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
('202882697', 'ID0105410', 'ID0105410', 'IDBOISTD', 'The Pediatric & Adolescent Center', 'Cathy', '', 'Sandstrom', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1215926845', 0, 'n', 0, '2013-07-02', NULL, NULL, 43.6606, -116.341, NULL, NULL),
('202882697', 'ID0105409', 'ID0105409', 'IDBOISTD', 'The Pediatric & Adolescent Center', 'William', 'S', 'Bourquard', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1568451193', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.6606, -116.341, NULL, NULL),
('202882697', 'ID0105408', 'ID0105408', 'IDBOISTD', 'The Pediatric & Adolescent Center', 'Steven', 'K', 'Dahlke', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '          ', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1710976337', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.6606, -116.341, NULL, NULL),
('820537848', 'ID0105443', 'ID0105443', 'IDBOISTD', 'The Shoulder Clinic of Idaho', 'Robert', 'J', 'Buzzini', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497703730', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.611, -116.293, NULL, NULL),
('820537848', 'ID0105444', 'ID0105444', 'IDBOISTD', 'The Shoulder Clinic of Idaho', 'Thomas', 'M', 'Chopp', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720081060', 0, 'n', 0, '2012-10-18', NULL, NULL, 43.611, -116.293, NULL, NULL),
('820537848', 'ID0105441', 'ID0105441', 'IDBOISTD', 'The Shoulder Clinic of Idaho', 'Thomas', 'E', 'Goodwin', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649208851', 0, 'n', 0, '2012-10-18', NULL, NULL, 43.611, -116.293, NULL, NULL),
('820537848', 'ID0105442', 'ID0105442', 'IDBOISTD', 'The Shoulder Clinic of Idaho', 'Kathryn', 'A', 'Colson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457363970', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.611, -116.293, NULL, NULL),
('820457091', 'ID0105482', 'ID0105482', 'IDBOISTD', 'Idaho Diabetes & Endocrine Associates PA', 'Theodore', 'S', 'Roosevelt', 'MD', 'Endocrinology', '', '', NULL, 'O', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1699754697', 0, 'n', 0, '2013-07-12', NULL, NULL, 43.611, -116.296, NULL, NULL),
('742083988', 'TX0105815', 'TX0105815', 'TXSATSTD', 'Renal Associates', 'Jessica', 'L', 'Pierce', 'MD', 'Nephrology', '', '', NULL, 'O', '4499 Medical Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78229', '2109490469', NULL, '4499 Medical Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78229', '2109490469', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1831120344', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5105, -98.5737, NULL, NULL),
('742083988', 'TX0105813', 'TX0105813', 'TXSATSTD', 'Renal Associates', '', '', 'Renal Associates PA', 'GROUP', 'Nephrology', '', '', NULL, 'B', 'PO Box 701008', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', NULL, 'PO Box 701008', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008357', 0, 'y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0105811', 'TX0105811', 'TXSATSTD', 'Renal Associates', '', '', 'Renal Associates PA', 'GROUP', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008357', 0, 'y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0105814', 'TX0105814', 'TXSATSTD', 'Renal Associates', 'Brijesh', '', 'Kapoor', 'MD', 'Nephrology', '', '', NULL, 'O', '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', NULL, '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North East Baptist Hospital', 'North Central Baptist Hospital', NULL, 'HCFA|UB|', '1518988104', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5428, -98.3399, NULL, NULL),
('820333564', 'ID0105800', 'ID0105800', 'IDBOISTD', 'Richard F Starkey', 'Richard', 'F', 'Starkey', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 427', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', NULL, 'PO Box 427', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|UB|', '1831206135', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('820333564', 'ID0105803', 'ID0105803', 'IDBOISTD', '', 'Linda', 'G', 'Shaw', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 427', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', NULL, 'PO Box 427', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669561049', 0, 'Y', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('820333564', 'ID0105801', 'ID0105801', 'IDBOISTD', NULL, 'Richard', 'F', 'Starkey', 'MD', 'Family Practice', '', '', NULL, 'o', '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', NULL, '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|UB|', '1831206135', 0, 'N', 0, '2013-01-17', NULL, NULL, 43.1387, -115.693, NULL, NULL),
('820333564', 'ID0105802', 'ID0105802', 'IDBOISTD', 'Michael P Koelsch', 'Linda', 'G', 'Shaw', 'FNP', 'Family Practice', '', '', NULL, 'o', '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', NULL, '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879736', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669561049', 0, 'N', 0, '2013-10-25', NULL, NULL, 43.1376, -115.693, NULL, NULL),
('820392395', 'ID0105806', 'ID0105806', 'IDBOISTD', 'Edwward H Newcombe', 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', NULL, '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'N', 0, '2013-10-30', NULL, NULL, 43.6237, -116.274, NULL, NULL),
('741849254', 'TX0105971', 'TX0105971', 'TXSATSTD', 'Southeast Surgical Associates', 'Jeffrey', 'L', 'Glass', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '          ', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-07-14', 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', '', '', 'HCFA|UB|', '1487615720', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.3749, -98.4113, NULL, NULL),
('741849254', 'TX0105973', 'TX0105973', 'TXSATSTD', 'Southeast Surgical Associates', '', '', 'Southeast Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', NULL, 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008843', 0, 'y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('826003542', 'ID0106036', 'ID0106036', 'IDBOISTD', 'Trinity Mountain Medical Clinic', 'Karl', 'H', 'Olson', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'o', '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', NULL, '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-03-31', 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|', '1508846353', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.139, -115.695, NULL, NULL),
('826003542', 'ID0106032', 'ID0106032', 'IDBOISTD', 'Trinity Mountain Medical Clinic', 'Dennis', 'D', 'Crossley', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'o', '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', NULL, '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-03-31', 0, 0, 0, 'Elmore Medical Center', '', '', '', 'HCFA|', '1558341594', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.139, -115.695, NULL, NULL),
('826003542', 'ID0106031', 'ID0106031', 'IDBOISTD', 'Trinity Mountain Medical Clinic', 'Timothy', '', 'Brininger', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'o', '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', NULL, '465 McKenna Dr', 'Mountain Home', 'Elmore', 'ID', '83647', '2085879703', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-12-22', 0, 0, 0, '', '', '', '', 'HCFA|', '1124008164', 0, 'N', 0, '2013-12-26', NULL, NULL, 43.139, -115.695, NULL, NULL),
('820477852', 'ID0106102', 'ID0106102', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820477852', 'ID0106096', 'ID0106096', 'IDBOISTD', 'Saint Alphonsus Medical Group Cherry Lane', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820477852', 'ID0106101', 'ID0106101', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820477852', 'ID0106089', 'ID0106089', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820496280', 'ID0106152', 'ID0106152', 'IDBOISTD', 'Dermatology Clinic of ID', 'Stephen', 'J', 'Frelly', 'PA', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', NULL, '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114966959', 0, 'N', 0, '2013-07-05', NULL, NULL, 43.6886, -116.356, NULL, NULL),
('820496280', 'ID0106153', 'ID0106153', 'IDBOISTD', 'Dermatology Clinic of ID', 'James', 'H', 'Stewart', 'MD PHD', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', NULL, '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-05-05', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104870567', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.6892, -116.355, NULL, NULL),
('820496280', 'ID0106151', 'ID0106151', 'IDBOISTD', 'Dermatology Clinic of ID', 'Mariya', 'R', 'Ostermiller', 'PA', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', NULL, '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-05-05', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407047202', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.6892, -116.355, NULL, NULL),
('820496280', 'ID0106150', 'ID0106150', 'IDBOISTD', 'Dermatology Clinic of ID', 'Alexander', 'J', 'Arhets', 'PA', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', NULL, '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-05-05', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013956853', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.6892, -116.355, NULL, NULL),
('820343079', 'ID0106145', 'ID0106145', 'IDBOISTD', 'Richard F Starkey', 'Linda', 'G', 'Shaw', 'FNP', 'Family Practice', '', '', NULL, 'O', '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875880', NULL, '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875880', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669561049', 0, 'N', 0, '2013-10-08', NULL, NULL, 43.1376, -115.693, NULL, NULL),
('820343079', 'ID0106142', 'ID0106142', 'IDBOISTD', 'Michael P Koelsch', 'Michael', 'P', 'Koelsch', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085873082', NULL, '805 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085873082', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952482440', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.1387, -115.693, NULL, NULL),
('820343079', 'ID0106143', 'ID0106143', 'IDBOISTD', NULL, 'Michael', 'P', 'Koelsch', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 940', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875880', NULL, 'PO Box 940', 'Mountain Home', 'Elmore', 'ID', '83647', NULL, NULL, 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952482440', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('820343079', 'ID0106144', 'ID0106144', 'IDBOISTD', '', 'Linda', 'G', 'Shaw', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 940', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875880', NULL, 'PO Box 940', 'Mountain Home', 'Elmore', 'ID', '83647', '2085875880', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669561049', 0, 'Y', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
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('203717348', 'ID0107024', 'ID0107024', 'IDBOISTD', 'Ada Orthopaedic Clinic Don’t give out as Participating', 'Don’t map or give provider as participating', '', 'Only par with Dr Jeffrey Shilt for Radiology codes.', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2012-08-20', '2012-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386806347', 0, 'N', 0, '2012-08-27', NULL, NULL, 43.612, -116.262, NULL, NULL),
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('743003947', 'TX0108275', 'TX0108275', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Casey', 'D', 'Taber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972711463', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('680569751', 'ID0108277', 'ID0108277', 'IDBOISTD', 'Davis Family Medicine', 'Amy', 'L', 'Gallaway', 'NP', 'Family Practice', '', '', NULL, 'O', '222 N 2nd St Ste 204', 'Boise', 'Ada', 'ID', '83702', '2084299100', NULL, '222 N 2nd St Ste 204', 'Boise', 'Ada', 'ID', '83702', '2084299100', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306817226', 0, 'Y', 0, '2013-08-30', NULL, NULL, 43.613, -116.195, NULL, NULL),
('820457091', 'ID0108288', 'ID0108288', 'IDBOISTD', 'Idaho Diabetes & Endocrine Associates PA', 'Sarah', 'M', 'Lane', 'PA', 'Endocrinology', '', '', NULL, 'O', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336334192', 0, 'n', 0, '2013-02-05', NULL, NULL, 43.611, -116.296, NULL, NULL),
('820200895', 'ID0108294', 'ID0108294', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Katherine', 'A', 'Mathews', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083673951', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083673951', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1841296902', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('331078261', 'ID0108409', 'ID0108409', 'IDBOISTD', 'Saint Alphonsus Physicians PA', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'B', '6140 W Curtisian Ste 400', 'Boise', 'Ada', 'ID', '83706', '2083673500', NULL, '6140 W Curtisian Ste 400', 'Boise', 'Ada', 'ID', '83706', '2083673500', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2012-08-20', '2012-12-25', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('202595845', 'ID0112274', 'ID0112274', 'IDBOISTD', 'Boise Kidney & Hypertension Institute', 'Amit', '', 'Sharma', 'MD', 'Nephrology', '', '', NULL, 'O', '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', NULL, '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', '          ', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1730123779', 0, 'N', 0, '2013-07-01', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('202595845', 'ID0112271', 'ID0112271', 'IDBOISTD', 'Boise Kidney & Hypertension Institute', 'Amit', '', 'Sharma', 'MD', 'Nephrology', '', '', NULL, 'O', '222 N 2nd Ste 112', 'Boise', 'Ada', 'ID', '83702', '2088468335', NULL, '222 N 2nd Ste 112', 'Boise', 'Ada', 'ID', '83702', '2088468335', '          ', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1730123779', 0, 'N', 0, '2013-07-01', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('820491054', 'ID0112396', 'ID0112396', 'IDBOISTD', 'Scott L Christensen', 'Scott', 'L', 'Christensen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', NULL, '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', '          ', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1386672228', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6132, -116.194, NULL, NULL),
('820491054', 'ID0112394', 'ID0112394', 'IDBOISTD', 'Glen S Lovelace', 'Glen', 'S', 'Lovelace', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', NULL, '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', '          ', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720023930', 0, 'N', 0, '2013-11-14', NULL, NULL, 43.6132, -116.194, NULL, NULL),
('432043556', 'ID0112411', 'ID0112411', 'IDBOISTD', 'Rocky Mountain Health & Wellness', 'Cynthia', 'R', 'Culp', 'NP', 'Family Practice', '', '', NULL, 'O', '951 E Plaza Dr', 'Eagle', 'Ada', 'ID', '83616', '2089385680', NULL, '951 E Plaza Dr', 'Eagle', 'Ada', 'ID', '83616', '2089385680', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643146', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.6917, -116.342, NULL, NULL),
('203164316', 'ID0112472', 'ID0112472', 'IDBOISTD', 'Garden Valley Family Medicine', 'Michael', 'R', 'Koenig', 'MD', 'Family Practice', '', '', NULL, 'O', '980 Banks Lowman Rd', 'Garden Valley', 'Boise', 'ID', '83622', '2084623533', NULL, '980 Banks Lowman Rd', 'Garden Valley', 'Boise', 'ID', '83622', '2084623533', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851396386', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('203164316', 'ID0112473', 'ID0112473', 'IDBOISTD', 'Garden Valley Family Medicine', 'Michael', 'R', 'Koenig', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 270', 'Garden Valley', 'Boise', 'ID', '83622', '2084623533', NULL, 'PO Box 270', 'Garden Valley', 'Boise', 'ID', '83622', '2084623533', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851396386', 0, 'y', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('203164316', 'ID0112475', 'ID0112475', 'IDBOISTD', 'Garden Valley Family Medicine', 'Michael', 'R', 'Koenig', 'MD', 'Family Practice', '', '', NULL, 'O', '102 Quinn St', 'Horse Shoe Bend', 'Boise', 'ID', '83629', '2087932257', NULL, '102 Quinn St', 'Horse Shoe Bend', 'Boise', 'ID', '83629', '2087932257', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851396386', 0, 'N', 0, '2013-06-26', NULL, NULL, 43.916, -116.204, NULL, NULL),
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('870478993', 'ID0114887', 'ID0114887', 'IDBOISTD', 'U-U General Medicine Division', '', '', 'U-U General Medicine Division', 'GROUP', 'Internal Medicine', 'General Practice', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009378', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'ID0114893', 'ID0114893', 'IDBOISTD', 'U-U Rheumatology Division', '', '', 'U-U Rheumatology Division', 'GROUP', 'Rheumatology', '', '', NULL, 'O', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009387', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('861168471', 'ID0114895', 'ID0114895', 'IDBOISTD', 'U of U Palliative Care', '', '', 'U of U Palliative Care', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'Po Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'Po Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009244', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'ID0114886', 'ID0114886', 'IDBOISTD', 'U-U Gastroenterology Division', '', '', 'U-U Gastroenterology Division', 'GROUP', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009377', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'ID0114898', 'ID0114898', 'IDBOISTD', 'U-U Dermatology Division', '', '', 'U-U Dermatology Division', 'GROUP', 'Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876348', NULL, 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876348', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009375', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'ID0114907', 'ID0114907', 'IDBOISTD', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'O', '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015874888', NULL, '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015874888', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870551055', 'ID0114912', 'ID0114912', 'IDBOISTD', 'Pediatric Cardiothoracic Surgeons', '', '', 'Pediatric Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2800', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625566', NULL, '100 N Mario Capecchi Dr Ste 2800', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625566', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008111', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'ID0114904', 'ID0114904', 'IDBOISTD', 'Pediatric Urology Associates', '', '', 'Pediatric Urology Associates', 'GROUP', 'Urology', 'Pediatric Urology', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2200', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', NULL, '100 N Mario Capecchi Dr Ste 2200', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008124', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'ID0114901', 'ID0114901', 'IDBOISTD', 'U-U Otolaryngology - Pediatrics', '', '', 'U-U Otolaryngology - Pediatrics', 'GROUP', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009383', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('810574312', 'ID0114914', 'ID0114914', 'IDBOISTD', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'ID0114922', 'ID0114922', 'IDBOISTD', 'U of U Hospitals and Clinics - FPO', '', '', 'U of U Hospitals and Clinics - FPO', 'GROUP', 'Cardiovascular Disease', 'Gastroenterology', 'Internal Medicine', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009234', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'ID0114920', 'ID0114920', 'IDBOISTD', 'U of U Hospitals and Clinics', '', '', 'U of U Hospitals and Clinics', 'GROUP', 'Family Practice', 'Optometry', 'Internal Medicine', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009233', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'ID0114905', 'ID0114905', 'IDBOISTD', 'Pediatric Urology Associates', '', '', 'Pediatric Urology Associates', 'GROUP', 'Urology', 'Pediatric Urology', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008124', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870584427', 'ID0114909', 'ID0114909', 'IDBOISTD', 'University of Utah Vascular Surgeons', '', '', 'University of Utah Vascular Surgeons', 'GROUP', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009325', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'ID0114906', 'ID0114906', 'IDBOISTD', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'ID0114903', 'ID0114903', 'IDBOISTD', 'University Ear Nose and Throat Associates', '', '', 'University Ear, Nose, and Throat Associates', 'CCCA', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003005', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'ID0114902', 'ID0114902', 'IDBOISTD', 'U-U Otolaryngology - Pediatrics', '', '', 'U-U Otolaryngology - Pediatrics', 'GROUP', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009383', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870460977', 'ID0114908', 'ID0114908', 'IDBOISTD', 'U-U Non-Invasive Vascular Lab', '', '', 'U-U Non-Invasive Vascular Lab', 'GROUP', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009382', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'ID0114910', 'ID0114910', 'IDBOISTD', 'University of Utah Surgical Associates', '', '', 'University of Utah Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009322', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'ID0114911', 'ID0114911', 'IDBOISTD', 'University of Utah Cardiothoracic Surgeons', '', '', 'University of Utah Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009282', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870551055', 'ID0114913', 'ID0114913', 'IDBOISTD', 'Pediatric Cardiothoracic Surgeons', '', '', 'Pediatric Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883345', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883345', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008111', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870526462', 'ID0114916', 'ID0114916', 'IDBOISTD', 'University of Utah Plastic Surgery Associates', '', '', 'University of Utah Plastic Surgery Associates', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009320', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'ID0114923', 'ID0114923', 'IDBOISTD', 'College of Nursing University of Utah', '', '', 'College of Nursing, University of Utah', 'GROUP', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005767', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'ID0114929', 'ID0114929', 'IDBOISTD', 'University of Utah Surgical Intensive Care Unit', '', '', 'University of Utah Surgical Intensive Care Unit', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009323', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('810574312', 'ID0114915', 'ID0114915', 'IDBOISTD', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('752646025', 'TX0115151', 'TX0115151', 'TXSATSTD', 'Metro North Cardiovascular Associates', 'M', 'Gearald', 'Garoutte', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8715 Village Dr Ste 519', 'San Antonio', 'Bexar', 'TX', '78217', '2106546000', NULL, '8715 Village Dr Ste 519', 'San Antonio', 'Bexar', 'TX', '78217', '2106546000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235135344', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('820487790', 'ID0115162', 'ID0115162', 'IDBOISTD', 'Selah Medical Center', 'Gloria', '', 'Beery', 'CNP', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '          ', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '          ', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-05-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043263064', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.612, -116.263, NULL, NULL),
('743003947', 'TX0115251', 'TX0115251', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Eloy', '', 'Ochoa', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144209990', 0, 'N', 0, '2013-07-09', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('743003947', 'TX0115250', 'TX0115250', 'TXSATSTD', 'The San Antonio Orthopaedic Group', '', '', 'The San Antonio Orthopedic Group LLP', 'GROUP', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '          ', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009051', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('743003947', 'TX0115252', 'TX0115252', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Casey', 'D', 'Taber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972711463', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('820470163', 'ID0115230', 'ID0115230', 'IDBOISTD', 'FirstLine Medical', 'Karen', 'B', 'Barrett', 'PA', 'Family Practice', '', '', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', NULL, '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598921595', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820470163', 'ID0115231', 'ID0115231', 'IDBOISTD', 'FirstLine Medical', 'Briant', 'E', 'Burke', 'MD', 'Family Practice', '', '', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538322854', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('204969546', 'ID0115228', 'ID0115228', 'IDBOISTD', 'Meridian Pediatrics', 'Barbara', '', 'Kissam', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', NULL, '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '          ', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881689362', 0, 'N', 0, '2013-10-18', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('208192751', 'ID0115267', 'ID0115267', 'IDBOISTD', 'Matt H Joyce', 'Matt', 'H', 'Joyce', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '520 S Eagle Rd Ste 1200', 'Meridian', 'Ada', 'ID', '83642', '2083214609', NULL, '520 S Eagle Rd Ste 1200', 'Meridian', 'Ada', 'ID', '83642', '2083214609', '          ', 'IDPED', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891785820', 0, 'N', 0, '2013-04-16', NULL, NULL, 43.5994, -116.355, NULL, NULL),
('208192751', 'ID0115268', 'ID0115268', 'IDBOISTD', NULL, 'Matt', 'H', 'Joyce', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 44619', 'Boise', 'Ada', 'ID', '83711', '2083214609', NULL, 'PO Box 44619', 'Boise', 'Ada', 'ID', '83711', NULL, NULL, 'IDPED', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891785820', 0, 'y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('742719352', 'TX0116551', 'TX0116551', 'TXSATSTD', 'Urology of San Antonio', 'Lewis', 'F', 'Russell', 'MD', 'Urology', '', '', NULL, 'B', '7909 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', NULL, '7909 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1760596415', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
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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
('742719352', 'TX0116553', 'TX0116553', 'TXSATSTD', 'Urology of San Antonio', 'George', 'J', 'Vassar', 'MD', 'Urology', '', '', NULL, 'O', '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', NULL, '128 W Bandera Ste 3', 'Boerne', 'Kendall', 'TX', '78006', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932297157', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.7804, -98.7296, NULL, NULL),
('742719352', 'TX0116554', 'TX0116554', 'TXSATSTD', 'Urology of San Antonio', 'George', 'J', 'Vassar', 'MD', 'Urology', '', '', NULL, 'B', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', NULL, '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932297157', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
('742915297', 'TX0116884', 'TX0116884', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Allan', 'J', 'White', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1497782114', 0, 'N', 0, '2014-07-17', NULL, NULL, 29.5109, -98.5711, NULL, NULL),
('742915297', 'TX0116885', 'TX0116885', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Allan', 'J', 'White', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1497782114', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('205764098', 'TX0117133', 'TX0117133', 'TXSATSTD', 'Boerne Pediarics', 'Sheralyn', 'D', 'Wood', 'MD', 'Pediatrics', '', '', NULL, 'O', '124 E Bandera Rd Ste 304', 'Boerne', 'Kendall', 'TX', '78006', '8308165055', NULL, '124 E Bandera Rd Ste 304', 'Boerne', 'Kendall', 'TX', '78006', '8308165055', '', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1902830318', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.7804, -98.7283, NULL, NULL),
('742915297', 'TX0117134', 'TX0117134', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.511, -98.5709, NULL, NULL),
('742915297', 'TX0117135', 'TX0117135', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0117136', 'TX0117136', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Kyriakos', 'P', 'Papadopoulos', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376546861', 0, 'y', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0117137', 'TX0117137', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Kyriakos', 'P', 'Papadopoulos', 'MD', 'Oncology', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376546861', 0, 'N', 0, '2014-02-03', NULL, NULL, 29.511, -98.5709, NULL, NULL),
('743003947', 'TX0117283', 'TX0117283', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Richard', 'L', 'Ursone', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528059722', 0, 'Y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'TX0117288', 'TX0117288', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Richard', 'L', 'Ursone', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '11212 Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528059722', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('820477852', 'ID0117340', 'ID0117340', 'IDBOISTD', 'Saint Alphonsus Medical Group Pediatrics', 'Alanna', 'C', 'Moore', 'PA-C', 'Pediatrics', 'Physician Assistant', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1982864278', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('820477852', 'ID0117344', 'ID0117344', 'IDBOISTD', 'Saint Alphonsus OB Hospitalist Program', 'Martha', 'H', 'Lund', 'MD', 'Obstetrics and Gynecology', 'Hospitalist', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1053356923', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820477852', 'ID0117345', 'ID0117345', 'IDBOISTD', 'Saint Alphonsus Medical Group Womens Health- do not post on', 'Christina', 'M', 'Knutson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-09', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649212119', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.6151, -116.256, NULL, NULL),
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('264333033', 'TX0118255', 'TX0118255', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Mark', 'E', 'Thompson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821017484', 0, 'N', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118256', 'TX0118256', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Anna', 'L', 'Chavana', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1689683039', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118257', 'TX0118257', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Cameron', '', 'Powell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008243', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118258', 'TX0118258', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Joy', 'T', 'Aden', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114936408', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118259', 'TX0118259', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Joseph', 'R', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144210121', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118274', 'TX0118274', 'TXSATSTD', 'Northeast OB/GYN Associates', 'Paula', 'M', 'Bilica', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467620260', 0, 'y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118275', 'TX0118275', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Celyna', 'D', 'Delgado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12709 Toepperwein Ste 309', 'San Antonio', 'Bexar', 'TX', '78233', '2106574099', NULL, '12709 Toepperwein Ste 309', 'San Antonio', 'Bexar', 'TX', '78233', '2106574099', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417946625', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('264333033', 'TX0118297', 'TX0118297', 'TXSATSTD', 'Institute for Womens Health', 'Valentin', '', 'Almendarez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037615', 0, 'N', 0, '2013-12-09', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('264333033', 'TX0118298', 'TX0118298', 'TXSATSTD', 'Institute for Womens Health', 'Karen', 'M', 'Carcamo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2102631200', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2102631200', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235129271', 0, 'N', 0, '2013-08-07', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('264333033', 'TX0118299', 'TX0118299', 'TXSATSTD', 'Institute for Womens Health', 'Celyna', 'D', 'Delgado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', NULL, '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-31', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417946625', 0, 'N', 0, '2012-08-24', NULL, NULL, 29.5128, -98.5757, NULL, NULL),
('264333033', 'TX0118300', 'TX0118300', 'TXSATSTD', 'Institute for Womens Health', 'David', 'R', 'Dooley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518947902', 0, 'N', 0, '2013-03-12', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'TX0118301', 'TX0118301', 'TXSATSTD', 'Institute for Womens Health', 'Camilo', 'A', 'Gonima', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', NULL, '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-31', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316964745', 0, 'N', 0, '2012-08-24', NULL, NULL, 29.5128, -98.5757, NULL, NULL),
('264333033', 'TX0118302', 'TX0118302', 'TXSATSTD', 'Institute for Womens Health', 'Cesar', '', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801885959', 0, 'N', 0, '2013-04-11', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'TX0118303', 'TX0118303', 'TXSATSTD', 'Institute for Womens Health', 'Jose', 'M', 'Ruiz III', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093705089', 0, 'N', 0, '2013-03-12', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'TX0118304', 'TX0118304', 'TXSATSTD', 'Institute for Womens Health', 'Vincenzo', '', 'Sabella', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', NULL, '7950 Floyd Curl Dr Ste 600', 'San Antonio', 'Bexar', 'TX', '78229', '2106158585', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-31', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780601773', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.5128, -98.5757, NULL, NULL),
('264333033', 'TX0118305', 'TX0118305', 'TXSATSTD', 'Institute for Womens Health', 'Ronald', 'A', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', NULL, '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841280849', 0, 'N', 0, '2013-09-27', NULL, NULL, 29.512, -98.5761, NULL, NULL),
('264333033', 'TX0118306', 'TX0118306', 'TXSATSTD', 'Institute for Womens Health', 'Daniel', 'A', 'Calderon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083603252', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118307', 'TX0118307', 'TXSATSTD', 'Institute for Womens Health', 'Carlos', 'A', 'Cardenas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487643664', 0, 'N', 0, '2014-03-18', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118308', 'TX0118308', 'TXSATSTD', 'Institute for Womens Health', 'Elisa', 'F', 'Carroll', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962491159', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118309', 'TX0118309', 'TXSATSTD', 'Institute for Womens Health', 'Victor', 'L', 'Casiano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679562862', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118310', 'TX0118310', 'TXSATSTD', 'Institute for Womens Health', 'Evangeline', '', 'Ramos-Gonzales', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922097070', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118311', 'TX0118311', 'TXSATSTD', 'Institute for Womens Health', 'Orlando', 'J', 'Suris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471825', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118312', 'TX0118312', 'TXSATSTD', 'Institute for Womens Health', 'Michael', '', 'Troy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184613242', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118313', 'TX0118313', 'TXSATSTD', 'Institute for Womens Health', 'Daniel', 'A', 'Calderon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083603252', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118314', 'TX0118314', 'TXSATSTD', 'Institute for Womens Health', 'Carlos', 'A', 'Cardenas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487643664', 0, 'N', 0, '2014-03-18', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118315', 'TX0118315', 'TXSATSTD', 'Institute for Womens Health', 'Elisa', 'F', 'Carroll', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962491159', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118316', 'TX0118316', 'TXSATSTD', 'Institute for Womens Health', 'Victor', 'L', 'Casiano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679562862', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118317', 'TX0118317', 'TXSATSTD', 'Institute for Womens Health', 'Evangeline', '', 'Ramos-Gonzales', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922097070', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118318', 'TX0118318', 'TXSATSTD', 'Institute for Womens Health', 'Orlando', 'J', 'Suris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471825', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118319', 'TX0118319', 'TXSATSTD', 'Institute for Womens Health', 'Michael', '', 'Troy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184613242', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0118320', 'TX0118320', 'TXSATSTD', 'Institute for Womens Health', 'Luis', 'L', 'Castellanos', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', NULL, '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-31', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538158720', 0, 'N', 0, '2012-12-04', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('264333033', 'TX0118321', 'TX0118321', 'TXSATSTD', 'Institute for Womens Health', 'Joe', 'R', 'Childress', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '          ', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-13', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1063401271', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('264333033', 'TX0118322', 'TX0118322', 'TXSATSTD', 'Institute for Womens Health', 'Eduardo', '', 'Raez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '          ', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-13', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1255320404', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('264333033', 'TX0118323', 'TX0118323', 'TXSATSTD', 'Institute for Womens Health', 'Joseph', 'R', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 230', 'San Antonio', 'Bexar', 'TX', '78258', '2106160680', NULL, '502 Madison Oak Dr Ste 230', 'San Antonio', 'Bexar', 'TX', '78258', '2106160680', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-09', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144210121', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6202, -98.49, 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
('264333033', 'TX0118324', 'TX0118324', 'TXSATSTD', 'Institute for Womens Health', 'Cesar', '', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7616 Culebera Rd Ste 124', 'San Antonio', 'Bexar', 'TX', '78251', '2105208484', NULL, '7616 Culebera Rd Ste 124', 'San Antonio', 'Bexar', 'TX', '78251', '2105208484', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801885959', 0, 'N', 0, '2013-04-11', NULL, NULL, 29.4593, -98.6388, NULL, NULL),
('264333033', 'TX0118325', 'TX0118325', 'TXSATSTD', 'Institute for Womens Health', 'Jose', 'M', 'Ruiz III', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7616 Culebera Rd Ste 124', 'San Antonio', 'Bexar', 'TX', '78251', '2105208484', NULL, '7616 Culebera Rd Ste 124', 'San Antonio', 'Bexar', 'TX', '78251', '2105208484', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093705089', 0, 'N', 0, '2013-03-12', NULL, NULL, 29.4593, -98.6388, NULL, NULL),
('264333033', 'TX0118328', 'TX0118328', 'TXSATSTD', 'Institute for Womens Health', 'Paula', 'M', 'Bilica', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3902 Wiseman', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', NULL, '3902 Wiseman', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467620260', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118329', 'TX0118329', 'TXSATSTD', 'Institute for Womens Health', 'Aspen', 'E', 'Laneman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619079274', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118330', 'TX0118330', 'TXSATSTD', 'Institute for Womens Health', 'Aspen', 'E', 'Laneman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3902 Wiseman', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', NULL, '3902 Wiseman', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619079274', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118331', 'TX0118331', 'TXSATSTD', 'Institute for Womens Health', 'Susan', 'A', 'Crockett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821169228', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('264333033', 'TX0118332', 'TX0118332', 'TXSATSTD', 'Institute for Womens Health', 'Susan', 'A', 'Crockett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821169228', 0, 'y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0118333', 'TX0118333', 'TXSATSTD', 'Institute for Womens Health', 'Susan', 'A', 'Crockett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2104942000', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2104942000', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821169228', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('742145952', 'TX0118526', 'TX0118526', 'TXSATSTD', 'Endocrinology-Nuclear Medicine Associates', 'Jeannie', 'A', 'Baquero', 'MD', 'Endocrinology', '', '', NULL, 'O', '1303 McCullough Ave Ste 374', 'San Antonio', 'Bexar', 'TX', '78212', '2102235483', NULL, '1303 McCullough Ave Ste 374', 'San Antonio', 'Bexar', 'TX', '78212', '2102235483', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1255301149', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('262427082', 'TX0118541', 'TX0118541', 'TXSATSTD', 'San Antonio Premier Internal Medicane', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 145', 'San Antonio', 'Bexar', 'TX', '78222', '2104473033', NULL, '4212 E Southcross Blvd Ste 145', 'San Antonio', 'Bexar', 'TX', '78222', '2104473033', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871557454', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.3746, -98.4125, NULL, NULL),
('262427082', 'TX0118542', 'TX0118542', 'TXSATSTD', 'San Antonio Premier Internal Medicane', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1746', 'San Antonio', 'Bexar', 'TX', '78296', '2104473033', NULL, 'PO Box 1746', 'San Antonio', 'Bexar', 'TX', '78296', '2104473033', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871557454', 0, 'y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'ID0118650', 'ID0118650', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.615, -116.256, NULL, NULL),
('331078261', 'ID0118651', 'ID0118651', 'IDBOISTD', 'Saint Alphonsus Physicians PA', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'o', '211 Forest St', 'McCall', 'Valley', 'ID', '83638', '2083674278', '2083675200', '211 Forest St', 'McCall', 'Valley', 'ID', '83638', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'N', 0, '2014-06-11', NULL, NULL, 44.9086, -116.11, NULL, NULL),
('264660061', 'TX0118875', 'TX0118875', 'TXSATSTD', 'Mimari Surgical Associates', 'George', 'E', 'Mimari', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', NULL, '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982602546', 0, 'N', 0, '2013-07-19', NULL, NULL, 29.514, -98.5778, NULL, NULL),
('820477852', 'ID0119216', 'ID0119216', 'IDBOISTD', 'SAMG Boise OB/GYN', 'Jon', 'R', 'Kattenhorn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-08-20', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881648251', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820477852', 'ID0119219', 'ID0119219', 'IDBOISTD', 'SAMG Boise OB/GYN', 'JoAnn', 'M', 'Johnson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-08-20', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801842257', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820477852', 'ID0119220', 'ID0119220', 'IDBOISTD', 'SAMG Boise OB/GYN', 'Georgianna', '', 'Ainslie', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1073566089', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820200895', 'ID0119224', 'ID0119224', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', NULL, '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-08', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'Y', 0, '2013-02-06', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'ID0119225', 'ID0119225', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', NULL, '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-08', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'Y', 0, '2013-02-06', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'ID0119226', 'ID0119226', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', NULL, '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-08', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'Y', 0, '2013-02-06', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'ID0119227', 'ID0119227', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674197', NULL, '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674197', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-25', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'N', 0, '2012-12-26', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('742885976', 'TX0119366', 'TX0119366', 'TXSATSTD', 'Creedmoor Orthopedics', 'Frank', 'W', 'Schroeder', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 210', 'San Antonio', 'Bexar', 'TX', '78222', '2104481140', NULL, '4212 E Southcross Blvd Ste 210', 'San Antonio', 'Bexar', 'TX', '78222', '2104481140', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528167368', 0, 'N', 0, '2013-12-18', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('820200895', 'ID0119367', 'ID0119367', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise 503', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '8013771000', NULL, '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '8013771000', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-08', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'Y', 0, '2013-02-06', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820477852', 'ID0119391', 'ID0119391', 'IDBOISTD', 'Saint Alphonsus Medical Group Womens Health', 'Juliana', 'L', 'DiGiosia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1144335332', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820477852', 'ID0119425', 'ID0119425', 'IDBOISTD', 'Saint Alphonsus Medical Group Womens Health', 'Juliana', 'L', 'DiGiosia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1144335332', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'ID0119527', 'ID0119527', 'IDBOISTD', 'Saint Alphonsus OB Hospitalist Program', 'Julia', 'K', 'Bouchard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674505', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083674505', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-25', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861436081', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('263747461', 'TX0119462', 'TX0119462', 'TXSATSTD', 'Lone Star Cancer Associates', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '515 N King St Ste 104', 'Seguin', 'Guadalupe', 'TX', '78155', '8303031121', NULL, '515 N King St Ste 104', 'Seguin', 'Guadalupe', 'TX', '78155', '8303031121', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5728, -97.9499, NULL, NULL),
('263747461', 'TX0119463', 'TX0119463', 'TXSATSTD', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '116 Gallery Cir Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104954999', NULL, '116 Gallery Cir Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104954999', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-10-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('263747461', 'TX0119464', 'TX0119464', 'TXSATSTD', 'Lone Star Cancer Associates', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '925 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102276156', NULL, '925 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102276156', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.442, -98.4992, NULL, NULL),
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('263747461', 'TX0119466', 'TX0119466', 'TXSATSTD', 'Lone Star Cancer Associates PA', 'Devendra', 'Kumar', 'Bhachawat', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '9102 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78240', '2102470920', NULL, '9102 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78240', '2102470920', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-10-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053338731', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5287, -98.5918, NULL, NULL),
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('742591869', 'TX0119532', 'TX0119532', 'TXSATSTD', 'Women Partners in OBGYN', 'Susan', 'P', 'Novak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5000 Baptist Health Dr Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2109461300', NULL, '5000 Baptist Health Dr Ste 100', 'Schertz', 'Guadalupe', 'TX', '78154', '2109461300', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720075021', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.599, -98.2749, NULL, NULL),
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('741967809', 'TX0119621', 'TX0119621', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'James', 'F', 'Jackson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2105828000', NULL, '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2105828000', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1730115528', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.6121, -98.4806, NULL, NULL),
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('202148889', 'TX0119715', 'TX0119715', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', '', '', 'Health Texas Medical Group of San Antonio', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006634', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('953134847', 'ID0119806', 'ID0119806', 'IDBOISTD', '', 'Lucius', 'L', 'Blanchard', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', NULL, 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2083672864', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-12-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134147853', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('161751617', 'TX0119852', 'TX0119852', 'TXSATSTD', 'Rheumatology Associates of South Texas', 'Thomas', '', 'Rennie', 'MD', 'Rheumatology', '', '', NULL, 'O', '11212 Hwy 151 Bld 1 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2106563926', NULL, '11212 Hwy 151 Bld 1 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2106563926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008358', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('260168070', 'ID0120053', 'ID0120053', 'IDBOISTD', 'Kyle L Palmer', 'Louis', 'A', 'Burke', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', NULL, '3875 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088848300', '          ', 'IDORTHO2+5', '', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952518060', 0, 'N', 0, '2013-06-17', NULL, NULL, 43.5904, -116.345, NULL, NULL),
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('741967809', 'TX0120112', 'TX0120112', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Alfredo', '', 'Espinoza', 'MD', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', NULL, '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1629185616', 0, 'N', 0, '2012-10-23', NULL, NULL, 29.6121, -98.4806, NULL, NULL),
('743003947', 'TX0120115', 'TX0120115', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Billy', 'K', 'Parsley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255544904', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
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('264480825', 'ID0120119', 'ID0120119', 'IDBOISTD', 'Thomas Hammer Pediatrics', 'Thomas', 'J', 'Hammer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2084618700', NULL, '1209 N  Jacob Allcott Way', 'Nampa', 'Ada', 'ID', '83687', NULL, NULL, 'IDPED', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1053301911', 0, 'y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'ID0120156', 'ID0120156', 'IDBOISTD', 'Saint Alphonsus Coughlin Clinic', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2012-08-20', '2013-01-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.255, NULL, NULL),
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('820477852', 'ID0120158', 'ID0120158', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland', 'Anne', 'P', 'Burgess', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1194767178', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5899, -116.31, NULL, NULL),
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('742592013', 'TX0120434', 'TX0120434', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Mark', 'F', 'Naylor', 'MD', 'Dermatology', '', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1518916386', 0, 'N', 0, '2013-07-29', NULL, NULL, 29.5632, -98.3343, NULL, NULL),
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('260553931', 'ID0120696', 'ID0120696', 'IDBOISTD', 'Saint Alphonsus Medical Group OB Hospitalist Boise', 'Martha', 'H', 'Lund', 'MD', 'Obstetrics and Gynecology', 'Hospitalist', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676222', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676222', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1053356923', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL);
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('260553931', 'ID0120703', 'ID0120703', 'IDBOISTD', 'Saint Alphonsus Heart Care Boise ', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'Y', 0, '2014-06-11', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('260553931', 'ID0120704', 'ID0120704', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('260553931', 'ID0120705', 'ID0120705', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Hailey', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '21 E Maple St Ste A', 'Hailey', 'Blaine', 'ID', '83333', '2083674278', NULL, '21 E Maple St Ste A', 'Hailey', 'Blaine', 'ID', '83333', '2083674278', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'Y', 0, '2014-06-11', NULL, NULL, 43.5139, -114.311, NULL, NULL),
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('260553931', 'ID0120772', 'ID0120772', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083771000', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083771000', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.254, NULL, NULL),
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('260553931', 'ID0120775', 'ID0120775', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'Y', 0, '2013-09-17', NULL, NULL, 43.6335, -116.296, NULL, NULL),
('260553931', 'ID0120776', 'ID0120776', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-10-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'Y', 0, '2014-01-06', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'ID0120777', 'ID0120777', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-10-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'Y', 0, '2014-01-06', NULL, NULL, 43.6335, -116.296, NULL, NULL),
('742246239', 'TX0120914', 'TX0120914', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'O', '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102710606', NULL, '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2102710606', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'N', 0, '2013-04-29', NULL, NULL, 29.4396, -98.4902, NULL, NULL),
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('742246239', 'TX0120916', 'TX0120916', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Antonio', '', 'Serna', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 840390', 'Dallas', 'Dallas', 'TX', '75284', '2104263994', NULL, 'PO Box 840390', 'Dallas', 'Dallas', 'TX', '75284', '2104263994', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538208541', 0, 'y', 0, '2013-04-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0120932', 'ID0120932', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Sherri', 'L', 'Brown', 'MD', 'Family Practice', 'Internal Medicine/Nursing Home Only', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', '', 'HCFA|', '1235172644', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120933', 'ID0120933', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Anne', 'P', 'Burgess', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1194767178', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5903, -116.31, NULL, NULL),
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('820200895', 'ID0120937', 'ID0120937', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Charles', 'M', 'Davis', 'DO', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1104877364', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
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('820200895', 'ID0120939', 'ID0120939', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Matthew', 'K', 'Eastman', 'DO', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952344962', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120940', 'ID0120940', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Matthew', 'K', 'Eastman', 'DO', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952344962', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120941', 'ID0120941', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Fred', 'W', 'Fender', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste 204', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1558300491', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120942', 'ID0120942', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'James', 'W', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1730275876', 0, 'N', 0, '2014-03-24', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120943', 'ID0120943', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Michelle', '', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1437231354', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120944', 'ID0120944', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Sheila', 'M', 'Giffen', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1013957802', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0120945', 'ID0120945', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Marcel', 'A', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801837141', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6193, -116.431, NULL, NULL),
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('820200895', 'ID0120948', 'ID0120948', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120950', 'ID0120950', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Randall', 'H', 'Hutchings', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1609818228', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('820200895', 'ID0120951', 'ID0120951', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Lisa', 'M', 'Kern', 'MD', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1588618219', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('820200895', 'ID0120952', 'ID0120952', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Daniel', 'S', 'Knorpp', 'DO', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1538214184', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120953', 'ID0120953', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Stacy', 'J', 'Lamers', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1003867094', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120954', 'ID0120954', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Gregory', 'S', 'Lewer', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-11', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|', '1669414975', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820200895', 'ID0120956', 'ID0120956', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120957', 'ID0120957', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0120958', 'ID0120958', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120959', 'ID0120959', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('820200895', 'ID0120960', 'ID0120960', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0120961', 'ID0120961', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan', 'Katherine', 'E', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225066707', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'ID0120962', 'ID0120962', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Ryan', 'A', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1386664654', 0, 'N', 0, '2012-11-15', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120964', 'ID0120964', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Robert', 'K', 'Perko', 'MD', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1043261803', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'ID0120965', 'ID0120965', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Samantha', 'J', 'Portenier', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1356385132', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120982', 'ID0120982', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Michael', 'L', 'Roach', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1528004389', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6534, -116.695, 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
('820200895', 'ID0120983', 'ID0120983', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Louis', 'A', 'Roser', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1497715866', 0, 'N', 0, '2012-11-16', NULL, NULL, 43.5913, -116.204, NULL, NULL),
('820200895', 'ID0120984', 'ID0120984', 'IDBOISTD', 'CARE Maternal/Child Health Program - Do Not Publish', 'Louis', 'A', 'Roser', 'MD', 'Family Practice', '', '', NULL, 'O', '900 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1497715866', 0, 'Y', 0, '2012-11-16', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0120985', 'ID0120985', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Scott', 'N', 'Schwendiman', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1538110234', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0120986', 'ID0120986', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Scott', 'A', 'Shappard', 'DO', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649275587', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5903, -116.31, NULL, NULL),
('820200895', 'ID0120987', 'ID0120987', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'ID0120989', 'ID0120989', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Samuel', 'M', 'Summers', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1649216805', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120992', 'ID0120992', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Caldwell', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('820200895', 'ID0120993', 'ID0120993', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0120994', 'ID0120994', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0120995', 'ID0120995', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'ID0120996', 'ID0120996', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'ID0120997', 'ID0120997', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0120998', 'ID0120998', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'ID0120999', 'ID0120999', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0121000', 'ID0121000', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6117, -116.257, NULL, NULL),
('820200895', 'ID0121001', 'ID0121001', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('820200895', 'ID0121002', 'ID0121002', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'ID0121003', 'ID0121003', 'IDBOISTD', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083677090', NULL, '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083677090', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121004', 'ID0121004', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5913, -116.204, NULL, NULL),
('820200895', 'ID0121005', 'ID0121005', 'IDBOISTD', 'CARE Maternal/Child Health Program - Do Not Publish', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121006', 'ID0121006', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5903, -116.31, NULL, NULL),
('820200895', 'ID0121007', 'ID0121007', 'IDBOISTD', 'Saint Alphonsus Boise OB-Gyn', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121008', 'ID0121008', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Karl', 'N', 'Watts', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1578591053', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5903, -116.31, NULL, NULL),
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('820200895', 'ID0121013', 'ID0121013', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Stan', 'A', 'Eisele', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1306886767', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0121014', 'ID0121014', 'IDBOISTD', 'Guicheteau, John E', 'John', 'E', 'Guicheteau', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1902840473', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'ID0121015', 'ID0121015', 'IDBOISTD', 'Maderious, Alan M', 'Alan', 'M', 'Maderious', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1134162530', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'ID0121021', 'ID0121021', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Snehlata', 'K', 'Mehta', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-03-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1851331045', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('820200895', 'ID0121024', 'ID0121024', 'IDBOISTD', 'St Alphonsus Regional Medical Center', 'Joel', 'C', 'Swanson', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1013956705', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'ID0121025', 'ID0121025', 'IDBOISTD', 'Saint Alphonsus  Medical Group OBGYN Boise BOGA Bldg ', 'Georgianna', '', 'Ainslie', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1073566089', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121026', 'ID0121026', 'IDBOISTD', 'Saint Alphonsus  Medical Group OBGYN Boise BOGA Bldg ', 'JoAnn', 'M', 'Johnson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801842257', 0, 'N', 0, '2013-08-21', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820200895', 'ID0121027', 'ID0121027', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2013-09-18', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'ID0121028', 'ID0121028', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise Liberty Bldg  do not list on websites', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2014-02-26', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121031', 'ID0121031', 'IDBOISTD', 'CARE Maternal/Child Health Program - Do Not Publish', 'Charlotte', 'R', 'Wilkes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1487899373', 0, 'Y', 0, '2014-02-26', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121032', 'ID0121032', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'ID0121034', 'ID0121034', 'IDBOISTD', 'CARE Maternal/Child Health Program - Do Not Publish', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSAMG2', NULL, NULL, '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121035', 'ID0121035', 'IDBOISTD', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820200895', 'ID0121037', 'ID0121037', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0121038', 'ID0121038', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0121039', 'ID0121039', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0121040', 'ID0121040', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0121041', 'ID0121041', 'IDBOISTD', 'Barnes, Keri J', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'ID0121043', 'ID0121043', 'IDBOISTD', 'Barnes, Keri J', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('820200895', 'ID0121063', 'ID0121063', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0121064', 'ID0121064', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0121065', 'ID0121065', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0121066', 'ID0121066', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0121067', 'ID0121067', 'IDBOISTD', 'Saint Alphonsus Express Care, Inc.', 'Lane', '', 'Deitchler', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740464783', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6474, -116.354, NULL, NULL),
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('820200895', 'ID0121201', 'ID0121201', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Stacey', '', 'Townsend', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1962554568', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'ID0121202', 'ID0121202', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Shana', 'L', 'Tubach', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205879483', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'ID0121203', 'ID0121203', 'IDBOISTD', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Shana', 'L', 'Tubach', 'MD', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205879483', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'ID0121237', 'ID0121237', 'IDBOISTD', 'Saint Alphonsus Medical GroupBoise Pediatrics', 'Alanna', 'C', 'Moore', 'PA-C', 'Pediatrics', 'Physician Assistant', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674252', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674252', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1982864278', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, 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
('820200895', 'ID0121238', 'ID0121238', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Alanna', 'C', 'Moore', 'PA-C', 'Pediatrics', 'Physician Assistant', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1982864278', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'ID0121253', 'ID0121253', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720020217', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0121254', 'ID0121254', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720020217', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('264333033', 'TX0121267', 'TX0121267', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Robin', 'L', 'Womack', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', NULL, '12602 Toepperwein Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78233', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750370821', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0121268', 'TX0121268', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Robin', 'L', 'Womack', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', NULL, '502 Madison Oak Dr Ste 240', 'San Antonio', 'Bexar', 'TX', '78258', '2104951900', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750370821', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('820200895', 'ID0121315', 'ID0121315', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205882743', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'ID0121316', 'ID0121316', 'IDBOISTD', 'Idaho Neurology Saint Alphonsus', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '706 S Main St', 'Hailey', 'Blaine', 'ID', '83333', '2083677272', '2083677111', '706 S Main St', 'Hailey', 'Blaine', 'ID', '83333', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205882743', 0, 'Y', 0, '2014-05-20', NULL, NULL, 43.5138, -114.311, NULL, NULL),
('820200895', 'ID0121318', 'ID0121318', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2013-09-18', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1497797302', 0, 'Y', 0, '2013-09-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'ID0121320', 'ID0121320', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Clive', 'R', 'Cooper', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962446104', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121321', 'ID0121321', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Stephen', 'J', 'Focht', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2013-03-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1043288004', 0, 'Y', 0, '2013-02-21', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'ID0121322', 'ID0121322', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Lisa', 'M', 'Hunt', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225066103', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121323', 'ID0121323', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Tanya', 'S', 'Krafft', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356370563', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121324', 'ID0121324', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Katherine', 'A', 'Mathews', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1841296902', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121325', 'ID0121325', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Lisa', 'M', 'Nelson', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1194840397', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121326', 'ID0121326', 'IDBOISTD', 'Saint Alphonsus Inpatient Medicine', 'Robert', 'L', 'Petersen', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1043229685', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121329', 'ID0121329', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Gregory', 'T', 'Trapp', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1851407944', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0121332', 'ID0121332', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise ', 'Emily', 'D', 'Ruprecht', 'NP-C', 'Internal Medicine', 'Nurse Practitioner', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2013-09-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1518059534', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'ID0121335', 'ID0121335', 'IDBOISTD', 'Saint Alphonsus Pediatric Orthopedics', 'John', '', 'Shilt', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-08', 0, 0, 0, '', '', '', '', 'HCFA|', '1497930101', 0, 'Y', 0, '2013-02-06', NULL, NULL, 43.612, -116.262, NULL, NULL),
('742083988', 'TX0121404', 'TX0121404', 'TXSATSTD', 'Renal Associates', 'Shweta', '', 'Bansal', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215083894', 0, 'Y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0121405', 'TX0121405', 'TXSATSTD', 'Renal Associates', 'Shweta', '', 'Bansal', 'MD', 'Nephrology', '', '', NULL, 'O', '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', NULL, '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215083894', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.4358, -98.493, NULL, NULL),
('742083988', 'TX0121406', 'TX0121406', 'TXSATSTD', 'Renal Associates', 'Carlos', 'H', 'Zem', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', NULL, '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2102262001', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1437237914', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0121407', 'TX0121407', 'TXSATSTD', 'Renal Associates', 'Carlos', 'H', 'Zem', 'MD', 'Nephrology', '', '', NULL, 'O', '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', NULL, '215 E Quincy Ste 610', 'San Antonio', 'Bexar', 'TX', '78215', '2102262001', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1437237914', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('742743906', 'TX0121417', 'TX0121417', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Matthias', 'H', 'Kapturczak', 'MD', 'Nephrology', '', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2106615622', NULL, '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2106615622', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1861429755', 0, 'y', 0, '2013-08-07', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'TX0121418', 'TX0121418', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Matthias', 'H', 'Kapturczak', 'MD', 'Nephrology', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 500', 'San Antonio', 'Bexar', 'TX', '78229', '2106927228', NULL, '8042 Wurzbach Rd Ste 500', 'San Antonio', 'Bexar', 'TX', '78229', '2106927228', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1861429755', 0, 'N', 0, '2013-08-07', NULL, NULL, 29.514, -98.5778, NULL, NULL),
('742743906', 'TX0121757', 'TX0121757', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Heather', 'E', 'Banks', 'MD', 'Nephrology', '', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '8306204650', NULL, '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '8306204650', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982884763', 0, 'y', 0, '2013-08-05', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'TX0121758', 'TX0121758', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Heather', 'E', 'Banks', 'MD', 'Nephrology', '', '', NULL, 'O', '1528 E Commons St Ste 1', 'New Braunfels', 'Comal', 'TX', '78130', '8306204650', NULL, '1528 E Commons St Ste 1', 'New Braunfels', 'Comal', 'TX', '78130', '8306204650', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982884763', 0, 'N', 0, '2013-08-05', NULL, NULL, 29.723, -98.0996, NULL, NULL),
('742743906', 'TX0121763', 'TX0121763', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Ashutosh', 'K', 'Mahajan', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2104030765', NULL, '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2104030765', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932140183', 0, 'N', 0, '2013-02-04', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'TX0121764', 'TX0121764', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Ashutosh', 'K', 'Mahajan', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '102 Palo Alto Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78211', '2104030765', NULL, '102 Palo Alto Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78211', '2104030765', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932140183', 0, 'N', 0, '2013-02-04', NULL, NULL, 29.3533, -98.5514, NULL, NULL),
('742743906', 'TX0121765', 'TX0121765', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Rajeev', '', 'Narayan', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2102280743', NULL, '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2102280743', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093805863', 0, 'y', 0, '2013-08-07', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'TX0121766', 'TX0121766', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Rajeev', '', 'Narayan', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '102 Palo Alto Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78211', '2104030765', NULL, '102 Palo Alto Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78211', '2104030765', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093805863', 0, 'N', 0, '2013-08-07', NULL, NULL, 29.3537, -98.5522, NULL, NULL),
('742743906', 'TX0121767', 'TX0121767', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Matthew', 'E', 'Schaefer', 'DO', 'Nephrology', 'Internal Medicine', '', NULL, 'B', '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2102280743', NULL, '7142 San Pedro Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78216', '2102280743', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346205648', 0, 'y', 0, '2013-08-07', NULL, NULL, 29.5128, -98.4973, NULL, NULL),
('742743906', 'TX0121768', 'TX0121768', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Matthew', 'E', 'Schaefer', 'DO', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '1008 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102280743', NULL, '1008 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102280743', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346205648', 0, 'N', 0, '2013-08-07', NULL, NULL, 29.4377, -98.4891, NULL, NULL),
('942764098', 'ID0121839', 'ID0121839', 'IDBOISTD', 'University Neurosurgery Associates', '', '', 'University Neurosurgery Associates', 'GROUP', 'Neurosurgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', '          ', 'WUUNEURO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009280', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'ID0121830', 'ID0121830', 'IDBOISTD', 'University Neurosurgery Associates', '', '', 'University Neurosurgery Associates', 'GROUP', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUNEURO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009280', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('161751617', 'TX0122474', 'TX0122474', 'TXSATSTD', 'Rheumatology Associates of South Texas', 'Gautam', '', 'Moorjani', 'MD', 'Rheumatology', '', '', NULL, 'O', '19272 Stone Oak Pkwy Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2102658851', NULL, '19272 Stone Oak Pkwy Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2102658851', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780617282', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.63, -98.4952, NULL, NULL),
('820200895', 'ID0122527', 'ID0122527', 'IDBOISTD', '', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-17', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1710190665', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'ID0122528', 'ID0122528', 'IDBOISTD', NULL, 'Donald', 'K', 'Stott', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649264003', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0122538', 'ID0122538', 'IDBOISTD', '', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', NULL, 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-17', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1710190665', 0, 'Y', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0122539', 'ID0122539', 'IDBOISTD', NULL, 'Donald', 'K', 'Stott', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', NULL, 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1649264003', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('742072186', 'TX0122553', 'TX0122553', 'TXSATSTD', 'San Antonio Infectious Diseases Conultants', 'Kimberly', 'A', 'Moran', 'MD', 'Internal Medicine', '', '', NULL, 'B', '8042 Wurzbach Rd Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106148100', NULL, '8042 Wurzbach Rd Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106148100', '', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922209733', 0, 'Y', 0, '2013-03-28', NULL, NULL, 29.5151, -98.5765, NULL, NULL),
('742072186', 'TX0122554', 'TX0122554', 'TXSATSTD', 'San Antonio Infectious Diseases Consultants', 'Kimberly', 'A', 'Moran', 'MD', 'Internal Medicine', '', '', NULL, 'O', '343 W Houston St Ste 808', 'San Antonio', 'Bexar', 'TX', '78205', '2102249616', NULL, '343 W Houston St Ste 808', 'San Antonio', 'Bexar', 'TX', '78205', '2102249616', '', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922209733', 0, 'N', 0, '2013-03-28', NULL, NULL, 29.4264, -98.4967, NULL, NULL),
('562613565', 'TX0122555', 'TX0122555', 'TXSATSTD', 'Arthritis Associates', 'Jose', 'F', 'Roldan', 'MD', 'Rheumatology', '', '', NULL, 'O', '4511 Horizon Hill Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78229', '2104772626', NULL, '4511 Horizon Hill Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78229', '2104772626', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1285644427', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5178, -98.5579, NULL, NULL),
('746141855', 'TX0122556', 'TX0122556', 'TXSATSTD', 'Pediatrics and Adolescents', 'Rebecca', '', 'Rizo', 'DO', 'Pediatrics', '', '', NULL, 'O', '3111 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2107327141', NULL, '3111 San Pedro Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2107327141', '', 'TXPED', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740342724', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.4642, -98.4993, NULL, NULL),
('742989234', 'TX0122571', 'TX0122571', 'TXSATSTD', 'Diabetes & Endocrinology Consultants', 'Jaime', 'O', 'Cruz', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 855', 'San Antonio', 'Bexar', 'TX', '78293', '2109462520', NULL, 'PO Box 855', 'San Antonio', 'Bexar', 'TX', '78293', '2109462520', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', '', '', 'HCFA|UB|', '1396746442', 0, 'y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('742989234', 'TX0122572', 'TX0122572', 'TXSATSTD', 'Diabetes & Endocrinology Consultants', 'Jaime', 'O', 'Cruz', 'MD', 'Endocrinology', '', '', NULL, 'O', '155 E Sonterra Blvd Ste 105', 'San Antonio', 'Bexar', 'TX', '78258', '2109462520', NULL, '155 E Sonterra Blvd Ste 105', 'San Antonio', 'Bexar', 'TX', '78258', '2109462520', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', '', '', 'HCFA|UB|', '1396746442', 0, 'N', 0, '2014-05-30', NULL, NULL, 29.6164, -98.493, NULL, NULL),
('742989234', 'TX0122573', 'TX0122573', 'TXSATSTD', 'Diabetes & Endocrinology Consultants', 'Jaime', 'O', 'Cruz', 'MD', 'Endocrinology', '', '', NULL, 'O', '215 E Quincy Ste 319', 'San Antonio', 'Bexar', 'TX', '78215', '2102269520', NULL, '215 E Quincy Ste 319', 'San Antonio', 'Bexar', 'TX', '78215', '2102269520', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', '', '', 'HCFA|UB|', '1396746442', 0, 'N', 0, '2014-05-30', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('260553931', 'ID0122769', 'ID0122769', 'IDBOISTD', 'Saint Alphonsus Medical Group OB Hospitalist Boise', 'Patricia', '', 'Caplinger', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083676222', '          ', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083676222', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588605364', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('742915297', 'TX0122822', 'TX0122822', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', NULL, '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742915297', 'TX0122824', 'TX0122824', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', NULL, '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'TX0122823', 'TX0122823', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6164, -98.493, NULL, NULL),
('742915297', 'TX0122825', 'TX0122825', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Ardow', 'R', 'Ameduri', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '502 Madison Oak Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '502 Madison Oak Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861412348', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('742915297', 'TX0122826', 'TX0122826', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', NULL, '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742915297', 'TX0122827', 'TX0122827', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6171, -98.4927, NULL, NULL),
('742915297', 'TX0122828', 'TX0122828', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', NULL, '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'TX0122829', 'TX0122829', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Muralidhar', '', 'Beeram', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265426282', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('742915297', 'TX0122834', 'TX0122834', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Keith', 'E', 'Eyre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', NULL, '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841223351', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742915297', 'TX0122835', 'TX0122835', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Keith', 'E', 'Eyre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841223351', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6171, -98.4927, NULL, NULL),
('742915297', 'TX0122836', 'TX0122836', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Keith', 'E', 'Eyre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', NULL, '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841223351', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'TX0122837', 'TX0122837', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Keith', 'E', 'Eyre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', NULL, '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841223351', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('742915297', 'TX0122850', 'TX0122850', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Steven', 'P', 'Kalter', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', NULL, '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922032218', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
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('742944052', 'TX0123445', 'TX0123445', 'TXSATSTD', 'Responsive ID Solutions', 'Robert', 'A', 'Zajac', 'MD', 'Internal Medicine', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 170', 'San Antonio', 'Bexar', 'TX', '78258', '2104812800', NULL, '150 E Sonterra Blvd Ste 170', 'San Antonio', 'Bexar', 'TX', '78258', '2104812800', '', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013907963', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('264333033', 'TX0123455', 'TX0123455', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Joy', 'T', 'Aden', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 410', 'San Antonio', 'Bexar', 'TX', '78217', '2106509978', NULL, '8715 Village Dr Ste 410', 'San Antonio', 'Bexar', 'TX', '78217', '2106509978', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114936408', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('264333033', 'TX0123456', 'TX0123456', 'TXSATSTD', 'Institute for Womens Health', 'Joseph', 'R', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 410', 'San Antonio', 'Bexar', 'TX', '78217', '2106509978', NULL, '8715 Village Dr Ste 410', 'San Antonio', 'Bexar', 'TX', '78217', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144210121', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('911394965', 'ID0123482', 'ID0123482', 'IDBOISTD', 'Pacific Cataract & Laser', 'Paul', 'Y', 'Chung', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306953617', 0, 'n', 0, '2014-05-08', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123483', 'ID0123483', 'IDBOISTD', 'Pacific Cataract & Laser', 'Robert', 'O', 'Ford', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295842524', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123484', 'ID0123484', 'IDBOISTD', 'Pacific Cataract & Laser', 'David', 'L', 'Gano', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891862769', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123485', 'ID0123485', 'IDBOISTD', 'Pacific Cataract & Laser', 'Arthur', 'W', 'Giebel', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083665954', 0, 'N', 0, '2014-05-08', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123486', 'ID0123486', 'IDBOISTD', 'Pacific Cataract & Laser', 'William', 'D', 'Gruzensky', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992812234', 0, 'n', 0, '2013-10-04', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123487', 'ID0123487', 'IDBOISTD', 'Pacific Cataract & Laser', 'James', 'P', 'Guzek', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104878859', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123488', 'ID0123488', 'IDBOISTD', 'Pacific Cataract & Laser', 'Gordon', 'E', 'Johns', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053358077', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('911394965', 'ID0123490', 'ID0123490', 'IDBOISTD', 'Pacific Cataract & Laser', 'Ronald', 'K', 'Sugiyama', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376650267', 0, 'n', 0, '2012-08-20', NULL, NULL, 43.5768, -116.214, NULL, NULL),
('271145419', 'ID0123704', 'ID0123704', 'IDBOISTD', 'Ada Orthopaedic Clinic', 'Mark', 'S', 'Williams', 'DO; Sports Med', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '          ', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114961166', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.6119, -116.262, NULL, NULL),
('742447500', 'TX0123717', 'TX0123717', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Kevin', '', 'Steel', 'MD DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', NULL, 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578624979', 0, 'N', 0, '2013-04-25', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0123718', 'TX0123718', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Kevin', '', 'Steel', 'MD DO', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578624979', 0, 'N', 0, '2013-04-25', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742743906', 'TX0123719', 'TX0123719', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Heather', 'E', 'Banks', 'MD', 'Nephrology', '', '', NULL, 'O', '1344 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8306204650', NULL, '1344 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8306204650', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982884763', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('742743906', 'TX0123720', 'TX0123720', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Carl', 'J', 'Blond', 'MD', 'Nephrology', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 4', 'San Antonio', 'Bexar', 'TX', '78222', '2103374911', NULL, '4242 E Southcross Blvd Ste 4', 'San Antonio', 'Bexar', 'TX', '78222', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-01-31', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174507776', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('742743906', 'TX0123721', 'TX0123721', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Rahul', '', 'Koushik', 'MD', 'Nephrology', '', '', NULL, 'O', '116 Gallery Cir Ste 202', 'San Antonio', 'Bexar', 'TX', '78258', '2104958280', NULL, '116 Gallery Cir Ste 202', 'San Antonio', 'Bexar', 'TX', '78258', '2104958280', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275518755', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0123731', 'TX0123731', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Christopher', '', 'Thompson', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2104906000', NULL, 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2104906000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891774667', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0123732', 'TX0123732', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Christopher', '', 'Thompson', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891774667', 0, 'N', 0, '2013-11-15', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742447500', 'TX0123735', 'TX0123735', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', '', 'Eckart', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', NULL, 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366479404', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0123736', 'TX0123736', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', '', 'Eckart', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366479404', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('742447500', 'TX0123740', 'TX0123740', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Rachel', '', 'Beck', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', NULL, 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053391912', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('742447500', 'TX0123741', 'TX0123741', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Rachel', '', 'Beck', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', NULL, '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053391912', 0, 'N', 0, '2012-10-16', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('113676182', 'TX0123834', 'TX0123834', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Jeff', 'S', 'Henke', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '5122683668', NULL, 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '5122683668', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871539007', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('742246239', 'TX0123883', 'TX0123883', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Jeffery', 'S', 'Bullock', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', NULL, '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', 'St Lukes Baptist Hospital', NULL, 'HCFA|UB|', '1528062288', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('742246239', 'TX0123884', 'TX0123884', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', NULL, '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6162, -98.493, NULL, NULL),
('742915297', 'TX0123938', 'TX0123938', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Alexander', 'R', 'Miller', 'MD', 'General Surgery', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265435663', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.511, -98.5709, NULL, NULL),
('742915297', 'TX0123939', 'TX0123939', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Alexander', 'R', 'Miller', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265435663', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('741850643', 'TX0123941', 'TX0123941', 'TXSATSTD', 'General Surgical Associates', 'David', 'C', 'Mullins', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106145113', NULL, '8042 Wurzbach Rd Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106145113', '', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1114946928', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.514, -98.5778, NULL, NULL),
('741895428', 'TX0123943', 'TX0123943', 'TXSATSTD', 'Ear Nose and Throat Clinics of San Antonio', 'Nathan', 'W', 'Hales', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '11212 State Hwy 151 Ste 310', 'San Antonio', 'Bexar', 'TX', '78251', '2102494840', NULL, '11212 State Hwy 151 Ste 310', 'San Antonio', 'Bexar', 'TX', '78251', '2102494840', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1053450304', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('741895428', 'TX0123944', 'TX0123944', 'TXSATSTD', 'Ear Nose and Throat Clinics of San Antonio', 'Nathan', 'W', 'Hales', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '926 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102245481', NULL, '926 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102245481', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1053450304', 0, 'N', 0, '2013-11-20', NULL, NULL, 29.4377, -98.4884, NULL, NULL),
('741895428', 'TX0123945', 'TX0123945', 'TXSATSTD', 'Ear Nose and Throat Clinics of San Antonio', 'Nathan', 'W', 'Hales', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2102245481', NULL, 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2102245481', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1053450304', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('742885893', 'TX0123947', 'TX0123947', 'TXSATSTD', 'Neurology Associates', 'Toan', 'Q', 'Vu', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1341 Thorpe', 'San Marcos', 'Hays', 'TX', '78666', '5125587770', NULL, '1341 Thorpe', 'San Marcos', 'Hays', 'TX', '78666', NULL, NULL, 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760463293', 0, 'Y', 0, '2012-08-20', NULL, NULL, 29.8894, -97.9216, NULL, NULL),
('742885893', 'TX0123948', 'TX0123948', 'TXSATSTD', 'Neurology Associates', 'Toan', 'Q', 'Vu', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '255 E Sonterra Blvd Ste 211', 'San Antonio', 'Bexar', 'TX', '78258', '2106562333', NULL, '1341 Thorpe', 'San Marcos', 'Bexar', 'TX', '78666', NULL, NULL, 'TXSURGD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760463293', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('742796322', 'TX0123953', 'TX0123953', 'TXSATSTD', 'Southwest Allergy & Asthma Clinic', 'Roberto', '', 'Rodriguez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '7711 Louis Pasteur Dr Ste 901/905', 'San Antonio', 'Bexar', 'TX', '78229', '2106160690', NULL, '7711 Louis Pasteur Dr Ste 901/905', 'San Antonio', 'Bexar', 'TX', '78229', '2106160690', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1821069550', 0, 'n', 0, '2013-11-18', NULL, NULL, 29.5088, -98.57, NULL, NULL),
('742796322', 'TX0123954', 'TX0123954', 'TXSATSTD', 'Southwest Allergy & Asthma Clinic', 'Roberto', '', 'Rodriguez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 202', 'San Antonio', 'Bexar', 'TX', '78251', '2107670690', NULL, '3903 Wiseman Blvd Ste 202', 'San Antonio', 'Bexar', 'TX', '78251', '2107670690', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1821069550', 0, 'n', 0, '2013-11-18', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
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('742592013', 'TX0124008', 'TX0124008', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'David', 'W', 'Bray', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-02-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740266386', 0, 'N', 0, '2013-02-26', NULL, NULL, 29.6125, -98.4829, NULL, NULL),
('742592013', 'TX0124009', 'TX0124009', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'David', 'W', 'Bray', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-02-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740266386', 0, 'N', 0, '2013-02-26', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
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('742763430', 'TX0124030', 'TX0124030', 'TXSATSTD', 'Allergy Asthma and Immunology Associates of South Texas', 'Joseph', 'D', 'Diaz', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', NULL, '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417948241', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6182, -98.4941, NULL, NULL),
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('742083988', 'TX0124700', 'TX0124700', 'TXSATSTD', 'Renal Associates', 'Robert', 'E', 'Stevens', 'MD', 'Nephrology', '', '', NULL, 'O', '16620 US Hway 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', NULL, '16620 US Hway 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528035185', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.6548, -98.446, NULL, NULL),
('820200895', 'ID0124725', 'ID0124725', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Ryan', 'A', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1386664654', 0, 'N', 0, '2012-11-15', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'ID0124727', 'ID0124727', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Michael', 'L', 'Roach', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1528004389', 0, 'N', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'ID0124728', 'ID0124728', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Louis', 'A', 'Roser', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1497715866', 0, 'N', 0, '2012-11-16', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'ID0124729', 'ID0124729', 'IDBOISTD', 'Dominican Health Services', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.025, -116.928, NULL, NULL),
('742592013', 'TX0124743', 'TX0124743', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Chantal', 'B', 'DeVillena', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093925778', 0, 'N', 0, '2014-03-20', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0124744', 'TX0124744', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Chantal', 'B', 'DeVillena', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093925778', 0, 'y', 0, '2014-03-20', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('741967809', 'TX0124746', 'TX0124746', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Donna', 'M', 'McMyler', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1861599524', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.5159, -98.5758, NULL, NULL),
('741967809', 'TX0124747', 'TX0124747', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Donna', 'M', 'McMyler', 'MD', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', NULL, '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1861599524', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.6121, -98.4806, NULL, NULL),
('741967809', 'TX0124748', 'TX0124748', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Donna', 'M', 'McMyler', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78299', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78299', '2106141234', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1861599524', 0, 'y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('741895428', 'TX0124751', 'TX0124751', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2106160283', NULL, 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2106160283', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('741895428', 'TX0124752', 'TX0124752', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4775 Hamilton Wolfe Bldg 1', 'San Antonio', 'Bexar', 'TX', '78229', '2106158332', NULL, '4775 Hamilton Wolfe Bldg 1', 'San Antonio', 'Bexar', 'TX', '78229', '2106158332', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5215, -98.5823, NULL, NULL),
('741895428', 'TX0124753', 'TX0124753', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '926 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102245481', NULL, '926 Brooklyn Ave', 'San Antonio', 'Bexar', 'TX', '78215', '2102245481', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.4377, -98.4884, NULL, NULL),
('741895428', 'TX0124754', 'TX0124754', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '150 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104994589', NULL, '150 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104994589', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('741895428', 'TX0124755', 'TX0124755', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '12709 Toepperwein Ste 111', 'San Antonio', 'Bexar', 'TX', '78233', '2106569506', NULL, '12709 Toepperwein Ste 111', 'San Antonio', 'Bexar', 'TX', '78233', '2106569506', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('741895428', 'TX0124756', 'TX0124756', 'TXSATSTD', 'Ear Nose and Throat of San Antonio', 'Jerry', 'M', 'Sandhaus', 'PA', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4025 E Southcross Blvd Bldg 4 Ste 24', 'San Antonio', 'Bexar', 'TX', '78222', '2103371050', NULL, '4025 E Southcross Blvd Bldg 4 Ste 24', 'San Antonio', 'Bexar', 'TX', '78222', '2103371050', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508075250', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.3751, -98.4158, NULL, NULL),
('010839544', 'TX0124793', 'TX0124793', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Carlos', 'G', 'Martinez', 'MD', 'General Surgery', '', '', NULL, 'O', '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', NULL, '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', '          ', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780894113', 0, 'N', 0, '2013-02-22', NULL, NULL, 29.5191, -98.4295, NULL, NULL),
('010839544', 'TX0124794', 'TX0124794', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'John', 'J', 'Gonzalez', 'MD', 'General Surgery', '', '', NULL, 'O', '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', NULL, '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'South East Baptist Hospital', '', '', '', 'HCFA|UB|', '1700857927', 0, 'n', 0, '2014-06-16', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('010839544', 'TX0124795', 'TX0124795', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Ramiro', 'D', 'Cavazos', 'MD', 'General Surgery', '', '', NULL, 'O', '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1619977055', 0, 'n', 0, '2012-08-20', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('010839544', 'TX0124796', 'TX0124796', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Linda', '', 'Golden', 'NP', 'General Surgery', '', '', NULL, 'O', '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', NULL, '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578735692', 0, 'n', 0, '2014-06-30', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('010839544', 'TX0124797', 'TX0124797', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Monica', '', 'Anz-Cavazos', 'MD', 'General Surgery', '', '', NULL, 'O', '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', NULL, '8811 Village Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78217', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1114792080', 0, 'n', 0, '2014-07-09', NULL, NULL, 29.5197, -98.4275, NULL, NULL),
('010839544', 'TX0124798', 'TX0124798', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Monica', '', 'Anz-Cavazos', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', NULL, 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1114792080', 0, 'y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL);
