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
('850300232', 'W12014743', 'W12014743', 'NM01', 'Southwest Gastroenterology Associates', 'Angelina', 'A', 'Villas-Adams', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1295874220', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('850446046', 'W12014745', 'W12014745', 'NM01', 'Southwest Endocrinology Associates', 'Leisha', 'A', 'Bevoni', 'PA', 'Endocrinology', '', '', NULL, 'O', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', 'NMENDO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508956210', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('850446046', 'W12014746', 'W12014746', 'NM01', 'Southwest Endocrinology Associates', 'Robert', 'T', 'Ferraro', 'MD', 'Endocrinology', '', '', NULL, 'O', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', 'NMENDO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1124118963', 0, 'N', 0, '2011-11-04', NULL, NULL, 35.1435, -106.597, NULL, NULL),
('850446046', 'W12014747', 'W12014747', 'NM01', 'Southwest Endocrinology Associates', 'Karla', 'K', 'Giese', 'NP', 'Endocrinology', '', '', NULL, 'O', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', 'NMENDO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-04-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780676262', 1, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('850446046', 'W12014748', 'W12014748', 'NM01', 'Southwest Endocrinology Associates', 'Anita', 'L', 'Sloan', 'MD', 'Endocrinology', '', '', NULL, 'O', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', '5501 Jefferson St NE Ste 700', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058721002', '5058883708', 'NMENDO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1831262781', 0, 'N', 0, '2011-10-12', NULL, NULL, 35.1435, -106.597, NULL, NULL),
('202344885', 'W12014749', 'W12014749', 'NM01', 'New Mexico Chiropractic Center', 'Paul', 'R', 'Hordes', 'DC', 'Chiropractic', '', '', NULL, 'O', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', '2013-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407089196', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('202344885', 'W12014750', 'W12014750', 'NM01', 'New Mexico Chiropractic Center', 'David', 'W', 'Peer', 'DC', 'Chiropractic', '', '', NULL, 'O', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427099381', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('203720017', 'W12014753', 'W12014753', 'UT01', 'Abundo Eye Care', 'Roland', 'E', 'Abundo', 'OD', 'Optometry', '', '', NULL, 'O', '579 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8012558500', '8012552334', '579 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8012558500', '8012552334', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013970235', 0, 'N', 0, '2014-01-08', NULL, NULL, 40.6208, -111.875, NULL, NULL),
('850300232', 'W12014754', 'W12014754', 'NM01', 'Southwest Gastroenterology Associates', 'John', 'A', 'Burdon', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1134128416', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014721', 'W12014721', 'NM01', 'Southwest Gastroenterology Associates', 'Gabrielle', 'M', 'Adams', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1477552958', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014722', 'W12014722', 'NM01', 'Southwest Gastroenterology Associates', 'Gabrielle', 'M', 'Adams', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1477552958', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014762', 'W12014762', 'NM01', 'Southwest Gastroenterology Associates', 'Howard', 'K', 'Gogel', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1194724484', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014761', 'W12014761', 'NM01', 'Southwest Gastroenterology Associates', 'Howard', 'K', 'Gogel', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1194724484', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('421662165', 'W12014763', 'W12014763', 'UTMH1', 'Sunset Counseling Services', 'Evan', 'T', 'Kenison', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2356 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358502547', NULL, '2356 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358502547', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-10-17', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912977505', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('331132310', 'W12014751', 'W12014751', 'NM01', '', 'Barbara', 'J', 'Knighton', 'DOM', 'Acupuncture', '', '', NULL, 'O', '1014 Shirley NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052982927', '5052948397', '1014 Shirley NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052982927', '5052948397', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891872115', 0, 'N', 0, '2011-11-21', NULL, NULL, 35.0886, -106.519, NULL, NULL),
('850436842', 'W12014911', 'W12014911', 'NM01', 'Cardiac Care Consultants of New Mexico', 'Elizabeth', 'O', 'Palmer', 'MD', 'Cardiology', '', '', NULL, 'O', '715 Dr Martin Luther King Jr Ave Ste 210', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052481800', '5052481917', '715 Dr Martin Luther King Jr Ave Ste 210', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052481800', '5052481917', 'NMRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801890702', 0, 'N', 0, '2013-12-09', NULL, NULL, 35.0856, -106.639, NULL, NULL),
('870642984', 'W12014771', 'W12014771', 'UT01', 'InVision Eye Health', 'Brenden', 'R', 'White', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '10835 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8015723937', '8014952020', '10835 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8015723937', '8014952020', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558357954', 0, 'N', 0, '2013-11-15', NULL, NULL, 40.5545, -111.872, NULL, NULL),
('820554961', 'W12014772', 'W12014772', 'NM01', '', 'Jan', 'C', 'Jay', 'DOM', 'Acupuncture', '', '', NULL, 'O', '11110 San Rafael Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5053238100', '5052920555', '11110 San Rafael Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5053238100', '5052920555', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', '2013-09-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376555359', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('262667297', 'W12014773', 'W12014773', 'NM01', 'Southwest Physical Medicine and Diagnostics', 'Jeffrey', 'P', 'Schnapp', 'DC', 'Chiropractic', '', '', NULL, 'O', '1701 Moon NE Ste 300', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053234407', '5053229483', '1701 Moon NE Ste 300', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053234407', '5053229483', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '75.00', 3, '2012-01-01', '2013-08-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003895673', 0, 'Y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('850465424', 'W12014810', 'W12014810', 'NM01', '', 'Merrilee ', '', 'Foreman', 'DC', 'Chiropractic', '', '', NULL, 'O', '8000 Manaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052948889', '5052949494', '8000 Manaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052948889', '5052949494', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093723694', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014811', 'W12014811', 'WYT1', 'Campbell County Memorial Hospital', 'Charles', '', 'Barnett', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005199', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014812', 'W12014812', 'WYT1', 'Campbell County Clinics OB/GYN Specialists', 'Angela', '', 'Biggs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', NULL, '1414 W 4th St  ', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689787814', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014813', 'W12014813', 'WYT1', '', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', NULL, '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', '', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014814', 'W12014814', 'WYT1', 'Campbell County Clinics Internal Medicine', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', NULL, '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', '', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', '2013-09-30', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014815', 'W12014815', 'WYT1', 'Campbell County Memorial Hospital', 'Judith', '', 'Boyle', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000005387', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014817', 'W12014817', 'WYT1', 'Orthopedic Specialists of Wyoming', 'Patricia ', 'A', 'Connally', 'DO', 'Family Practice', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', '2014-07-22', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1538142930', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014818', 'W12014818', 'WYT1', 'Orthopedic Specialists of Wyoming', 'Patricia ', 'A', 'Connally', 'DO', 'Family Practice', '', '', NULL, 'B', 'Po Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', 'Po Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1538142930', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014819', 'W12014819', 'WYT1', 'Campbell County Memorial Hospital', 'Brian', '', 'Cullison', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave  ', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005851', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014821', 'W12014821', 'WYT1', 'Campbell County Memorial Hospital', 'Robin', '', 'Eicher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1518074442', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014822', 'W12014822', 'WYT1', 'Campbell County Clinics Internal Medicine', 'Sameera', '', 'Fareed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', '2013-09-30', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083600183', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014824', 'W12014824', 'WYT1', 'Campbell County Memorial Hospital', 'Dennis', '', 'Ford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006280', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014829', 'W12014829', 'WYT1', 'Campbell County Memorial Hospital', 'Landi', '', 'Halloran', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006540', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014830', 'W12014830', 'WYT1', 'Campbell County Memorial Hospital', 'Suzanne', '', 'Harris', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006598', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014831', 'W12014831', 'WYT1', 'Campbell County Memorial Hospital', 'Jonathan', '', 'Hayden', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006620', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014832', 'W12014832', 'WYT1', 'Campbell County Clinics Internal Medicine', 'Farrukh', '', 'Javaid', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922094036', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014833', 'W12014833', 'WYT1', 'Campbell County Memorial Hospital', 'Stanley', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007220', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014834', 'W12014834', 'WYT1', 'Campbell County Memorial Hospital', 'Ted', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007221', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014835', 'W12014835', 'WYT1', 'Cottonwood Clinic', 'Phillip', '', 'McMahill', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007529', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
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('850232628', 'W12014837', 'W12014837', 'NM01', 'Womens Specialists of New Mexico', 'Consuelo', '', 'Carmona', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1093889537', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014841', 'W12014841', 'WYT1', 'Campbell County Clinics Orthopaedic Specialists', 'Monica', '', 'Morman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1962497958', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014842', 'W12014842', 'WYT1', 'Campbell County Memorial Hospital', 'Robert', '', 'Neuwirth', 'MD', 'Nephrology', 'Hospitalist', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007826', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014844', 'W12014844', 'WYT1', 'Sagebrush ENT', 'Brian', '', 'Peshek', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076851442', NULL, '1405 W 4th St  ', 'Gillette', 'Campbell', 'WY', '82716', '3076851442', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1952528572', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014845', 'W12014845', 'WYT1', 'Campbell County Memorial Hospital', 'Mark', 'D', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008265', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12014847', 'W12014847', 'NM01', 'Womens Specialists of NM', 'Rebecca', '', 'Okun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1881768547', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014848', 'W12014848', 'WYT1', 'Campbell County Memorial Hospital', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014850', 'W12014850', 'WYT1', 'Campbell County Clinics Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014851', 'W12014851', 'WYT1', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014852', 'W12014852', 'WYT1', 'Campbell County Memorial Hospital', 'Michael', '', 'Stolpe', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008930', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12014853', 'W12014853', 'NM01', 'Womens Specialists of New Mexico', 'Elizabeth ', 'A', 'Shanley', 'PA', 'Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1437223070', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014854', 'W12014854', 'WYT1', 'Wellness Health Works', '', '', 'Wellness Health Works', 'GROUP', 'Clinic', '', '', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009566', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12014857', 'W12014857', 'WYT1', 'Campbell County Memorial Hospital', 'Wojciech', '', 'Zolcik', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1417060427', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12014856', 'W12014856', 'NM01', 'Womens Specialists of NM', 'Jody', 'L', 'Stonehocker', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-02', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1225116791', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12014861', 'W12014861', 'WYT1', 'Campbell County Memorial Hospital', '', '', 'Campbell County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'Po Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'Po Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-10-01', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005551', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W12014864', 'W12014864', 'UT01', 'Pioneer Valley Orthopaedic Clinic', 'Dennis', 'H', 'Gordon', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', NULL, '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-10', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558301366', 0, 'N', 0, '2011-10-11', NULL, NULL, 40.6991, -111.99, NULL, NULL),
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('200065596', 'W12014866', 'W12014866', 'UT01', 'Advanced Orthopedic and Sports Medicine', 'Leslie', 'J', 'Harris', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-10', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679587687', 0, 'N', 0, '2012-07-19', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621795215', 'W12014867', 'W12014867', 'UT01', 'Pioneer Valley Orthopaedic Clinic', 'Ross', 'M', 'Jarrett', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', NULL, '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-10', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396789558', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6991, -111.99, NULL, NULL),
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('200065596', 'W12014869', 'W12014869', 'UT01', 'Advanced Orthopedic and Sports Medicine', 'James', 'Gillis', 'Macintyre', 'MD', 'Sports Medicine', 'Family Practice', 'Orthopedic Surgery', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-10', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871539411', 0, 'N', 0, '2012-10-24', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('204171933', 'W12014870', 'W12014870', 'UT01', 'The Eye Institute of Utah', 'John', 'D', 'McCann', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', NULL, NULL, 'O', '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012262283', '8012629216', '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012262283', '8012629216', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326006917', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.6871, -111.87, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12014888', 'W12014888', 'UTIHC04', '', 'Kristine', 'Lynn', 'Scritchfield', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste LL-10', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '652 S Medical Ctr Dr Ste LL-10', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598053159', 0, 'N', 0, '2011-10-11', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12014890', 'W12014890', 'UTIHC01', 'PCMC Child Psychiatry', 'Kevin', 'W', 'Kuich', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-10-03', '2012-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669425054', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014891', 'W12014891', 'UTIHC02', 'PCMC Child Psychiatry', 'Kevin', 'W', 'Kuich', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-10-03', '2012-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669425054', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014892', 'W12014892', 'UTIHC03', 'PCMC Child Psychiatry', 'Kevin', 'W', 'Kuich', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-10-03', '2012-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669425054', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'ABQ200097', 'ABQ200097', 'NM01', 'ABQ Health Partners', 'Stephen', '', 'Dunlap', 'MD', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700811809', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'ABQ300101', 'ABQ300101', 'NM01', 'ABQ Health Partners', 'Lori', '', 'Eanes', 'DO', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528091196', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.2284, -106.66, 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
('204043287', 'ABQ200101', 'ABQ200101', 'NM01', 'ABQ Health Partners', 'Lori', '', 'Eanes', 'DO', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528091196', 0, 'Y', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100101', 'ABQ100101', 'NM01', 'ABQ Health Partners', 'Lori', '', 'Eanes', 'DO', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528091196', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'ABQ200356', 'ABQ200356', 'NM01', 'ABQ Health Partners', 'Dale', '', 'Walaszek', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2014-04-01', 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1962512293', 0, 'Y', 0, '2014-04-29', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'ABQ100218', 'ABQ100218', 'NM01', 'ABQ Health Partners', 'Michael', '', 'Martinez', 'MD', 'Urology', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627275', '5052623366', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627275', '5052623366', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Westside Hospital', 'Lovelace Womens Hospital', NULL, NULL, 'HCFA|UB|', '1669407771', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ100105', 'ABQ100105', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ200105', 'ABQ200105', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ300105', 'ABQ300105', 'NM01', 'ABQ Health Partners', 'Megan', '', 'Edwards', 'MD', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821011933', 0, 'Y', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100208', 'ABQ100208', 'NM01', 'ABQ Health Partners', 'Bruce', '', 'Lundblad', 'DO', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902731', 0, 'Y', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ200208', 'ABQ200208', 'NM01', 'ABQ Health Partners', 'Bruce', '', 'Lundblad', 'DO', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902731', 0, 'Y', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ300208', 'ABQ300208', 'NM01', 'ABQ Health Partners', 'Bruce', '', 'Lundblad', 'DO', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902731', 0, 'Y', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100125', 'ABQ100125', 'NM01', 'ABQ Health Partners', 'Samira', '', 'Ghoreishi', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477717635', 0, 'Y', 0, '2012-03-05', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ200125', 'ABQ200125', 'NM01', 'ABQ Health Partners', 'Samira', '', 'Ghoreishi', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-02-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477717635', 0, 'Y', 0, '2012-03-05', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ300125', 'ABQ300125', 'NM01', 'ABQ Health Partners', 'Samira', '', 'Ghoreishi', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-02-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477717635', 0, 'Y', 0, '2012-03-05', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ200130', 'ABQ200130', 'NM01', 'ABQ Health Partners', 'Robert', '', 'Gilbert', 'CNP', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063435303', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'ABQ100130', 'ABQ100130', 'NM01', 'ABQ Health Partners', 'Robert', '', 'Gilbert', 'CNP', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063435303', 0, 'Y', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ300130', 'ABQ300130', 'NM01', 'ABQ Health Partners', 'Robert', '', 'Gilbert', 'CNP', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063435303', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ300201', 'ABQ300201', 'NM01', 'ABQ Health Partners', 'John', '', 'Link', 'MD', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780623801', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'ABQ200137', 'ABQ200137', 'NM01', 'ABQ Health Partners', 'Alyssa', '', 'Gonzales', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623219', '5052623243', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-08', 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992990436', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100193', 'ABQ100193', 'NM01', 'ABQ Health Partners', 'Laurence', '', 'Laudicina', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '10511 Golf Course Rd NW Ste 103', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5053428400', '5053428401', '10511 Golf Course Rd NW Ste 103', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134108186', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('204043287', 'ABQ300147', 'ABQ300147', 'NM01', 'ABQ Health Partners', 'Raul', '', 'Griego', 'MD', 'Urgent Care', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058736401', '5058736408', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245248814', 0, 'Y', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100147', 'ABQ100147', 'NM01', 'ABQ Health Partners', 'Raul', '', 'Griego', 'MD', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245248814', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ200147', 'ABQ200147', 'NM01', 'ABQ Health Partners', 'Raul', '', 'Griego', 'MD', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245248814', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'ABQ100189', 'ABQ100189', 'NM01', 'ABQ Health Partners', 'Vijayalakshmi', '', 'Kumar', 'MD', 'Rheumatology', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627248', '5052623190', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627248', '5052623190', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', NULL, NULL, 'HCFA|UB|', '1881627453', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('204043287', 'ABQ200183', 'ABQ200183', 'NM01', 'ABQ Health Partners', 'Brooke', '', 'Kivitz', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417100868', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ300183', 'ABQ300183', 'NM01', 'ABQ Health Partners', 'Brooke', '', 'Kivitz', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417100868', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100183', 'ABQ100183', 'NM01', 'ABQ Health Partners', 'Brooke', '', 'Kivitz', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417100868', 0, 'Y', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100172', 'ABQ100172', 'NM01', 'ABQ Health Partners', 'Linda', '', 'Johnson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '10511 Golf Course Rd NW Ste 204', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052546500', '5052546532', '10511 Golf Course Rd NW Ste 204', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-06-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932134962', 0, 'N', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ100170', 'ABQ100170', 'NM01', 'ABQ Health Partners', 'William', '', 'Hughes', 'DO', 'Urgent Care', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902608', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'ABQ300170', 'ABQ300170', 'NM01', 'ABQ Health Partners', 'William', '', 'Hughes', 'DO', 'Urgent Care', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623233', '5052623191', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902608', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ200170', 'ABQ200170', 'NM01', 'ABQ Health Partners', 'William', '', 'Hughes', 'DO', 'Urgent Care', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902608', 0, 'Y', 0, '2012-01-17', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('742838103', 'W12014913', 'W12014913', 'NM01', 'Southwest Eyecare Specialists', 'Peter', 'T', 'Beaudette', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1720053200', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1597, -106.56, NULL, NULL),
('742838103', 'W12014914', 'W12014914', 'NM01', 'Southwest Eyecare Specialists', 'Randolph', 'E', 'Black', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1497736870', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1597, -106.56, NULL, NULL),
('742838103', 'W12014915', 'W12014915', 'NM01', 'Southwest Eyecare Specialists', 'R', 'J', 'Cannon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215900717', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1597, -106.56, NULL, NULL),
('742838103', 'W12014916', 'W12014916', 'NM01', 'Southwest Eyecare Specialists', 'John', 'J', 'Teahan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1679545594', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1597, -106.56, NULL, NULL),
('870281337', 'W12014917', 'W12014917', 'UT01', '', 'Clark', 'C', 'Larsen', 'DPM', 'Podiatry', '', '', NULL, 'O', '11800 S State St', 'Murray', 'Salt Lake', 'UT', '8020', '8012611391', NULL, '11800 S State St', 'Murray', 'Salt Lake', 'UT', '8020', '8012611391', '          ', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-12', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427130335', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('200685493', 'W12014918', 'W12014918', 'UT01', 'Premier Plastic Surgery Group of Utah', 'Steven', 'H', 'Warnock', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '11762 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015712020', '8015716899', '11762 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015712020', '8015716899', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-12', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457337594', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.5389, -111.891, NULL, NULL),
('204043287', 'W12014919', 'W12014919', 'NM01', 'ABQ Health Partners', 'David', '', 'Paolini', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '715 Dr Martin Luther King Jr Ave NE Ste 301', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627281', '5052627622', '715 Dr Martin Luther King Jr Ave NE Ste 301', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627281', '5052627622', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245229004', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W12014921', 'W12014921', 'UT01', 'Blanding Family Practice', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-13', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('870212456', 'W12014924', 'W12014924', 'UT01', 'Gunnison Family Practice', 'Adam', '', 'Jensen', 'DO', 'Family Practice', '', '', NULL, 'O', '95 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287227', NULL, '95 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287227', '          ', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-13', '2013-01-31', 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1609072651', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W12014925', 'W12014925', 'UT01', 'Blanding Family Practice', 'Lloyd', 'V', 'Jones', 'MD', 'Family Practice', 'Emergency Medicine', NULL, NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-13', NULL, 0, 0, 0, 'Blue Mountain Hospital', '', '', '', 'HCFA|UB|', '1932102514', 0, 'N', 0, '2013-11-06', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('236178312', 'W12014926', 'W12014926', 'NM01', '', 'Zandall', 'J', 'Carpenter', 'DC', 'Chiropractic', '', '', NULL, 'O', '2730 San Pedro Dr NE Ste B1', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058881550', '5058812129', '2730 San Pedro Dr NE Ste B1', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058881550', '5058812129', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700854999', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1114, -106.578, NULL, NULL),
('264220261', 'W12014928', 'W12014928', 'NM01', 'Cardiac Care Consultants of New Mexico', 'Anthony', 'B', 'Sandoval', 'MD', 'Cardiology', '', '', NULL, 'O', '3917 W Rd Ste 101', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5056627008', NULL, '3917 W Rd Ste 101', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5056627008', '          ', 'NMRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528062346', 0, 'N', 0, '2011-11-04', NULL, NULL, 35.8824, -106.319, NULL, NULL),
('204818113', 'W12014929', 'W12014929', 'NM01', '', 'Eric', 'Y', 'Zhao', 'DOM', 'Acupuncture', '', '', NULL, 'O', '3737 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058815299', '5058815231', '3737 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058815299', '5058815231', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154496396', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1245, -106.533, NULL, NULL),
('850424076', 'W12014930', 'W12014930', 'NM01', 'New Mexico Heart Insitute ', 'Christopher', '', 'Wyndham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432956', '5059982612', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432956', '5059982612', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1871597674', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('300655165', 'W12014938', 'W12014938', 'UT01', 'University Health Care', 'Kristen', 'E', 'Day', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689826141', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
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('523565255', 'W12015049', 'W12015049', 'NM01', '', 'Jayne', 'L', 'Carpenter', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '8501 Candelaria NE Ste F2', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053232856', NULL, '8501 Candelaria NE Ste F2', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053232856', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861411340', 0, 'N', 0, '2011-12-09', NULL, NULL, 35.1165, -106.55, NULL, NULL),
('850246856', 'W12015050', 'W12015050', 'NM01', 'Eye Associates of New Mexico', 'Molly', 'E', 'Ritsema', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Drive, NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1356569867', 0, 'N', 0, '2011-10-24', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12015051', 'W12015051', 'NM01', 'Eye Associates of New Mexico', 'Nicholas', 'B', 'Ritz', 'OD', 'Optometry', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Drive, NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1881684678', 0, 'N', 0, '2011-10-24', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12015052', 'W12015052', 'NM01', 'Eye Associates of New Mexico', 'Nathaniel', '', 'Roland', 'OD', 'Optometry', '', '', NULL, 'O', '5200 Eubank Blvd NE A4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052984419', '5052980878', '5200 Eubank Blvd, NE A-4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052984419', '5052980878', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811981624', 0, 'N', 0, '2011-10-26', NULL, NULL, 35.1381, -106.533, NULL, NULL),
('850246856', 'W12015054', 'W12015054', 'NM01', 'Eye Associates of New Mexico', 'Mi-Kyoung', '', 'Song', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Drive, NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1619962131', 0, 'N', 0, '2011-10-25', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('301387179', 'W12015055', 'W12015055', 'NM01', '', 'Andrea', '', 'Duff', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '11930 Menaul Blvd NE Ste 220C', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053012971', NULL, '11930 Menaul Blvd NE Ste 220C', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053012971', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1649357419', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1087, -106.508, NULL, NULL),
('030528703', 'W12015059', 'W12015059', 'NM01', 'Lighthouse Counseling', 'Linda', '', 'Lombari', 'LISW', 'Social Worker', 'Mental Health', '', NULL, 'O', '2520 Virginia NE Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052964449', NULL, '2520 Virginia NE Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052964449', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356416655', 0, 'N', 0, '2012-01-03', NULL, NULL, 35.1096, -106.553, NULL, NULL),
('850246856', 'W12015058', 'W12015058', 'NM01', 'Eye Associates of New Mexico', 'Tina', 'M', 'Watterberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Drive, Ne', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1316932817', 0, 'N', 0, '2011-10-25', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12015060', 'W12015060', 'NM01', 'Eye Associates of New Mexico', 'Arthur', 'J', 'Weinstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1700871894', 0, 'N', 0, '2013-11-14', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12015104', 'W12015104', 'NM01', 'Eye Associates of New Mexico', 'William', 'K', 'Wieland', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1245225721', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('585489200', 'W12015063', 'W12015063', 'NM01', '', 'Demetra', '', 'Childress', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '2901 Juan Tabo NE Ste 11', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052928908', NULL, '2901 Juan Tabo NE Ste 11', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052928908', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801959432', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1149, -106.516, NULL, NULL),
('850246856', 'W12015064', 'W12015064', 'NM01', 'Eye Associates of New Mexico', 'Frank', 'W', 'Wyant ', 'DO', 'Ophthalmology', '', '', NULL, 'O', '806 Dr Martin Luther King Jr Ave, NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052486575', '5052433475', '806 Dr Martin Luther King Jr Ave, NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052486575', '5052433475', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1497740989', 0, 'N', 0, '2011-10-25', NULL, NULL, 35.0853, -106.638, NULL, NULL),
('558684750', 'W12015066', 'W12015066', 'NM01', '', 'Robert', '', 'Sullivan', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '3900 Eubank Blvd NE Ste 9A', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052864492', NULL, '3900 Eubank Blvd NE Ste 9A', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052864492', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598823049', 0, 'N', 0, '2011-11-09', NULL, NULL, 35.1264, -106.533, NULL, NULL),
('810678634', 'W12015068', 'W12015068', 'NM01', '', 'Brett', '', 'Nelson', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '11927 Menaul Blvd NE Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052751155', NULL, '11927 Menaul Blvd NE Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052751155', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1407965163', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.1088, -106.508, NULL, NULL),
('204076841', 'W12015070', 'W12015070', 'NM01', 'Life Change Therapy Institute', 'Thomas', 'F', 'McKenna', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '1200 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052715050', NULL, '1200 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052715050', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194897108', 0, 'N', 0, '2011-11-02', NULL, NULL, 35.0924, -106.533, NULL, NULL),
('850246856', 'W12015073', 'W12015073', 'NM01', 'Eye Associates of New Mexico', 'Craig', 'R', 'Vroman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Drive, Ne', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1851438550', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12015071', 'W12015071', 'NM01', 'Eye Associates of New Mexico', 'Jeffrey', 'C', 'Strosnider', 'OD', 'Optometry', '', '', NULL, 'O', '1740 Grande Blvd, SE Ste B', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058923434', '5058912402', '1740 Grande Blvd, SE Ste B', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058923434', '5058912402', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1669467163', 0, 'N', 0, '2011-10-26', NULL, NULL, 35.2285, -106.662, NULL, NULL),
('850246856', 'W12015074', 'W12015074', 'NM01', 'Eye Associates of New Mexico', 'Rebekah', 'C', 'Allen', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB', '1083810311', 0, 'N', 0, '2012-01-12', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015076', 'W12015076', 'NM01', 'Eye Associates of New Mexico', 'Daryl ', '', 'Bigelow', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548268428', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015077', 'W12015077', 'NM01', 'Eye Associates of New Mexico', 'Angela', 'R', 'Bratton', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962402081', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015078', 'W12015078', 'NM01', 'Eye Associates of New Mexico', 'Melinda', '', 'Cano-Howes', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1881650547', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015079', 'W12015079', 'NM01', 'Eye Associates of New Mexico', 'Thomas', 'J', 'Carlow', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1326048307', 0, 'N', 0, '2014-01-09', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015080', 'W12015080', 'NM01', 'Eye Associates of New Mexico', 'Mark', 'T', 'Chiu', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1821083932', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015081', 'W12015081', 'NM01', 'Eye Associates of New Mexico', 'Michael', 'L', 'DiMonaco', 'DO', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1295720621', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015082', 'W12015082', 'NM01', 'Eye Associates of New Mexico', 'Kirsten ', 'P', 'Dudeck', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1558356980', 0, 'N', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015083', 'W12015083', 'NM01', 'Eye Associates of New Mexico', 'Frank', '', 'Durso', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275528606', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015084', 'W12015084', 'NM01', 'Eye Associates of New Mexico', 'Kenneth ', 'S', 'Himmel', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972567154', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015086', 'W12015086', 'NM01', 'Eye Associates of New Mexico', 'Mark', 'P', 'Lesher', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1376533240', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015087', 'W12015087', 'NM01', 'Eye Associates of New Mexico', 'Frank', 'J', 'Mares', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316932437', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015088', 'W12015088', 'NM01', 'Eye Associates of New Mexico', 'Barbara', 'C', 'Marsh', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1194726240', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015089', 'W12015089', 'NM01', 'Eye Associates of New Mexico', 'Robert ', 'F', 'Melendez', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1316932742', 0, 'N', 0, '2012-01-12', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12015090', 'W12015090', 'NM01', 'Eye Associates of New Mexico', 'Cara', 'A', 'Morris', 'OD', 'Optometry', '', '', NULL, 'B', 'Po Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'Po Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1861427841', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('850232628', 'W12015145', 'W12015145', 'NM01', 'Womens Specialists of NM', 'Paul', 'B', 'Araiza', 'MD', 'Obstetrics and Gynecology', '', '', 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, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1457569758', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015148', 'W12015148', 'NM01', 'Womens Specialists of NM', 'Jennifer', '', 'Bach', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '207 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '207 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1578655254', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015147', 'W12015147', 'NM01', 'Womens Specialists of NM', 'Jennifer', '', 'Bach', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1578655254', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015150', 'W12015150', 'NM01', 'Samaritan Center', 'Frank', 'L', 'Spring', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316164312', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850342072', 'W12015154', 'W12015154', 'NM01', 'Samaritan Center', 'Patricia', '', 'Lake', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1457332835', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015151', 'W12015151', 'NM01', 'Womens Specialists of NM', 'Steven ', '', 'Gough', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1184783078', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015152', 'W12015152', 'NM01', 'Womens Specialists of NM', 'Steven ', '', 'Gough', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1184783078', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015155', 'W12015155', 'NM01', 'Womens Specialists of NM', 'Rebecca ', '', 'Leeman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1508930256', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015156', 'W12015156', 'NM01', 'Womens Specialists of NM', 'Rebecca ', '', 'Leeman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1508930256', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015157', 'W12015157', 'NM01', 'Womens Specialists of NM', 'Stephanie', 'L', 'Philippides', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1316088263', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015158', 'W12015158', 'NM01', 'Womens Specialists of NM', 'Stephanie', 'L', 'Philippides', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1316088263', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015159', 'W12015159', 'NM01', 'Womens Specialists of NM', 'Lydia', 'E', 'Prado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1598793655', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015160', 'W12015160', 'NM01', 'Womens Specialists of NM', 'Lydia', 'E', 'Prado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1598793655', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015162', 'W12015162', 'NM01', 'Samaritan Center', 'Mary Jane', '', 'Zimmerman', 'LMHC', 'Counseling', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275832511', 0, 'N', 0, '2011-11-02', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850342072', 'W12015165', 'W12015165', 'NM01', 'Samaritan Center', 'Anthony', 'P', 'Baca', 'LMHC', 'Counseling', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932372257', 0, 'N', 0, '2011-10-31', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015163', 'W12015163', 'NM01', 'Womens Specialists of NM', 'Patricia', '', 'Heinz', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1093741985', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015166', 'W12015166', 'NM01', 'Womens Specialists of NM', 'Patricia', '', 'Heinz', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1093741985', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015168', 'W12015168', 'NM01', 'Samaritan Center', 'Manuela', '', 'Mondloch', 'LMHC', 'Counseling', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386943678', 0, 'N', 0, '2011-12-13', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015169', 'W12015169', 'NM01', 'Womens Specialists of NM', 'Carol ', '', 'Kiesling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1912075847', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015170', 'W12015170', 'NM01', 'Womens Specialists of New Mexico', 'Carol ', '', 'Kiesling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Lane, NW', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1912075847', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015172', 'W12015172', 'NM01', 'Samaritan Center', 'Mayra', 'E', 'Haynes', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1295949956', 0, 'N', 0, '2013-09-27', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015173', 'W12015173', 'NM01', 'Womens Specialists of NM', 'Gileen', '', 'Elder', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1962576603', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015174', 'W12015174', 'NM01', 'Womens Specialists of NM', 'Gileen', '', 'Elder', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Lane NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Lane NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1962576603', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015175', 'W12015175', 'NM01', 'Womens Specialists of NM', 'Mary', 'E', 'Mark', 'MD', 'Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1548334204', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015176', 'W12015176', 'NM01', 'Womens Specialists of NM', 'Mary', 'E', 'Mark', 'MD', 'Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1548334204', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015179', 'W12015179', 'NM01', 'Samaritan Center', 'Margaret', '', 'Lucas', 'LISW', 'Social Worker', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033363551', 0, 'N', 0, '2014-04-14', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015178', 'W12015178', 'NM01', 'Womens Specialists of NM', 'Michelle', 'L', 'Pino', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-08-28', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1992864896', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015180', 'W12015180', 'NM01', 'Womens Specialists of NM', 'Michelle', 'L', 'Pino', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-08-28', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1992864896', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015182', 'W12015182', 'NM01', 'Samaritan Center', 'Sarah', '', 'Brennan', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1407881261', 0, 'N', 0, '2011-10-31', NULL, NULL, 35.0898, -106.63, NULL, NULL),
('850232628', 'W12015183', 'W12015183', 'NM01', 'Womens Specialists of NM', 'Jeanine ', 'L', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street, SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1215078167', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12015184', 'W12015184', 'NM01', 'Womens Specialists of NM', 'Jeanine ', 'L', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Lane, NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|DEN|', '1215078167', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('850342072', 'W12015186', 'W12015186', 'NM01', 'Samaritan Center', 'Miquela', '', 'Rivera', 'PHD', 'Counseling', 'Mental Health', '', NULL, 'O', '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', NULL, '1101 Medical Arts Ave NE Bldg 3', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058425300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639487044', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.0898, -106.63, NULL, NULL),
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('585265648', 'W12015192', 'W12015192', 'NM01', '', 'Steven', 'A', 'Washburn', 'PHD LPCC ', 'Psychology', 'Counseling', 'Mental Health', NULL, 'O', '3901 Georgia NE Ste B-2', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058371177', NULL, '3901 Georgia NE Ste B-2', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058371177', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023096872', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.1288, -106.571, NULL, NULL),
('710959164', 'W12015194', 'W12015194', 'NM01', '', 'Kari', 'W', 'Karr', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '12412 Menaul NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5057101640', NULL, '12412 Menaul NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5057101640', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1699957480', 0, 'N', 0, '2012-01-05', NULL, NULL, 35.1092, -106.499, NULL, NULL),
('265885719', 'W12015196', 'W12015196', 'NM01', '', 'Laurie', '', 'Stevenson', 'LISW', 'Social Worker', 'Mental Health', '', NULL, 'O', '4135 Montgomery NE Ste B', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5056100171', NULL, '4135 Montgomery NE Ste B', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5056100171', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740214485', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.131, -106.598, NULL, NULL),
('309502218', 'W12015198', 'W12015198', 'NM01', '', 'Ann', '', 'Mastenbrook', 'LPCC', 'Counseling', 'Mental Health', '', NULL, 'O', '11930 Menaul NE Ste 220A', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052591305', NULL, '11930 Menaul NE Ste 220A', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052591305', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376534370', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1087, -106.508, NULL, NULL),
('347405806', 'W12015202', 'W12015202', 'NM01', '', 'Mary Ann', '', 'Shinnick', 'LISW', 'Social Worker', 'Mental Health', '', NULL, 'O', '4004 Carlisle Blvd NE Ste J', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5054597565', NULL, '4004 Carlisle Blvd NE Ste J', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5054597565', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821083130', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.1268, -106.604, NULL, NULL),
('850481490', 'W12015203', 'W12015203', 'NM01', 'Albuquerque Ambulatory Eye Surgery Center', '', '', 'Albuquerque Ambulatory Eye Surgery Center', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '5901 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057983550', '5057983565', '5901 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057983550', '5057983565', '', '', 'OP1', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1205878758', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.1532, -106.586, NULL, NULL),
('850481490', 'W12015204', 'W12015204', 'NM01', 'Albuquerque Ambulatory Eye Surgery Center', '', '', 'Albuquerque Ambulatory Eye Surgery Center', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5058238545', '5058238009', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5058238545', '5058238009', '', '', 'OP1', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1205878758', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('850450261', 'W12015206', 'W12015206', 'NM01', '', 'Rose', 'I', 'Montgomery', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '4708 Hannett Ave, NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052685098', '5052621903', '4708 Hannett Ave, NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052685098', '5052621903', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164520409', 0, 'N', 0, '2011-10-25', NULL, NULL, 0, 0, NULL, NULL),
('850449127', 'W12015210', 'W12015210', 'NM01', '', 'William', 'A', 'Brown', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3810 Masthead St NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052433514', '5052433451', '3810 Masthead St NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052433514', '5052433451', 'NMRECTAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710900220', 0, 'N', 0, '2011-11-14', NULL, NULL, 35.157, -106.598, NULL, NULL),
('270806125', 'W12015636', 'W12015636', 'NM01', 'Breathe America Albuquerque Inc', 'Karen ', 'K', 'Nester', 'PA-C', 'Allergy and Immunology', '', '', NULL, 'O', '4901 Lang Ave NE  100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', '4901 Lang Ave NE  100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', 'NMALLERGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083793665', 0, 'N', 0, '2012-07-26', NULL, NULL, 0, 0, NULL, NULL),
('850449127', 'W12015213', 'W12015213', 'NM01', '', 'Calvin', '', 'Dudley', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3810 Masthead St', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052433514', '5052433451', '3810 Masthead Street, NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052433514', '5052433451', 'NMRECTAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972524619', 0, 'N', 0, '2011-10-25', NULL, NULL, 35.157, -106.598, NULL, NULL),
('264079351', 'W12015215', 'W12015215', 'UT01', 'Tooele Urology ', 'Daniel', 'L', 'Hibbert', 'MD', 'Urology', '', '', NULL, 'O', '2376 N 400 E Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358820071', NULL, '2376 N 400 E Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358820071', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-19', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Mountain West Medical Center', NULL, NULL, 'HCFA|UB|', '1275647562', 0, 'N', 0, '2012-10-03', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('270806125', 'W12015214', 'W12015214', 'NM01', '', 'Bruce', '', 'Feldman', 'MD', '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', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1871672535', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1732, -106.59, NULL, NULL),
('870603341', 'W12015223', 'W12015223', 'UT01', '', 'Ivan', 'D', 'Flint', 'MD', 'Dermatology', '', '', NULL, 'O', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '8012623600', '8012622555', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '8012623600', '8012622555', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-19', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962484485', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.5651, -112.298, NULL, NULL),
('201577619', 'W12015226', 'W12015226', 'UT01', 'Bedtime Kids Care', 'Jim', 'J', 'Gould', 'MD', 'Pediatrics', 'Urgent Care', '', NULL, 'O', '2356 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358438380', NULL, '2356 N 400 E Ste 202', 'Tooele', 'Tooele', 'UT', '84074', '4358438380', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-19', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649200296', 0, 'N', 0, '2012-03-21', NULL, NULL, 40.5621, -112.293, NULL, NULL),
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('850275777', 'W12035527', 'W12035527', 'NM01', 'Southwest Medical Associates', '', '', 'Southwest Medical Associates', '', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', NULL, '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009787', 0, 'Y', 0, '2013-10-31', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12015254', 'W12015254', 'NM01', 'Southwest Medical Associates', 'Katherine', '', 'Pickett', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', NULL, '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1861451718', 0, 'N', 0, '2012-01-12', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850381680', 'W12015229', 'W12015229', 'NM01', 'Albuquerque Urology Associates', 'Aaron', 'J', 'Geswaldo', 'DO', 'Urology', '', '', NULL, 'O', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1639174550', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850381680', 'W12015230', 'W12015230', 'NM01', 'Albuquerque Urology Associates', 'Aaron', 'J', 'Geswaldo', 'DO', 'Urology', '', '', NULL, 'O', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1639174550', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.0883, -106.644, NULL, NULL),
('850381680', 'W12015232', 'W12015232', 'NM01', 'Albuquerque Urology Associates', 'Jamie', '', 'Fanning', 'MS PAC', 'Urology', '', '', NULL, 'O', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1508034588', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850381680', 'W12015231', 'W12015231', 'NM01', 'Albuquerque Urology Associates', 'Jamie', '', 'Fanning', 'MS PAC', 'Urology', '', '', NULL, 'O', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1508034588', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.0883, -106.644, NULL, NULL),
('850275777', 'W12015262', 'W12015262', 'NM01', 'Southwest Medical Associates', 'Lauren', '', 'Artiglia', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', '2014-07-29', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1568786085', 0, 'N', 0, '2014-06-30', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850381680', 'W12015233', 'W12015233', 'NM01', 'Albuquerque Urology Associates', 'Andrew', '', 'Grollman', 'MD', 'Urology', '', '', NULL, 'O', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1811157100', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850381680', 'W12015234', 'W12015234', 'NM01', 'Albuquerque Urology Associates', 'Andrew', '', 'Grollman', 'MD', 'Urology', '', '', NULL, 'O', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', '610 Broadway Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052423991', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1811157100', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.0883, -106.644, NULL, NULL),
('850381680', 'W12015236', 'W12015236', 'NM01', 'Albuquerque Urology Associates', 'Damara', 'L', 'Kaplan', 'MD', 'Urology', '', '', NULL, 'O', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', '4801 McMahon Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052423993', '5052438405', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1174525257', 0, 'N', 0, '2011-10-28', NULL, NULL, 35.2069, -106.678, NULL, NULL),
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('272825194', 'W12015425', 'W12015425', 'UT01', 'Lakeside Audiology', 'Jennie', '', 'Mollerup', 'AUD', 'Audiology', '', '', NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376662791', 0, 'N', 0, '2012-11-02', NULL, NULL, 40.8843, -111.879, NULL, NULL),
('850137632', 'W12015351', 'W12015351', 'NM01', 'Albuquerque Speech Language and Hearing Center', 'Linda', '', 'Byrne', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052744224', '5052471772', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052744224', '5052471772', '', '', '', '0.00', '0.00', '75.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245351303', 0, 'N', 0, '2013-08-07', NULL, NULL, 35.1306, -106.536, NULL, NULL),
('850137632', 'W12015352', 'W12015352', 'NM01', 'Albuquerque Speech Language and Hearing Center', 'Suzanne', '', 'Estep', 'CCC-AUD', 'Audiology', '', '', NULL, 'O', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052474224', '5052471772', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052474224', '5052471772', 'NMAUDIO', '', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356620025', 0, 'N', 0, '2013-08-07', NULL, NULL, 35.1306, -106.536, NULL, NULL),
('850137632', 'W12015358', 'W12015358', 'NM01', 'Albuquerque Speech Language and Hearing Center', 'Nicole', '', 'Muhlenbeck-Major', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052744224', '5052471772', '9500 Montgomery NE Ste 215', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052744224', '5052471772', '', '', '', '0.00', '0.00', '75.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760764039', 0, 'N', 0, '2013-08-07', NULL, NULL, 35.1306, -106.536, NULL, NULL),
('593358647', 'W12015361', 'W12015361', 'NM01', 'Major Medical', '', '', 'Roswell Home Medical Inc', '', 'Durable Medical Equipment', '', '', NULL, 'O', '4201 Yale Blvd NE Ste D', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5053438761', '          ', '4201 Yale Blvd NE Ste D', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5053438761', '          ', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104887769', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('593358647', 'W12015362', 'W12015362', 'NM01', 'Major Medical', '', '', 'Roswell Home Medical Inc', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '5053438761', '          ', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '5053438761', '          ', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104887769', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12015430', 'W12015430', 'UT01', 'ProRehab', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '355 E 175 S', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', '355 E 175 S', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-07-15', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12015431', 'W12015431', 'UT01', 'ProRehab', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '355 E 175 S', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', '355 E 175 S', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'N', 0, '2011-10-26', NULL, NULL, 38.9955, -110.162, NULL, NULL),
('452277880', 'W12015432', 'W12015432', 'UT01', 'Summit Hand Therapy', 'Samuel', '', 'DeLong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2179 N 1700 W Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017732633', '8017731553', '2179 N 1700 W Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017732633', '8017731553', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-08-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1780603910', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('452277880', 'W12015433', 'W12015433', 'UT01', 'Summit Hand Therapy', 'Samuel', '', 'DeLong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2179 N 1700 W Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017732633', '8017731553', '2179 N 1700 W Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017732633', '8017731553', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780603910', 0, 'N', 0, '2011-10-26', NULL, NULL, 41.089, -111.997, NULL, NULL),
('452648973', 'W12015434', 'W12015434', 'UTDT01', 'JESSENOFMS, Inc', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1448 N 2000 W Ste 12', 'Clearfield', 'Davis', 'UT', '84015', '8014798200', NULL, '1448 N 2000 W Ste 12', 'Clearfield', 'Davis', 'UT', '84015', '8014798200', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12015436', 'W12015436', 'UT01', 'Exodus Healthcare', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', '3336 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 1, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12015437', 'W12015437', 'UT01', 'Exodus Healthcare', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8014170063', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8014170063', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12015438', 'W12015438', 'UT01', 'Lakeside Audiology', 'Carolyn', 'S', 'Bennett', 'AUD', 'Audiology', '', '', NULL, 'O', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', '8016120662', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', '8016120662', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-07-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952388332', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12015439', 'W12015439', 'UT01', 'Lakeside Audiology', 'Carolyn', 'S', 'Bennett', 'AUD', 'Audiology', '', '', NULL, 'B', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-07-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952388332', 0, 'N', 0, '2013-10-30', 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
('870686529', 'W12015440', 'W12015440', 'UT01', 'Jordan River Womens Health', 'Denise', 'J', 'Boudreaux-Nippert', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3584 W 9000 S Ste 206', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015612227', '8015615353', '3584 W 9000 S Ste 206', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015612227', '8015615353', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497862031', 0, 'N', 0, '2012-04-23', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621762570', 'W12015444', 'W12015444', 'UT01', 'Roosevelt Community Clinic', 'Sarah', '', 'Heaton', 'PAC', 'Family Practice', '', '', NULL, 'B', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013297142', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12015443', 'W12015443', 'UT01', 'Roosevelt Community Clinic', 'Sarah', '', 'Heaton', 'PAC', 'Family Practice', '', '', NULL, 'O', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013297142', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.294, -109.989, NULL, NULL),
('518062432', 'W12015448', 'W12015448', 'UT01', 'Universal Diagnostic Testing', 'Troy', '', 'Hunter', 'APRN', 'Pain Management', NULL, NULL, NULL, 'O', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164416848', 0, 'N', 0, '2012-07-17', NULL, NULL, 40.5564, -111.853, NULL, NULL),
('518062432', 'W12015447', 'W12015447', 'UT01', 'Omega Interventional Pain', 'Troy', '', 'Hunter', 'APRN', 'Pain Management', NULL, NULL, NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164416848', 0, 'N', 0, '2012-07-17', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('518062432', 'W12015450', 'W12015450', 'UT01', 'Universal Diagnostic Testing', 'Troy', '', 'Hunter', 'APRN', 'Pain Management', NULL, NULL, NULL, 'B', '3874 Little Cottonwood Ln', 'Sandy', 'Salt Lake', 'UT', '84092', '8019385362', '8885030041', '3874 Little Cottonwood Ln', 'Sandy', 'Salt Lake', 'UT', '84092', '8019385362', '8885030041', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164416848', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12015457', 'W12015457', 'UT01', 'Silverton Group', 'Mark', 'L', 'Martinez', 'MD', 'Hospitalist', '', '', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508861964', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.8852, -111.872, NULL, NULL),
('270852226', 'W12015456', 'W12015456', 'UT01', 'Silverton Group', 'Mark', 'L', 'Martinez', 'MD', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508861964', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12015458', 'W12015458', 'UT01', 'Silverton Group', 'Mark', 'L', 'Martinez', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012952361', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508861964', 0, 'N', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12015459', 'W12015459', 'UT01', 'Lakeside Audiology', 'Mark', 'L', 'Plumley', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '8015476392', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '8015476392', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518140953', 0, 'N', 0, '2012-01-26', NULL, NULL, 41.0609, -111.945, NULL, NULL),
('272825194', 'W12015466', 'W12015466', 'UT01', 'Lakeside Audiology', 'Aaron', 'C', 'Turgoose', 'AUD', 'Audiology', '', '', NULL, 'B', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '8015476392', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '8015476392', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689719445', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12015465', 'W12015465', 'UT01', 'Lakeside Audiology', 'Aaron', 'C', 'Turgoose', 'AUD', 'Audiology', '', '', NULL, 'O', '74 E 500 S  Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', '8015476392', '74 E 500 S  Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', '8015476392', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689719445', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.8843, -111.879, NULL, NULL),
('621762570', 'W12015467', 'W12015467', 'UT01', 'Ashley Regional General Surgery', 'Bruce', 'J', 'Watkins', 'MD', 'General Surgery', '', '', NULL, 'O', '175 N 100 W Ste 202', 'Vernal', 'Uintah', 'UT', '84078', '4357890990', '4357890992', '175 N 100 W Ste 202', 'Vernal', 'Uintah', 'UT', '84078', '4357890990', '4357890992', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1326240425', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('850442797', 'W12015473', 'W12015473', 'NM01', 'NM Dermatology Associates', 'Amanda', '', 'Harper', 'MD', 'Dermatology', '', '', NULL, 'O', '7520 Montgomery Blvd NE Ste D-4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058847070', '5058846018', '7520 Montgomery Blvd NE Ste D-4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058847070', '5058846018', 'NMSTD+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700925740', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.1307, -106.561, NULL, NULL),
('273766839', 'W12017251', 'W12017251', 'UTDT01', 'Anderton Dental Group', 'Brett', '', 'Anderton', 'DDS', 'Dentist', '', '', NULL, 'O', '1220 33rd St Ste A', 'Ogden', 'Weber', 'UT', '84403', '8016211835', NULL, '1220 33rd St Ste A', 'Ogden', 'Weber', 'UT', '84403', '8016211835', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009864', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('850394465', 'W12015475', 'W12015475', 'NM01', '', 'Janice', 'F', 'Moranz', 'MD', 'Dermatology', '', '', NULL, 'O', '6409-A Candelaria Road NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058801920', '5058801076', '6409-A Candelaria Road NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058801920', '5058801076', 'NMSTD+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295821098', 0, 'Y', 0, '2014-06-13', NULL, NULL, 35.1165, -106.576, NULL, NULL),
('850248687', 'W12015476', 'W12015476', 'NM01', 'Dermatology Consultants of Albuquerque', 'William', '', 'Chapman', '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, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235139569', 0, 'N', 0, '2011-11-21', NULL, NULL, 35.0925, -106.552, NULL, NULL),
('850248687', 'W12015477', 'W12015477', 'NM01', 'Dermatology Consultants of Albuquerque', 'James', 'N', 'Icken', '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, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730156225', 0, 'N', 0, '2011-11-01', NULL, NULL, 35.0925, -106.552, NULL, NULL),
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('621801973', 'W12015493', 'W12015493', 'UT01', 'Salt Lake Regional Medical Associates', 'Kathryn', '', 'Casull', 'MD', 'Internal Medicine', NULL, NULL, 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, '2011-10-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831256635', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
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('742825864', 'W12015507', 'W12015507', 'NM01', 'Western Dermatology Consultants', 'Carol', '', 'Purcell', 'PA', 'Dermatology', '', '', NULL, 'O', '10151 Montgomery NE Ste A Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058555503', '5058555533', '10151 Montgomery NE Ste A Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058555503', '5058555533', 'NMSTD+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043336126', 0, 'N', 0, '2011-11-07', NULL, NULL, 35.1307, -106.527, NULL, NULL),
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('208670470', 'W12015561', 'W12015561', 'UT01', 'Heart of Dixie Cardiology', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'N', 0, '2012-11-05', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('870560452', 'W12015562', 'W12015562', 'UT01', 'Heart of Dixie Cardiology', 'Gary', 'V', 'Petersen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', '2013-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295775971', 0, 'N', 0, '2013-04-30', 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
('208670470', 'W12015563', 'W12015563', 'UT01', 'Heart of Dixie Cardiology', 'Gregory', 'D', 'Price', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', NULL, '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1699761106', 0, 'N', 0, '2014-04-16', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('870465532', 'W12015564', 'W12015564', 'UT01', '', 'Ronald', 'M', 'Pugh', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '321 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987496', '8013732144', '321 W Center St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987496', '8013732144', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013012715', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('202963453', 'W12015565', 'W12015565', 'UT01', 'Alpine Vision Center', 'William', 'Carlan', 'Reese', 'OD', 'Optometry', '', '', NULL, 'O', '76 E Commerce Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017681900', '8017681904', '76 E Commerce Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017681900', '8017681904', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790757110', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('202963453', 'W12015566', 'W12015566', 'UT01', 'Alpine Vision Center', 'William', 'Carlan', 'Reese', 'OD', 'Optometry', '', '', NULL, 'O', '11038 N Highland Blvd Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017567150', '8017681904', '11038 N Highland Blvd Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017567150', '8017681904', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790757110', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.4402, -111.818, NULL, NULL),
('870507858', 'W12015567', 'W12015567', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '41 N 400 W', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '41 N 400 W', 'Payson', 'Utah', 'UT', '84651', '8014654809', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.044, -111.738, NULL, NULL),
('203151071', 'W12015568', 'W12015568', 'UT01', '', 'Chad', 'L', 'Rigtrup', 'OD', 'Optometry', '', '', NULL, 'O', '262 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8013742227', NULL, '262 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8013742227', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821109059', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('161767581', 'W12015569', 'W12015569', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-30', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('200792714', 'W12015570', 'W12015570', 'UT01', 'The Rose Clinic for Plastic and Migraine Surgery', 'Kevin', 'G', 'Rose', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '320 River Park Dr Ste 245', 'Provo', 'Utah', 'UT', '84604', '8013757673', '8013757679', '320 River Park Dr Ste 245', 'Provo', 'Utah', 'UT', '84604', '8013757673', '8013757679', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245276021', 0, 'N', 0, '2011-11-01', NULL, NULL, 40.3038, -111.662, NULL, NULL),
('352271214', 'W12015571', 'W12015571', 'UT01', '', 'Bradley', 'B', 'Rounds', 'OD', 'Optometry', '', '', NULL, 'O', '37 E 100 N', 'Heber City', 'Wasatch', 'UT', '84032', '4356541863', NULL, '37 E 100 N', 'Heber City', 'Wasatch', 'UT', '84032', '4356541863', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265514988', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.5089, -111.413, NULL, NULL),
('020541777', 'W12015572', 'W12015572', 'UT01', '', 'Frank', 'A', 'Siddoway', 'OD', 'Optometry', '', '', NULL, 'O', '262 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8013742227', '8013745197', '262 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8013742227', '8013745197', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255343695', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('161767581', 'W12015573', 'W12015573', 'UT01', 'Layton Family Practice', 'Casey', 'L', 'Stelter', 'MD', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073607222', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12015575', 'W12015575', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Nikki', '', 'Switzer', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1851468367', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12015577', 'W12015577', 'UT01', 'Salt Lake Regional Medical Associates', 'Lorraine', 'B', 'Szczesny', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518022896', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('201766124', 'W12015578', 'W12015578', 'UT01', 'Dixie Dermatology', 'Karl', 'K', 'Trimble', 'MD', 'Dermatology', '', '', NULL, 'O', '169 W 2710 S Cir Ste 107', 'St George', 'Washington', 'UT', '84790', '4356743552', '4356745905', '169 W 2710 S Cir Ste 107', 'St George', 'Washington', 'UT', '84790', '4356743552', '4356745905', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1184616880', 0, 'N', 0, '2014-06-16', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('202963126', 'W12015582', 'W12015582', 'UT01', 'Alpine Vision Center', 'Steven', 'J', 'Weaver', 'OD', 'Optometry', '', '', NULL, 'O', '11038 N Highland Blvd Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017567150', '8017567206', '11038 N Highland Blvd Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017567150', '8017567206', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487630588', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.4402, -111.818, NULL, NULL),
('161767581', 'W12015583', 'W12015583', 'UT01', 'Layton Family Practice', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('743111545', 'W12015584', 'W12015584', 'WY01', 'Beartooth Orthopedic and Spine', 'Stephen', '', 'Emery', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781952', '3075781979', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781952', '3075781979', '', '', '', '0.00', '25.00', '0.00', 3, '2012-02-01', '2013-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720189335', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('743111545', 'W12015585', 'W12015585', 'WYT1', 'Beartooth Orthopedic and Spine', 'Stephen', '', 'Emery', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781952', '3075781979', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781952', '3075781979', '', '', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2013-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720189335', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('261787543', 'W12015586', 'W12015586', 'WY01', 'Kister Eyecare', 'Benjamin', 'J', 'Kister', 'OD', 'Optometry', '', '', NULL, 'O', '400 E Adams Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', '400 E Adams Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336125319', 0, 'N', 0, '2011-11-18', NULL, NULL, 43.0226, -108.386, NULL, NULL),
('261787543', 'W12015587', 'W12015587', 'WY01', 'Kister Eyecare', 'Benjamin', 'J', 'Kister', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 873', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', 'PO Box 873', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336125319', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('261787543', 'W12015588', 'W12015588', 'WYT1', 'Kister Eyecare', 'Benjamin', 'J', 'Kister', 'OD', 'Optometry', '', '', NULL, 'O', '400 E Adams Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', '400 E Adams Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078566531', '3078561306', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336125319', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
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('753143209', 'W12015599', 'W12015599', 'WYT1', 'Big Horn Basin Bone and Joint', 'Adam', '', 'Mattingly', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '1739 Spring Creek Ln', 'Billings', 'Yellowstone', 'MT', '59102', '3075181955', '3075781979', '1739 Spring Creek Ln', 'Billings', 'Yellowstone', 'MT', '59102', '3075181955', '3075781979', '', '', '', '0.00', '25.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1295836831', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
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('270806125', 'W12015626', 'W12015626', 'NM01', 'Breathe America Albuquerque Inc', '', '', 'Breathe America Albuquerque Inc', '', 'Allergy and Immunology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5058830725', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5058830725', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009790', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('270806125', 'W12015641', 'W12015641', 'NM01', 'Breathe America Albuquerque Inc', 'Jennifer', '', 'Urbina', 'PA-C', 'Allergy and Immunology', '', '', NULL, 'O', '4901 Lang Ave NE 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', '4901 Lang Ave NE 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5058830725', 'NMALLERGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-03-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295028363', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12015644', 'W12015644', 'UT01', 'Cache Valley Specialty Hospital', 'Shirley', 'Barbee', 'Shaw', '', 'Physical Therapy', '', '', NULL, 'O', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', 'WESTREHAB', '', '', '0.00', '0.00', '73.00', 8, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1841415304', 0, 'N', 0, '2011-10-31', NULL, NULL, 41.7118, -111.829, NULL, NULL),
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