548586431', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021976', 'W12021976', 'UTIHC04', '', 'Isaac', 'R', 'Rasmussen', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '126 S White Sage Ave    ', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1548586431', 0, 'N', 0, '2012-08-17', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021977', 'W12021977', 'UTIHC04', '', 'Isaac', 'R', 'Rasmussen', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99     ', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', 'Delta Community Medical Center', 'Fillmore Community Medical Center', '', 'HCFA|UB|', '1548586431', 0, 'N', 0, '2012-08-17', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12021978', 'W12021978', 'UTIHC04', '', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '1100 S Medical Dr  ', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'N', 0, '2013-06-03', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021979', 'W12021979', 'UTIHC04', '', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622441', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021980', 'W12021980', 'UTIHC04', '', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '126 S White Sage Ave   ', 'Delta', 'Millard', 'UT', '84624', '4358645591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'N', 0, '2013-06-03', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12021981', 'W12021981', 'UTIHC04', '', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '674 S Hwy 99    ', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '0000000000', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'N', 0, '2013-06-03', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12021983', 'W12021983', 'UTIHC04', '', 'Ashley', 'L', 'Kernan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346558517', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021984', 'W12021984', 'UTIHC04', '', 'Ashley', 'L', 'Kernan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', NULL, 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', '', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346558517', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021986', 'W12021986', 'UTIHC04', '', 'Wyatt', 'J', 'West', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730497108', 0, 'Y', 0, '2013-11-13', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12021988', 'W12021988', 'UTIHC04', '', 'Wyatt', 'J', 'West', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', NULL, 'PO Box 30180   ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4352074510', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730497108', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('710948567', 'W12021990', 'W12021990', 'NA01', 'Life Care Solutions', '', '', 'Life Care Solutions', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1801 N Government Way Ste 3', 'Coeur D Alene', 'Kootenai', 'ID', '83814', '8005840710', '8005840712', '1801 N Government Way Ste 3', 'Coeur D Alene', 'Kootenai', 'ID', '83814', '8005840710', '8005840712', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689956575', 0, 'Y', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('752890546', 'W12021991', 'W12021991', 'NA01', 'Preferred Homecare', '', '', 'Park Infusion Care', '', 'Durable Medical Equipment', '', '', NULL, 'B', '4319 Medical Dr Ste 250', 'San Antonio', 'Bexar', 'TX', '78229', '2106157475', '2106973801', '4319 Medical Dr Ste 250', 'San Antonio', 'Bexar', 'TX', '78229', '2106157475', '2106973801', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689761462', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12021992', 'W12021992', 'UT01', 'Obstetrix Medical Group of Utah PC', 'Andrew', 'H', 'Spencer', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1467647537', 0, 'N', 0, '2012-09-04', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('454855728', 'W12021994', 'W12021994', 'UT01', 'Obstetrix Medical Group of Utah PC', 'Andrew', 'H', 'Spencer', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434700', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1467647537', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12021996', 'W12021996', 'UT01', 'Obstetrix Medical Group of Utah PC', 'Andrew', 'H', 'Spencer', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8017434700', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1467647537', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12021997', 'W12021997', 'UT01', 'Northern Utah Cardiovascular Associates ', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'N', 0, '2012-08-17', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('371625746', 'W12021998', 'W12021998', 'UT01', 'Northern Utah Cardiovascular Associates ', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'N', 0, '2012-08-17', NULL, NULL, 41.775, -111.823, NULL, NULL),
('371625746', 'W12021999', 'W12021999', 'UT01', 'MountainStar Cardiology St Marks', 'Peter', 'G', 'Forstall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982844098', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('264537352', 'W12022000', 'W12022000', 'UT01', 'Coral Desert Spine LLC', 'Ryan', 'D', 'Church', 'FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-10-25', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1912909714', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12022001', 'W12022001', 'UT01', 'Northern Utah Cardionvascular Associates ', 'Michael', 'E', 'Crawford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', 'Lakeview Hospital', '', 'HCFA|UB', '1699760397', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('270968062', 'W12022003', 'W12022003', 'UTMH1', 'The Counseling Center', 'Cindie ', '', 'Parker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669623765', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W12022002', 'W12022002', 'UTMH1', 'The Counseling Center', 'Cindie ', '', 'Parker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669623765', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W12022004', 'W12022004', 'UTMH1', 'The Counseling Center', 'Hilary', 'C', 'Madsen', 'LCSW', 'Mental Health', '', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528214327', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12022006', 'W12022006', 'NM01', 'Womens Specialist ', 'Mary', 'T', 'Cunnane', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '201 Cedar St Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-06-30', 0, 0, 1, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1518920099', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W12022005', 'W12022005', 'UTMH1', 'The Counseling Center', 'Hilary', 'C', 'Madsen', 'LCSW', 'Mental Health', '', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528214327', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12022007', 'W12022007', 'UT01', 'Northern Utah Cardiovascular Assocites ', 'Michael', 'J', 'Diehl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1265427371', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('371625746', 'W12022008', 'W12022008', 'UT01', 'Northern Utah Cardiovascular Assocites ', 'Michael', 'J', 'Diehl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1265427371', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.775, -111.823, NULL, NULL),
('371625746', 'W12022009', 'W12022009', 'UT01', 'MountainStar Cariology St Marks', 'Michael', 'J', 'Diehl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1265427371', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12022010', 'W12022010', 'UT01', 'Ogden Clinic ORMC/OB', 'Alexander', 'J', 'Larson', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '8014753101', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '8014753101', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265695019', 0, 'N', 0, '2012-10-04', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('383809303', 'W12022012', 'W12022012', 'ID01', 'Serenity Neuropsychology & Counseling', 'Melody', 'L', 'Snider', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088935484', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088935484', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982734984', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022018', 'W12022018', 'UT01', 'Central Utah Clinic PC', 'Joseph', 'D', 'Te', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '2019 E Riverside Dr Ste A200', 'St George', 'Washington', 'UT', '84790', '4356289298', '4356289655', '2019 E Riverside Dr Ste A200', 'St George', 'Washington', 'UT', '84790', '4356289298', '4356289655', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1700946423', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022020', 'W12022020', 'UT01', 'Central Utah Clinic PC', 'Joseph', 'D', 'Te', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1700946423', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12022021', 'W12022021', 'UT01', 'Central Utah Clinic PC', 'Joseph', 'D', 'Te', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1700946423', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022022', 'W12022022', 'UT01', 'Jordan Parkway  Medical Clinic ', 'Rebecca', 'P', 'Tanner', '', 'Internal Medicine', '', '', NULL, 'O', '1325 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015083111', '8015083105', '1325 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015083111', '8015083105', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629050067', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.5621, -111.93, NULL, NULL),
('621801973', 'W12022023', 'W12022023', 'UT01', 'Jordan Parkway  Medical Clinic ', 'Rebecca', 'P', 'Tanner', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629050067', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12022024', 'W12022024', 'UT01', 'Physician Group of Utah ', 'Megan', 'J', 'Engelen', '', 'Internal Medicine', '', '', NULL, 'O', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154529246', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7203, -111.816, NULL, NULL),
('621801973', 'W12022025', 'W12022025', 'UT01', 'Physician Group of Utah ', 'Megan', 'J', 'Engelen', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154529246', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12022026', 'W12022026', 'UT01', 'Northern Utah Cardionvascular Associates ', 'Michael', 'E', 'Crawford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', 'Lakeview Hospital', '', 'HCFA|UB', '1699760397', 0, 'N', 0, '2014-07-03', NULL, NULL, 41.775, -111.823, NULL, NULL),
('371625746', 'W12022027', 'W12022027', 'UT01', 'MountainStair Cardiology St Marks', 'Michael', 'E', 'Crawford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', 'Lakeview Hospital', '', 'HCFA|UB', '1699760397', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12022028', 'W12022028', 'UT01', 'Northern Utah Cardiovascular Associates ', 'Gregory', 'T', 'Almony', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', '', '', 'HCFA|UB|', '1023003142', 0, 'N', 0, '2014-06-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('371625746', 'W12022029', 'W12022029', 'UT01', 'Northern Utah Cardiovascular Associates ', 'Gregory', 'T', 'Almony', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', '2380 N 400 E', 'Logan', 'Cache', 'UT', '84341', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', '', '', 'HCFA|UB|', '1023003142', 0, 'N', 0, '2014-06-03', NULL, NULL, 41.775, -111.823, NULL, NULL),
('371625746', 'W12022030', 'W12022030', 'UT01', 'MountainStar Cariology St Marks', 'Gregory', 'T', 'Almony', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital', '', '', 'HCFA|UB|', '1023003142', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('270300360', 'ELHCA0165', 'ELHCA0165', 'TXHOUSTD', 'General Surgeons of Houston ', 'Don', 'Calfred', 'Quast', 'MD', 'General Surgery', '', '', NULL, 'O', '1213 Hermann Dr                         Ste 560', 'Houston', 'Harris', 'TX', '77004', '7135210017', '7135210240', '1213 Hermann Dr                         Ste 560', 'Houston', 'Harris', 'TX', '77004', '7135210017', '7135210240', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1639164114', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.7231, -95.3892, NULL, NULL),
('201657769', 'ELHCA0164', 'ELHCA0164', 'TXHOUSTD', 'North Pines General Surgery', 'Jeffrey', 'A', 'Przybyla', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942454137', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12022033', 'W12022033', 'ID01', 'Life Counseling Center', 'Janelle', '', 'Stauffer-Boothby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922247410', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870548726', 'W12021754', 'W12021754', 'UT01', 'Snow Creek Emergency Physicians ', 'Celeste', 'E', 'Raffin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Snowcreek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', '1600 W Snowcreek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '4356558979', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174552863', 0, 'N', 0, '2013-09-12', NULL, NULL, 40.662, -111.511, NULL, NULL),
('870548726', 'W12021755', 'W12021755', 'UT01', 'Snow Creek Emergency Physicians ', 'Celeste', 'E', 'Raffin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356550055', '4356558979', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '4356550055', '4356558979', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174552863', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022034', 'W12022034', 'UT01', 'Families First Pediatrics', 'Matthew', 'N', 'Cox', 'MD', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1811081904', 0, 'N', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022035', 'W12022035', 'UT01', 'Families First Pediatrics', 'Tiffany', 'A', 'Thomas', 'MD', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790939866', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022036', 'W12022036', 'UT01', 'Families First Pediatrics', 'Zachary', 'R', 'Zarbock', 'MD', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780862425', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022037', 'W12022037', 'UT01', 'Families First Pediatrics', 'Barbara', 'E', 'Bean', 'MD', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659353472', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022038', 'W12022038', 'UT01', 'Families First Pediatrics', 'Camille', '', 'Goff', 'NP', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629175047', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022039', 'W12022039', 'UT01', 'Families First Pediatrics', 'Dallen', 'K', 'Ormond', 'NP', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1497850069', 0, 'N', 0, '2014-05-26', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12022040', 'W12022040', 'UT01', 'Families First Pediatrics', 'Michael', 'R', 'Johnson', 'MD', 'Pediatrics', '', '', NULL, 'O', '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', NULL, '13242 S 5000 W', 'Herriman', 'Salt Lake', 'UT', '84096', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-16', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1396839403', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('611463417', 'W12022042', 'W12022042', 'UT01', 'University of Utah OB Diagnostic Center', '', '', 'University of Utah OB Diagnostic Center', 'GROUP', 'Obstetrics and Gynecology', 'OB Diagnotic', '', NULL, 'O', '30 N 1900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', NULL, '30 N 1900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009314', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('611463417', 'W12022043', 'W12022043', 'UT01', 'University of Utah OB Diagnostic Center', '', '', 'University of Utah OB Diagnostic Center', 'GROUP', 'Obstetrics and Gynecology', 'OB Diagnotic', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009314', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870410144', 'W12022044', 'W12022044', 'UT01', 'University of Utah Dept of OB/GYN', '', '', 'University of Utah Dept of OB/GYN', 'GROUP', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009285', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870410144', 'W12022045', 'W12022045', 'UT01', 'University of Utah Dept of OB/GYN', '', '', 'University of Utah Dept of OB/GYN', 'GROUP', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009285', 0, 'N', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('742763430', 'TX0100001', 'TX0100001', 'TXSATSTD', 'Allergy Asthma and Immunology Associates of South Texas', 'Joseph', 'D', 'Diaz', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '2414 Babcock Rd Ste 109', 'San Antonio', 'Bexar', 'TX', '78229', '2106160882', NULL, '2414 Babcock Rd Ste 109', 'San Antonio', 'Bexar', 'TX', '78229', '2106160882', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417948241', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5057, -98.5856, NULL, NULL),
('742763430', 'TX0100003', 'TX0100003', 'TXSATSTD', 'Allergy Asthma and Immunology Associates of South Texas', 'Joseph', 'D', 'Diaz', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '525 Oak Ctr Dr Ste 400', 'San Antonio', 'Bexar', 'TX', '78229', '2106160882', NULL, '525 Oak Ctr Dr Ste 400', 'San Antonio', 'Bexar', 'TX', '78229', '2106160882', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417948241', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('830413759', 'TX0100004', 'TX0100004', 'TXSATSTD', 'Dalys F Gomez MD', 'Dalys', 'F', 'Gomez', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '24165 IH 10 W Ste 126', 'San Antonio', 'Bexar', 'TX', '78257', '2106871222', NULL, '24165 IH 10 W Ste 126', 'San Antonio', 'Bexar', 'TX', '78257', '2106871222', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1558367508', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.6644, -98.6315, NULL, NULL),
('710913692', 'TX0100006', 'TX0100006', 'TXSATSTD', 'Victor A Estrada MD', 'Victor', 'A', 'Estrada', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '14615 San Pedro Ste 250', 'San Antonio', 'Bexar', 'TX', '78232', '2104902051', NULL, '14615 San Pedro Ste 250', 'San Antonio', 'Bexar', 'TX', '78232', '2104902051', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487716353', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5753, -98.479, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('743009460', 'TX0100008', 'TX0100008', 'TXSATSTD', 'Dilley Allergy and Asthma Specialists', 'Dennis', 'E', 'Dilley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '7711 Louis Pasteur Dr Ste 407', 'San Antonio', 'Bexar', 'TX', '78229', '2106144405', NULL, '7711 Louis Pasteur Dr Ste 407', 'San Antonio', 'Bexar', 'TX', '78229', '2106144405', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1720029218', 0, 'N', 0, '2014-04-07', NULL, NULL, 29.5088, -98.5702, NULL, NULL),
('742047021', 'TX0100011', 'TX0100011', 'TXSATSTD', '', 'Frank', 'C', 'Hampel', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '705 A Landa', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', NULL, '705 A Landa', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1295751188', 0, 'N', 0, '2013-03-28', NULL, NULL, 0, 0, NULL, NULL),
('742047021', 'TX0100012', 'TX0100012', 'TXSATSTD', '', 'Frank', 'C', 'Hampel', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2106540944', NULL, '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2106540944', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1295751188', 0, 'N', 0, '2013-03-28', NULL, NULL, 0, 0, NULL, NULL),
('743020306', 'TX0100015', 'TX0100015', 'TXSATSTD', 'Margaret Ontiveros MD', 'Margaret', 'M', 'Ontiveros', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '311 Camden Ste 102', 'San Antonio', 'Bexar', 'TX', '78215', '2102819800', NULL, '311 Camden Ste 102', 'San Antonio', 'Bexar', 'TX', '78215', '2102819800', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346310968', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.4345, -98.4923, NULL, NULL),
('743020306', 'TX0100016', 'TX0100016', 'TXSATSTD', 'Margaret M Ontiveros MD', 'Margaret', 'M', 'Ontiveros', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690264', 'San Antonio', 'Bexar', 'TX', '78269', '2102819800', NULL, 'PO Box 690264', 'San Antonio', 'Bexar', 'TX', '78269', '2102819800', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346310968', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100017', 'TX0100017', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100018', 'TX0100018', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100019', 'TX0100019', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100020', 'TX0100020', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100021', 'TX0100021', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kevin', 'F', 'James', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063432938', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100022', 'TX0100022', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100023', 'TX0100023', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100025', 'TX0100025', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100026', 'TX0100026', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100027', 'TX0100027', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100029', 'TX0100029', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edwin', 'J', 'Whitney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669563656', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100030', 'TX0100030', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Richard', 'F', 'Wilks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1023109295', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100031', 'TX0100031', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100032', 'TX0100032', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100033', 'TX0100033', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0100034', 'TX0100034', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', NULL, '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('742688457', 'TX0100035', 'TX0100035', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', NULL, '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('742688457', 'TX0100036', 'TX0100036', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.7245, -98.097, NULL, NULL),
('742688457', 'TX0100037', 'TX0100037', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', NULL, '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5682, -97.9489, NULL, NULL),
('742688457', 'TX0100038', 'TX0100038', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.8484, -98.1712, NULL, NULL),
('742688457', 'TX0100039', 'TX0100039', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100040', 'TX0100040', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '825 4th St', 'New Braunfels', 'Comal', 'TX', '78130', '8308335581', NULL, '825 4th St', 'New Braunfels', 'Comal', 'TX', '78130', '8308335581', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100041', 'TX0100041', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', NULL, '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.355, -98.8616, NULL, NULL),
('742688457', 'TX0100042', 'TX0100042', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('742688457', 'TX0100043', 'TX0100043', 'TXSATSTD', 'Heart and  Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', NULL, '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.7259, -99.0703, NULL, NULL),
('742688457', 'TX0100044', 'TX0100044', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', NULL, '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 28.7952, -97.8507, NULL, NULL),
('742688457', 'TX0100045', 'TX0100045', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', NULL, '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0100046', 'TX0100046', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '32665 Hwy 281 N Ste 206', 'Bulverde', 'Comal', 'TX', '78163', '2108046000', NULL, '32665 Hwy 281 N Ste 206', 'Bulverde', 'Comal', 'TX', '78163', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.6588, -98.4527, NULL, NULL),
('742688457', 'TX0100047', 'TX0100047', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100048', 'TX0100048', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100049', 'TX0100049', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100051', 'TX0100051', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100052', 'TX0100052', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100053', 'TX0100053', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edwin', 'J', 'Whitney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669563656', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100054', 'TX0100054', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Richard', 'F', 'Wilks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1023109295', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0100055', 'TX0100055', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0100056', 'TX0100056', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0100057', 'TX0100057', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0100058', 'TX0100058', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0100061', 'TX0100061', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', NULL, '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('742688457', 'TX0100062', 'TX0100062', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', NULL, '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('742688457', 'TX0100064', 'TX0100064', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kevin', 'F', 'James', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', NULL, '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063432938', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('742688457', 'TX0100065', 'TX0100065', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.7245, -98.097, NULL, NULL),
('742688457', 'TX0100066', 'TX0100066', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.7245, -98.097, NULL, NULL),
('742688457', 'TX0100067', 'TX0100067', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', NULL, '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5682, -97.9489, NULL, NULL),
('742688457', 'TX0100068', 'TX0100068', 'TXSATSTD', 'Heart & Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.8484, -98.1712, NULL, NULL),
('742688457', 'TX0100069', 'TX0100069', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100070', 'TX0100070', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2013-05-31', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100071', 'TX0100071', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100072', 'TX0100072', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100073', 'TX0100073', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2013-04-09', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0100075', 'TX0100075', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', NULL, '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'Y', 0, '2014-01-15', NULL, NULL, 29.355, -98.8616, NULL, NULL),
('742688457', 'TX0100076', 'TX0100076', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'Y', 0, '2014-01-15', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('742688457', 'TX0100077', 'TX0100077', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Edwin', 'J', 'Whitney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669563656', 0, 'Y', 0, '2014-01-15', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('742688457', 'TX0100078', 'TX0100078', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', NULL, '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'Y', 0, '2014-01-15', NULL, NULL, 29.7259, -99.0703, NULL, NULL),
('742688457', 'TX0100080', 'TX0100080', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', NULL, '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-14', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2013-04-17', NULL, NULL, 28.7952, -97.8507, NULL, NULL),
('742688457', 'TX0100081', 'TX0100081', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', NULL, '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-31', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0100082', 'TX0100082', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Randal', 'W', 'White', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851378889', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742447500', 'TX0100084', 'TX0100084', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Anatole', 'D', 'Trakhtenbroit', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972580967', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742447500', 'TX0100085', 'TX0100085', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Jose', 'F', 'Triana', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679550511', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742447500', 'TX0100092', 'TX0100092', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'H', 'Liu', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', NULL, '255 E Sonterra Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '0000007301', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('742447500', 'TX0100099', 'TX0100099', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Daniel', 'J', 'Donovan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730150160', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742337161', 'TX0100104', 'TX0100104', 'TXSATSTD', 'Alamo Heart Associates', 'Ricardo', 'A', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7726 Louis Pasteur Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106163307', NULL, '7726 Louis Pasteur Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106163307', '', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962409383', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5088, -98.5696, NULL, NULL),
('742337161', 'TX0100105', 'TX0100105', 'TXSATSTD', 'Alamo Heart Associates', 'Steven', 'E', 'Daniels', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7726 Louis Pasteur Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106163320', NULL, '7726 Louis Pasteur Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106163320', '          ', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-01-29', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1487650008', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.5087, -98.5686, NULL, NULL),
('742337161', 'TX0100107', 'TX0100107', 'TXSATSTD', 'Alamo Heart Associates', 'Ricardo', 'A', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163307', NULL, '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163307', '', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962409383', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.7804, -98.7296, NULL, NULL),
('742337161', 'TX0100108', 'TX0100108', 'TXSATSTD', 'Alamo Heart Associates', 'Steven', 'E', 'Daniels', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163320', NULL, '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163320', '          ', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-01-29', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1487650008', 0, 'Y', 0, '2013-05-23', NULL, NULL, 29.7807, -98.7308, NULL, NULL),
('742337161', 'TX0100109', 'TX0100109', 'TXSATSTD', 'Alamo Heart Associates', 'Fernando', '', 'Lopez', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163318', NULL, '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106163318', '', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1619974045', 0, 'Y', 0, '2013-05-24', NULL, NULL, 29.7807, -98.7308, NULL, NULL),
('455130920', 'TX0100114', 'TX0100114', 'TXSATSTD', 'San Antonio Skin & Cancer Clinic', 'Raul', '', 'Vela', 'MD', 'Dermatology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', NULL, '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821181678', 0, 'N', 0, '2014-03-18', NULL, NULL, 29.5123, -98.5764, NULL, NULL),
('731629369', 'TX0100115', 'TX0100115', 'TXSATSTD', 'San Antonio Skin & Cancer Clinic', 'Scott', 'M', 'Henslee', 'MD', 'Dermatology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', NULL, '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1538251319', 0, 'N', 0, '2014-04-09', NULL, NULL, 29.5123, -98.5764, NULL, NULL),
('742062761', 'TX0100116', 'TX0100116', 'TXSATSTD', 'San Antonio Skin and Cancer Clinic', 'Mark', 'B', 'Weinstein', 'MD', 'Dermatology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', NULL, '7950 Floyd Curl Dr Ste 909', 'San Antonio', 'Bexar', 'TX', '78229', '2106143575', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447369095', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5123, -98.5764, NULL, NULL),
('742062761', 'TX0100117', 'TX0100117', 'TXSATSTD', 'San Antonio Skin and Cancer Clinic', 'Mark', 'B', 'Weinstein', 'MD', 'Dermatology', '', '', NULL, 'O', '999 E Basse Rd Ste 127', 'San Antonio', 'Bexar', 'TX', '78209', '2106143575', NULL, '999 E Basse Rd Ste 127', 'San Antonio', 'Bexar', 'TX', '78209', '2106143575', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447369095', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('742528629', 'TX0100118', 'TX0100118', 'TXSATSTD', 'Neil F Haddock MD', 'Neil', 'F', 'Haddock', 'MD', 'Dermatology', '', '', NULL, 'O', '325 E Sonterra Blvd Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2104965792', NULL, '325 E Sonterra Blvd Ste 110', 'San Antonio', 'Bexar', 'TX', '78258', '2104965792', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699739052', 0, 'N', 0, '2013-12-12', NULL, NULL, 29.6163, -98.4896, NULL, NULL),
('742592013', 'TX0100119', 'TX0100119', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Eloise', 'L', 'Beightler', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154339455', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100120', 'TX0100120', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'David', 'L', 'Shriner', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609884915', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100121', 'TX0100121', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Thushan', 'N', 'DeSilva', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '0000005959', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100122', 'TX0100122', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Lisa', 'C', 'Walker', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578571816', 0, 'N', 0, '2013-09-03', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100123', 'TX0100123', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'A', 'D', 'Dotson', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548278815', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100124', 'TX0100124', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Alfred', 'J', 'Hockley', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235147810', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0100125', 'TX0100125', 'TXSATSTD', 'Skin Surgery Center of San Antonio', 'Paula', 'S', 'Vogel', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-03-31', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881678779', 0, 'N', 0, '2013-08-14', NULL, NULL, 29.6125, -98.4829, NULL, NULL),
('742592013', 'TX0100127', 'TX0100127', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'William', 'T', 'Parsons', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1811905417', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.5632, -98.3343, NULL, NULL),
('742592013', 'TX0100128', 'TX0100128', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Rinna', 'Conol', 'Johnson', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006974', 0, 'N', 0, '2012-10-30', NULL, NULL, 29.5632, -98.3343, NULL, NULL),
('742592013', 'TX0100129', 'TX0100129', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Alfred', 'J', 'Hockley', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235147810', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.5632, -98.3343, NULL, NULL),
('742592013', 'TX0100130', 'TX0100130', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Virnalisis', 'M', 'Gonzalez', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-09', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1194735290', 0, 'N', 0, '2013-12-12', NULL, NULL, 29.5623, -98.3334, 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
('742484538', 'TX0100134', 'TX0100134', 'TXSATSTD', 'Northeast Endocrinology Associates', 'Laura', 'S', 'Akright', 'MD', 'Endocrinology', '', '', NULL, 'O', '8715 Village Dr Ste 508', 'San Antonio', 'Bexar', 'TX', '78217', '2106503360', NULL, '8715 Village Dr Ste 508', 'San Antonio', 'Bexar', 'TX', '78217', '2106503360', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568548204', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('202148889', 'TX0100136', 'TX0100136', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Gabriel', '', 'Ortiz', 'MD', 'Family Practice', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1093795718', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100137', 'TX0100137', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Manuel', 'M', 'Quinones', 'MD', 'Family Practice', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881660686', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
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('741967809', 'TX0100232', 'TX0100232', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Michael', 'J', 'Guirl', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962496711', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'TX0100233', 'TX0100233', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Alejandro', '', 'Pruitt', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568447118', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'TX0100234', 'TX0100234', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Richard', 'T', 'Shaffer', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1134158736', 0, 'N', 0, '2012-10-17', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'TX0100235', 'TX0100235', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'John', 'T', 'Swan', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1366436032', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'TX0100236', 'TX0100236', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Patrick', 'A', 'Masters', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1073507836', 0, 'N', 0, '2013-02-06', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('680528956', 'TX0100237', 'TX0100237', 'TXSATSTD', 'Seema A Dar MD', 'Seema', 'A', 'Dar', 'MD', 'Gastroenterology', '', '', NULL, 'O', '19284 Stone Oak Pkwy Ste 102', 'San Antonio', 'Bexar', 'TX', '78258', '2102680124', '2102680146', '19284 Stone Oak Pkwy Ste 102', 'San Antonio', 'Bexar', 'TX', '78258', '2102680124', '2102680146', 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1942390901', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.631, -98.4953, NULL, NULL),
('680528956', 'TX0100238', 'TX0100238', 'TXSATSTD', '', 'Seema', 'A', 'Dar', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3338 Oakwell Ct Ste 205', 'San Antonio', 'Bexar', 'TX', '78258', '2106563715', NULL, '3338 Oakwell Ct Ste 205', 'San Antonio', 'Bexar', 'TX', '78258', '2106563715', '          ', 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1942390901', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('680528956', 'TX0100239', 'TX0100239', 'TXSATSTD', 'Seema A Dar MD', 'Seema', 'A', 'Dar', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 500', 'San Antonio', 'Bexar', 'TX', '78292', '2106563715', NULL, 'PO Box 500', 'San Antonio', 'Bexar', 'TX', '78292', '2106563715', '          ', 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1942390901', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0100240', 'TX0100240', 'TXSATSTD', 'South Texas Oncology and Hematology', '', '', 'South Texas Oncology & Hematology PA', '', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008837', 0, 'Y', 0, '2012-08-20', NULL, NULL, 29.5129, -98.5788, NULL, NULL),
('742915297', 'TX0100243', 'TX0100243', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('742915297', 'TX0100247', 'TX0100247', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Keith', 'E', 'Eyre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841223351', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('742915297', 'TX0100254', 'TX0100254', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Steven', 'P', 'Kalter', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922032218', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('742915297', 'TX0100267', 'TX0100267', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Allan', 'J', 'White', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1497782114', 0, 'N', 0, '2014-07-17', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('742938437', 'TX0100276', 'TX0100276', 'TXSATSTD', 'MacGregor Medical Center', NULL, NULL, 'MacGregor Medical Center', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', NULL, '9969 Fredericksburg Rd', 'San Antonio', '', 'TX', '78240', '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007376', 0, 'Y', 0, '2012-08-20', NULL, NULL, 29.5362, -98.5776, NULL, NULL),
('742944052', 'TX0100277', 'TX0100277', 'TXSATSTD', 'Responsive ID Solutions', 'Robert', 'A', 'Zajac', 'MD', 'Internal Medicine', '', '', NULL, 'O', '343 W Houston St Ste 612', 'San Antonio', 'Bexar', 'TX', '78205', '2102273200', NULL, '343 W Houston St Ste 612', 'San Antonio', 'Bexar', 'TX', '78205', '2102273200', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013907963', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.4267, -98.4973, NULL, NULL),
('742944052', 'TX0100278', 'TX0100278', 'TXSATSTD', 'Responsive ID Solutions', 'Robert', 'A', 'Zajac', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 840183', 'Dallas', 'Bexar', 'TX', '78205', '2102273200', NULL, 'PO Box 840183', 'Dallas', 'Bexar', 'TX', '78205', '2102273200', '', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013907963', 0, 'y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752990687', 'TX0100279', 'TX0100279', 'TXSATSTD', 'Sonterra Internal Medicine', 'John', 'E', 'Dickson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '325 Sonterra Bvld E Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104023069', NULL, '325 Sonterra Bvld E Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104023069', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1154467116', 0, 'N', 0, '2014-06-19', NULL, NULL, 29.6163, -98.4896, NULL, NULL),
('752990687', 'TX0100280', 'TX0100280', 'TXSATSTD', 'Sonterra Internal Medicine', 'John', 'E', 'Dickson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 65071', 'San Antonio', 'Bexar', 'TX', '78265', '2104023069', NULL, 'PO Box 65071', 'San Antonio', 'Bexar', 'TX', '78265', '2104023069', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1154467116', 0, 'y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('010798330', 'TX0100281', 'TX0100281', 'TXSATSTD', 'Daniel Juarez MD', 'Daniel', '', 'Juarez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 McCullough Ave Ste 248', 'San Antonio', 'Bexar', 'TX', '78212', '2102203737', NULL, '1303 McCullough Ave Ste 248', 'San Antonio', 'Bexar', 'TX', '78212', '2102203737', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1942303193', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('030468251', 'TX0100282', 'TX0100282', 'TXSATSTD', 'Steven M Bauer MD', 'Steven', 'M', 'Bauer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '20642 Stone Oak Pkwy Ste 108', 'San Antonio', 'Bexar', 'TX', '78258', '2104920505', NULL, '20642 Stone Oak Pkwy Ste 108', 'San Antonio', 'Bexar', 'TX', '78258', '2104920505', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1548228927', 0, 'N', 0, '2014-05-28', NULL, NULL, 29.6494, -98.4624, NULL, NULL),
('742778964', 'TX0100283', 'TX0100283', 'TXSATSTD', 'Independent Medical Associates', 'Raul', 'M', 'Montemayor', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2833 Babcock Rd Ste 435', 'San Antonio', 'Bexar', 'TX', '78229', '2106145855', NULL, '2833 Babcock Rd Ste 435', 'San Antonio', 'Bexar', 'TX', '78229', '2106145855', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1013998178', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5133, -98.5912, NULL, NULL),
('742938437', 'TX0100286', 'TX0100286', 'TXSATSTD', 'MacGregor Medical Center', NULL, NULL, 'MacGregor Medical Center', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, NULL, NULL, '', NULL, NULL, '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007376', 0, 'y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100287', 'TX0100287', 'TXSATSTD', 'MacGregor Medical Center', 'Jose', 'A', 'Sanchez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982600623', 0, 'y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100288', 'TX0100288', 'TXSATSTD', 'MacGregor Medical Center', 'Manuel', 'J', 'Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972500254', 0, 'y', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100289', 'TX0100289', 'TXSATSTD', 'MacGregor Medical Center', 'William', 'R', 'Beck', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609873660', 0, 'y', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100291', 'TX0100291', 'TXSATSTD', 'MacGregor Medical Center', 'Fernando', '', 'Aguirre', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861499444', 0, 'y', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100292', 'TX0100292', 'TXSATSTD', 'MacGregor Medical Center', 'Brian', 'P', 'Senger', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194722660', 0, 'y', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100294', 'TX0100294', 'TXSATSTD', 'MacGregor Medical Center', 'Ana', 'I', 'Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871599449', 0, 'y', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'TX0100296', 'TX0100296', 'TXSATSTD', 'MacGregor Medical Center', 'Dennis', 'C', 'Oliver', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', NULL, 'PO Box 2448', 'San Antonio', 'Bexar', 'TX', '78298', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265439541', 0, 'y', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100303', 'TX0100303', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Stella', NULL, 'Yu', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 l-10 W', 'San Antonio', '', 'TX', '78201', '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912973694', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100304', 'TX0100304', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Kristi', 'G', 'Clark', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912973769', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100305', 'TX0100305', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Jesus', 'J', 'Aguilar', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528034360', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100306', 'TX0100306', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Ramon', '', 'Colen', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811963697', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100308', 'TX0100308', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Richard', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326014069', 0, 'Y', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100309', 'TX0100309', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Rowland', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700852498', 0, 'Y', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100310', 'TX0100310', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', NULL, 'Blydenburgh', 'PA', 'Internal Medicine', NULL, NULL, NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005339', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100311', 'TX0100311', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Melba', 'J', 'Beine', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-22', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366417495', 0, 'Y', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100312', 'TX0100312', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Aris', '', 'Nikas', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093781890', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100313', 'TX0100313', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Robert', 'A', 'Tavera', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730155458', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100315', 'TX0100315', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Juan', 'A', 'Gonzalez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1920 S W Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109242337', NULL, '1920 S W Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109242337', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487620241', 0, 'N', 0, '2013-08-21', NULL, NULL, 29.3566, -98.5234, NULL, NULL),
('202148889', 'TX0100317', 'TX0100317', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Carmen', '', 'Perez', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982670790', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0100318', 'TX0100318', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Stella', NULL, 'Yu', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', NULL, '6243 IH 10 W', 'San Antonio', '', 'TX', '78201', '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912973694', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5207, -98.5727, NULL, NULL),
('202148889', 'TX0100319', 'TX0100319', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Kristi', 'G', 'Clark', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', NULL, '8542 Wurzbach', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912973769', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5207, -98.5727, NULL, NULL),
('202148889', 'TX0100320', 'TX0100320', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Ramon', '', 'Colen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '803 Castroville Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78237', '2104367402', NULL, '803 Castroville Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78237', '2104367402', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811963697', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.4169, -98.5526, NULL, NULL),
('202148889', 'TX0100322', 'TX0100322', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Richard', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', NULL, '215 E Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326014069', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('202148889', 'TX0100323', 'TX0100323', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Rowland', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', NULL, '215 E Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700852498', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('202148889', 'TX0100324', 'TX0100324', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', NULL, 'Blydenburgh', 'PA', 'Internal Medicine', NULL, NULL, NULL, 'B', '215 E Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', NULL, '6243 IH 10 W', 'San Antonio', '', 'TX', '78201', '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005339', 0, 'Y', 0, '2012-08-20', NULL, NULL, 29.4358, -98.493, NULL, NULL),
('202148889', 'TX0100325', 'TX0100325', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Melba', 'J', 'Beine', 'MD', 'Internal Medicine', '', '', NULL, 'O', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '          ', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-22', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366417495', 0, 'N', 0, '2014-06-13', NULL, NULL, 29.5079, -98.4797, NULL, NULL),
('202148889', 'TX0100326', 'TX0100326', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Joseph', NULL, 'Blydenburgh', 'PA', 'Internal Medicine', NULL, NULL, NULL, 'B', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', NULL, '6243 IH 10 W', 'San Antonio', '', 'TX', '78201', '', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005339', 0, 'Y', 0, '2012-08-20', NULL, NULL, 29.5077, -98.4807, NULL, NULL),
('742938437', 'TX0100327', 'TX0100327', 'TXSATSTD', 'MacGregor Medical Center', 'Jose', 'A', 'Sanchez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', NULL, '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982600623', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.5362, -98.5776, NULL, NULL),
('742938437', 'TX0100328', 'TX0100328', 'TXSATSTD', 'MacGregor Medical Center', 'Manuel', 'J', 'Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', NULL, '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972500254', 0, 'N', 0, '2013-09-03', NULL, NULL, 29.5362, -98.5776, NULL, NULL),
('742938437', 'TX0100329', 'TX0100329', 'TXSATSTD', 'MacGregor Medical Center', 'William', 'R', 'Beck', 'MD', 'Pediatrics', '', '', NULL, 'O', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', NULL, '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609873660', 0, 'N', 0, '2013-01-24', NULL, NULL, 29.5362, -98.5776, NULL, NULL);
