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
('836000241', 'W12018563', 'W12018563', 'WYT1', 'Sheridan Memorial Hospital', 'Corey', 'J', 'Jost', 'MD', 'General Surgery', '', '', NULL, 'O', '1333 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', NULL, '1333 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700914306', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018564', 'W12018564', 'WYT1', 'Sheridan Memorial Hospital', 'Corey', 'J', 'Jost', 'MD', 'General Surgery', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700914306', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018565', 'W12018565', 'WYT1', 'Sheridan Memorial Hospital', 'Barry', 'E', 'Magnus', 'MD', 'General Surgery', '', '', NULL, 'O', '1333 W 5th St Ste 200', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', NULL, '1333 W 5th St Ste 200', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063627115', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018566', 'W12018566', 'WYT1', 'Sheridan Memorial Hospital', 'Barry', 'E', 'Magnus', 'MD', 'General Surgery', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063627115', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018567', 'W12018567', 'WYT1', 'Sheridan Memorial Hospital', 'Jason', 'L', 'Otto', 'PA-C', 'Internal Medicine', '', '', NULL, 'O', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558697177', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018569', 'W12018569', 'WYT1', 'Sheridan Memorial Hospital', 'David', 'O', 'Pearson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447424312', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018568', 'W12018568', 'WYT1', 'Sheridan Memorial Hospital', 'David', 'O', 'Pearson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '944 Jackson', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754630', NULL, '944 Jackson', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754630', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447424312', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018570', 'W12018570', 'WYT1', 'Sheridan Memorial Hospital', 'Steve', 'E', 'Rabon', 'DPM', 'Podiatry', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721000', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053331504', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018571', 'W12018571', 'WYT1', 'Sheridan Memorial Hospital', 'Cindy', 'K', 'Sharp', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629138797', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018572', 'W12018572', 'WYT1', 'Sheridan Memorial Hospital', '', '', 'Sheridan Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721014', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721014', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'UB|HCFA|', '0000008695', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018573', 'W12018573', 'WYT1', 'Sheridan Memorial Hospital', 'Sarah', 'C', 'Smith', 'MD', 'General Surgery', '', '', NULL, 'O', '1333 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', NULL, '1333 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245280148', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018574', 'W12018574', 'WYT1', 'Sheridan Memorial Hospital', 'Sarah', 'C', 'Smith', 'MD', 'General Surgery', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245280148', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018576', 'W12018576', 'WYT1', 'Sheridan Memorial Hospital', 'Michael', 'J', 'Strahan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639177769', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018575', 'W12018575', 'WYT1', 'Sheridan Memorial Hospital', 'Michael', 'J', 'Strahan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639177769', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018577', 'W12018577', 'WYT1', 'Sheridan Memorial Hospital', 'Cheryl', 'L', 'Varner', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1416 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754646', NULL, '1416 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754646', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568443398', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018578', 'W12018578', 'WYT1', 'Sheridan Memorial Hospital', 'Cheryl', 'L', 'Varner', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568443398', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018580', 'W12018580', 'WYT1', 'Sheridan Memorial Hospital', 'Mark', 'O', 'Walter', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752649', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205910643', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'W12018579', 'W12018579', 'WYT1', 'Sheridan Memorial Hospital', 'Mark', 'O', 'Walter', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '944 Jackson', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754630', NULL, '944 Jackson', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754630', '          ', '', '', '5001W', '0.00', '0.00', '0.00', 3, '2012-03-01', '2012-03-01', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205910643', 0, 'N', 1, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018589', 'W12018589', 'ID02', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018586', 'W12018586', 'ID02', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018587', 'W12018587', 'ID02', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018588', 'W12018588', 'ID02', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018590', 'W12018590', 'ID02', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018582', 'W12018582', 'SACN', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018585', 'W12018585', 'SACN', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018584', 'W12018584', 'SACN', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018583', 'W12018583', 'SACN', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018581', 'W12018581', 'SACN', 'Family Medicine Health Center', 'Kelly', '', 'Showalter', 'MD', 'Pediatrics', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740303734', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('453773577', 'W12018592', 'W12018592', 'UTMH1', 'DP Counseling ', 'Derai', '', 'Paul', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1989 N 2700 W', 'Clearfield', 'Davis', 'UT', '84015', '8015891822', '8015939118', '1989 N 2700 W', 'Clearfield', 'Davis', 'UT', '84015', '8015891822', '8015939118', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356598635', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('453773577', 'W12018591', 'W12018591', 'UTMH1', 'DP Counseling ', 'Derai', '', 'Paul', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015891822', '8015939118', '2317 N Hill Field Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015891822', '8015939118', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356598635', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018593', 'W12018593', 'SACN', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018595', 'W12018595', 'SACN', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018596', 'W12018596', 'SACN', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018597', 'W12018597', 'SACN', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018598', 'W12018598', 'ID02', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W12018601', 'W12018601', 'ID02', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018602', 'W12018602', 'ID02', 'Family Medicine Residency of Idaho', 'Jordan', '', 'Miller', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003125758', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('820373344', 'W12018603', 'W12018603', 'ID02', '', 'Scott', 'R', 'Meissner', 'DC', 'Chiropractic', '', '', NULL, 'O', '10159 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083220051', NULL, '10159 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083220051', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447234620', 0, 'N', 0, '2012-03-07', NULL, NULL, 0, 0, NULL, NULL),
('519153933', 'W12018604', 'W12018604', 'ID01', 'Meridian Counseling Ctr', 'Aundrea', '', 'Peaslee', 'LCPC LMFT', 'Mental Health', 'Marriage and Family Therapy', 'Counseling', NULL, 'O', '13923 W Wainwright Dr Ste 302', 'Boise', 'Ada', 'ID', '83713', '2086021382', NULL, '13923 W Wainwright Dr Ste 302', 'Boise', 'Ada', 'ID', '83713', '2086021382', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598775405', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870562879', 'W12018605', 'W12018605', 'UT01', 'Urology Associates', 'Warren', 'J', 'Stucki', 'MD', 'Urology', NULL, NULL, NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356283606', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356283606', '          ', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588669535', 0, 'N', 0, '2013-09-20', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('205934739', 'W12018606', 'W12018606', 'ID02', 'Family Medicine Health Center', 'Casi', 'M', 'Wyatt', 'DO', 'Infectious Disease', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083716153', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018607', 'W12018607', 'ID02', 'Family Medicine Health Center', 'Casi', 'M', 'Wyatt', 'DO', 'Infectious Disease', '', '', NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083716153', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
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('205967125', 'W12018609', 'W12018609', 'ID02', 'Imaging Center of Idaho', 'Robert', 'T', 'Yeager', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'PO Box 571470', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '2084557482', '2084557538', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578521936', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('870391052', 'W12018615', 'W12018615', 'UT01', 'Audiology Associates', 'Tad', '', 'Bergen', 'AUD', 'Audiology', '', '', NULL, 'O', '10441 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028022', '8013021211', '10441 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013028022', '8013021211', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508177635', 0, 'N', 0, '2012-04-03', NULL, NULL, 40.5601, -111.939, NULL, NULL),
('870391052', 'W12018614', 'W12018614', 'UT01', 'Audiology Associates', 'Tad', '', 'Bergen', 'AUD', 'Audiology', '', '', NULL, 'O', '370 E S Temple Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013648692', '8013640807', '370 E S Temple Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013648692', '8013640807', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508177635', 0, 'N', 0, '2012-04-03', NULL, NULL, 40.7693, -111.88, NULL, NULL),
('830207671', 'W12018618', 'W12018618', 'WY01', 'West Park Hospital District', 'Bridget', 'A', 'Boudreaux', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782975', '3075782979', '424 Yellowstone Ave Ste 230', 'Cody', 'Park', 'WY', '82414', '3075782975', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336358670', 0, 'N', 0, '2013-06-28', NULL, NULL, 44.517, -109.083, NULL, NULL),
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('870354442', 'W12018621', 'W12018621', 'UT01', 'Rocky Mountain Womens Health Center', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('830358237', 'W12018622', 'W12018622', 'WY01', 'Back to Health Chiropractic', 'Jason', '', 'Haycock', 'DC', 'Chiropractic', '', '', NULL, 'O', '120 S Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '120 S Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-03-15', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1760668362', 0, 'N', 0, '2012-05-30', NULL, NULL, 41.3272, -110.293, NULL, NULL),
('830358237', 'W12018623', 'W12018623', 'WY01', 'Back to Health Chiropractic', 'Jason', '', 'Haycock', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 1194', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', 'PO Box 1194', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-03-15', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1760668362', 0, 'N', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
('830358237', 'W12018624', 'W12018624', 'WYT1', 'Back to Health Chiropractic', 'Jason', '', 'Haycock', 'DC', 'Chiropractic', '', '', NULL, 'O', '120 S Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '120 S Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-03-15', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1760668362', 0, 'N', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
('830358237', 'W12018625', 'W12018625', 'WYT1', 'Back to Health Chiropractic', 'Jason', '', 'Haycock', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 1194', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', 'PO Box 1194', 'Lyman', 'Uinta', 'WY', '82937', '3077876400', '3077876401', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-03-15', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1760668362', 0, 'N', 0, '2012-05-30', NULL, NULL, 0, 0, NULL, NULL),
('820504028', 'W12018626', 'W12018626', 'ID01', 'Living Hope Clinic', 'Brigett', 'W', 'Hollander', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3308 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083781122', '2083781142', '3308 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083781122', '2083781142', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578735270', 0, 'N', 0, '2012-04-04', NULL, NULL, 0, 0, NULL, NULL),
('826000428', 'W12018627', 'W12018627', 'UT01', 'Oneida County Clinic', 'John', 'A', 'Holley', 'MD', 'Family Practice', '', '', NULL, 'O', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087332600', '2087664258', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087332600', '2087664258', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2012-09-30', 0, 0, 0, 'Oneida County Hospital', '', '', '', 'HCFA|', '1447258157', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('202320132', 'W12018431', 'W12018431', 'ID01', 'Lifestages OB/GYN', 'Dustan', 'T', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1611 B 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83686', '2084428035', '2084428038', '1611 B 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83686', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-16', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1770513228', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.5534, -116.573, NULL, NULL),
('202320132', 'W12018432', 'W12018432', 'ID01', 'Lifestages OB/GYN', 'Juliette', 'E', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1611 B 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83686', '2084428035', '2084428038', '1611 B 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83686', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154344190', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.5534, -116.573, NULL, NULL),
('870179340', 'W12018628', 'W12018628', 'UT01', 'Standard Optical', 'Benjamin', 'H', 'Leishman', 'OD', 'Optometry', '', '', NULL, 'O', '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018862020', '8019540054', '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018862020', '8019540054', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942438015', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W12018629', 'W12018629', 'UT01', 'Standard Optical', 'Benjamin', 'H', 'Leishman', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8018862020', '8019540054', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8018862020', '8019540054', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942438015', 0, 'N', 0, '2014-02-25', NULL, NULL, 40.5806, -111.868, NULL, NULL),
('203276415', 'W12018630', 'W12018630', 'ID01', 'Ada West Dermatology', 'Christine', 'A', 'Measham', 'MD', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558321323', 0, 'N', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('870354442', 'W12018631', 'W12018631', 'UT01', 'Rocky Mountain Womens Health Center', 'Minita', 'S', 'Patel', 'MD', 'Urogynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1972714954', 0, 'N', 0, '2013-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12018632', 'W12018632', 'UT01', 'Rocky Mountain Womens Health Center', 'Minita', 'S', 'Patel', 'MD', 'Urogynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-01', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1972714954', 0, 'N', 0, '2013-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'W12018633', 'W12018633', 'UT01', 'Pediatric Anesthesiologists', 'Matthew', 'R', 'Seely', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014322604', '8014322670', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014322604', '8014322670', '', '', '', '0.00', '12.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639198336', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W12018634', 'W12018634', 'UT01', 'Western Anesthesia Associates', 'Erik', 'W', 'Shupe', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322601', '', '', '1000', '48.50', '0.00', '0.00', 3, '2012-11-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1831302645', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870578843', 'W12018636', 'W12018636', 'UT01', 'Bear Lake Physical Therapy', 'Bryce', 'S', 'Woodfield', 'PT', 'Physical Therapy', '', '', NULL, 'O', '35 N Main', 'Randolph', 'Rich', 'UT', '84064', '4357937000', '4359469777', '35 N Main', 'Randolph', 'Rich', 'UT', '84064', '4357937000', '4359469777', 'WESTREHAB', '', '', '0.00', '0.00', '68.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1063508885', 0, 'N', 0, '2012-08-16', NULL, NULL, 41.6663, -111.185, NULL, NULL),
('953382344', 'W12018637', 'W12018637', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '1127 Bryn Mawr Ave Ste A', 'Redlands', 'San Bernardino', 'CA', '92374', '8002372767', NULL, '1127 Bryn Mawr Ave Ste A', 'Redlands', 'San Bernardino', 'CA', '92374', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'W12018638', 'W12018638', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '19102 N Creek Pkwy', 'Bothell', 'King', 'WA', '98011', '8002372767', NULL, '19102 N Creek Pkwy', 'Bothell', 'King', 'WA', '98011', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'W12018639', 'W12018639', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '543 Pylon Dr', 'Raleigh', 'Wake', 'NC', '27606', '8002372767', NULL, '543 Pylon Dr', 'Raleigh', 'Wake', 'NC', '27606', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'W12018640', 'W12018640', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '543 W Hermosa Dr', 'San Antonio', 'Bexar', 'TX', '78212', '8002372767', NULL, '543 W Hermosa Dr', 'San Antonio', 'Bexar', 'TX', '78212', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'W12018641', 'W12018641', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', 'Po Box 840688', 'Dallas', 'Dallas', 'TX', '75284', '8002372767', NULL, 'Po Box 840688', 'Dallas', 'Dallas', 'TX', '75284', '8002372767', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018651', 'W12018651', 'WYREC', 'Community Health Ctr', 'Trent (Recognized PPO but not contracted)', '', 'Batty', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005222', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018652', 'W12018652', 'WYREC', 'Community Health Ctr', 'Jamie (Recognized PPO but not contracted)', '', 'Baum', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005226', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018653', 'W12018653', 'WYREC', 'Community Health Ctr', 'David (Recognized PPO but not contracted)', '', 'Butters', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005504', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018654', 'W12018654', 'WYREC', 'Community Health Ctr', 'Coleen (Recognized PPO but not contracted)', '', 'Haynes', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006622', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018655', 'W12018655', 'WYREC', 'Community Health Ctr', 'Vincent (Recognized PPO but not contracted)', '', 'Hinshaw', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006726', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018656', 'W12018656', 'WYREC', 'Community Health Ctr', 'Brandon (Recognized PPO but not contracted)', '', 'Isaacs', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006873', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018657', 'W12018657', 'WYREC', 'Community Health Ctr', 'Sharon (Recognized PPO but not contracted)', '', 'Kames', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007032', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018658', 'W12018658', 'WYREC', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Kooiker-Brostoski', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007140', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018659', 'W12018659', 'WYREC', 'Community Health Ctr', 'Paul (Recognized PPO but not contracted)', '', 'Langevin', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007191', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018660', 'W12018660', 'WYREC', 'Community Health Ctr', 'Eric (Recognized PPO but not contracted)', '', 'Lawrence', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007218', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018661', 'W12018661', 'WYREC', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Miller', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007622', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018662', 'W12018662', 'WYREC', 'Community Health Ctr', 'Michele (Recognized PPO but not contracted)', '', 'Mohr', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007660', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018663', 'W12018663', 'WYREC', 'Dubois Med ical Clinic', 'Vaughn (Recognized PPO but not contracted)', '', 'Morgan', '', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', NULL, '5647 US Hwy  26', 'Dubois', 'Fremont', 'WY', '82513', '3074552516', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007698', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018664', 'W12018664', 'WYREC', 'Community Health Ctr', 'Andrew (Recognized PPO but not contracted)', '', 'Roberts', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008421', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018665', 'W12018665', 'WYREC', 'Community Health Ctr', 'Beth (Recognized PPO but not contracted)', '', 'Robitaille', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008433', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018666', 'W12018666', 'WYREC', 'Community Health Ctr', 'Dale (Recognized PPO but not contracted)', '', 'Ross', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008486', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018667', 'W12018667', 'WYREC', 'Community Health Ctr', 'Lonnie (Recognized PPO but not contracted)', '', 'Teague', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009026', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018668', 'W12018668', 'WYREC', 'Community Health Ctr', 'Stephan (Recognized PPO but not contracted)', '', 'Trent', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009174', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018669', 'W12018669', 'WYREC', 'Community Health Ctr', 'Biran (Recognized PPO but not contracted)', '', 'Veauthier', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009433', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830326307', 'W12018670', 'W12018670', 'WYREC', 'Community Health Ctr', 'Karen (Recognized PPO but not contracted)', '', 'Wildman', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009619', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12018671', 'W12018671', 'WYREC', 'Community Health Ctr', 'Cynthia (Recognized PPO but not contracted)', '', 'Works', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009677', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'W12018672', 'W12018672', 'UT01', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', '7149612107', NULL, '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', '7149612107', '', 'DME8012', '', '', '0.00', '25.00', '0.00', 3, '2012-04-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12018673', 'W12018673', 'UT01', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '4356732619', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '4356732619', 'DME8012', '', '', '0.00', '25.00', '0.00', 3, '2012-04-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12018674', 'W12018674', 'WY01', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '148 E Arapaho Box 168', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', '148 E Arapaho Box 168', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', 'DME8012', '', '', '0.00', '25.00', '0.00', 3, '2012-04-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('830334941', 'W12018718', 'W12018718', 'WY01', 'Red Rock Family Practice', 'Jason', 'C', 'Weyer', 'DO', 'Family Practice', '', '', NULL, 'O', '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', NULL, '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417902354', 0, 'N', 0, '2012-04-09', NULL, NULL, 44.01, -107.954, NULL, NULL),
('830334941', 'W12018716', 'W12018716', 'WY01', 'Red Rock Family Practice', 'Jason', 'C', 'Weyer', 'DO', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417902354', 0, 'N', 0, '2012-04-09', NULL, NULL, 43.6466, -108.198, NULL, NULL),
('830334941', 'W12018719', 'W12018719', 'WYT1', 'Red Rock Family Practice', 'Jason', 'C', 'Weyer', 'DO', 'Family Practice', '', '', NULL, 'O', '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', NULL, '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417902354', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('830334941', 'W12018717', 'W12018717', 'WYT1', 'Red Rock Family Practice', 'Jason', 'C', 'Weyer', 'DO', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417902354', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('262102138', 'W12018720', 'W12018720', 'UT01', 'Heiden Davidson Orthopedics', 'Karen', 'D', 'Heiden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2200 Park Ave Bldg D Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '4356158823', '2200 Park Ave Bldg D Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '4356158823', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-11-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346230760', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('262102138', 'W12018721', 'W12018721', 'UT01', 'Heiden Davidson Orthopedics', 'Karen', 'D', 'Heiden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4888 S Highlind Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356158822', '4356158823', '4888 S Highlind Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356158822', '4356158823', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-11-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346230760', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870578843', 'W12018722', 'W12018722', 'UT01', 'Bear Lake Physical Therapy', 'Kam', 'E', 'Jarman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '35 N Main', 'Randolph', 'Rich', 'UT', '84064', '4357937000', '4359469777', '35 N Main', 'Randolph', 'Rich', 'UT', '84064', '4357937000', '4359469777', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710073523', 0, 'N', 0, '2012-06-29', NULL, NULL, 41.6663, -111.185, NULL, NULL),
('870578843', 'W12018723', 'W12018723', 'UT01', 'Bear Lake Physical Therapy', 'Kam', 'E', 'Jarman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '95 W 50 S', 'Garden City', 'Rich', 'UT', '84028', '4359462777', '4359469777', '95 W 50 S', 'Garden City', 'Rich', 'UT', '84028', '4359462777', '4359469777', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710073523', 0, 'N', 0, '2012-06-29', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('870578843', 'W12018724', 'W12018724', 'UT01', 'Bear Lake Physical Therapy', 'Kam', 'E', 'Jarman', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 276', 'Garden City', 'Rich', 'UT', '84028', '4359462777', '4359469777', 'PO Box 276', 'Garden City', 'Rich', 'UT', '84028', '4359462777', '4359469777', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710073523', 0, 'Y', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018725', 'W12018725', 'WY01', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 41.2433, -110.998, NULL, NULL),
('262554888', 'W12018727', 'W12018727', 'WY01', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'M', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018729', 'W12018729', 'WY01', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018726', 'W12018726', 'WYT1', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018728', 'W12018728', 'WYT1', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'M', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018730', 'W12018730', 'WYT1', 'Apogee Medical Group, Wyoming', 'Barbara', 'J', 'MacFarlane', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1821164849', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'W12018731', 'W12018731', 'WY01', 'Lander Family Medicine', 'Kathleen', 'A', 'Petro', 'FNP', 'Family Practice', '', '', NULL, 'O', '8195 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', '8195 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1730203613', 0, 'N', 0, '2012-06-30', NULL, NULL, 42.8355, -108.72, NULL, NULL),
('721537787', 'W12018733', 'W12018733', 'WY01', 'Lander Family Medicine', 'Kathleen', 'A', 'Petro', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 483', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'PO Box 483', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1730203613', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'W12018732', 'W12018732', 'WYT1', 'Lander Family Medicine', 'Kathleen', 'A', 'Petro', 'FNP', 'Family Practice', '', '', NULL, 'O', '8195 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', '8195 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1730203613', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'W12018734', 'W12018734', 'WYT1', 'Lander Family Medicine', 'Kathleen', 'A', 'Petro', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 483', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'PO Box 483', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '3073321553', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1730203613', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018735', 'W12018735', 'WY01', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-06-30', NULL, NULL, 41.2433, -110.998, NULL, NULL),
('262554888', 'W12018737', 'W12018737', 'WY01', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'M', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018739', 'W12018739', 'WY01', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018736', 'W12018736', 'WYT1', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018738', 'W12018738', 'WYT1', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'M', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', '2525 E Camelback Rd Ste 1100', 'Phoenix', 'Maricopa', 'AZ', '85016', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('262554888', 'W12018740', 'W12018740', 'WYT1', 'Apogee Medical Group, Wyoming', 'Layhong', '', 'Soth', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'PO Box 708878', 'Sandy', 'Salt Lake', 'UT', '84070', '3077893636', '3077898132', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1366602294', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018741', 'W12018741', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018742', 'W12018742', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12018743', 'W12018743', 'ID01', 'Saint Alphonsus Medical Group Pedicatics Boise', 'Colette', 'D', 'Weber', 'PAC', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2084665322', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-12-14', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1922042464', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('830326307', 'W12018744', 'W12018744', 'WYREC', 'Community Health Ctr', 'Thomas (Recognized PPO but not contracted)', '', 'Radosevich', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', 'Natrona', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-03-13', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008303', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('205917784', 'W12018745', 'W12018745', 'UTMH1', '', 'Brian', 'J', 'Taracena', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', NULL, '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-03-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730129883', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('731714968', 'W12018756', 'W12018756', 'UT01', 'Rocky Mountain Anesthesiology', '', '', 'Rocky Mountain Anesthesiology', 'Group', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', '', '', '', '0.00', '19.00', '0.00', 3, '2012-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009881', 0, 'Y', 0, '2012-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12018149', 'W12018149', 'ID01', 'West Valley Medical Group', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2012-06-28', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12018150', 'W12018150', 'ID01', 'West Valley Medical Group Nampa', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 203 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2012-06-28', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12018151', 'W12018151', 'ID01', 'West Valley Medical Group', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870668219', 'W12018757', 'W12018757', 'UTMH1', '', 'Becky', 'J', 'Bailey', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '508 E S Temple Ste 225', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015216234', '8017334083', '508 E S Temple Ste 225', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015216234', '8017334083', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700818911', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12018758', 'W12018758', 'NM01', 'New Mexico Heart Institute', 'Gretchen', 'H', 'Bailey-Cahana', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432592', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1629348115', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12018759', 'W12018759', 'NM01', 'New Mexico Heart Institute', 'Gretchen', 'H', 'Bailey-Cahana', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432853', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1629348115', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018760', 'W12018760', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018761', 'W12018761', 'UT01', 'MountainStar Cardiology St Marks', 'Edward', 'Wayne', 'Ganellen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164414017', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12018762', 'W12018762', 'UT01', 'Standard Optical', 'Curtis', 'S', 'Goodman', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-10', '2012-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497990642', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('271456616', 'W12020850', 'W12020850', 'UTMH1', '', 'Laura', 'P', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '881 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019970939', '8013592665', '881 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019970939', '8013592665', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-06-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144469727', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('870526286', 'W12018764', 'W12018764', 'UT01', 'Wasatch Internal Medicine', 'Margaret', 'E', 'Grogan', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 29675 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012621711', '8012889101', 'PO Box 29675 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012621711', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962669853', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12018765', 'W12018765', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-10', '2012-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018766', 'W12018766', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12018767', 'W12018767', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-12', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12018768', 'W12018768', 'UT01', 'Standard Optical', 'Benjamin', 'H', 'Leishman', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942438015', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('529154000', 'W12018772', 'W12018772', 'UTMH1', '', 'Corinna', '', 'Porter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '150 N Main St Ste 106', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', '150 N Main St Ste 106', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588871321', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('529154000', 'W12018773', 'W12018773', 'UTMH1', '', 'Corinna', '', 'Porter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '48 N Main St Ste 6', 'Nephi', 'Juab', 'UT', '84648', '4356543003', '4356540309', '48 N Main St Ste 6', 'Nephi', 'Juab', 'UT', '84648', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588871321', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W12018775', 'W12018775', 'ID02', 'Childrens Therapy Place Inc', 'Nicole', '', 'Nickell', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942506555', 0, 'N', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12018776', 'W12018776', 'UT01', 'Standard Optical', 'Russell', '', 'Purdy', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-10', '2012-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295823029', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870577721', 'W12018777', 'W12018777', 'UTMH1', 'St John Therapeutic Services Inc', 'Sharon', 'A', 'St John', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5333 S Adams Ave Ste A', 'Washington Terrace', 'Weber', 'UT', '84405', '8013171895', NULL, '5333 S Adams Ave Ste A', 'Washington Terrace', 'Weber', 'UT', '84405', '8013171895', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437121357', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12018778', 'W12018778', 'UTIHCPHY', 'North Canyon Family Practice', 'Thomas', 'E', 'Myers', 'MD', 'Family Practice', '', '', NULL, 'O', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497761621', 0, 'N', 0, '2012-03-20', NULL, NULL, 40.276, -111.651, NULL, NULL),
('942854057', 'W12018781', 'W12018781', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-02-27', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018782', 'W12018782', 'UTPEHP', 'Hurricane Valley Clinic', 'Laura', 'L', 'Thomas', 'APRN', 'Family Practice', 'Urgent Care', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2012-01-25', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1568779783', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018784', 'W12018784', 'UTPEHP', 'Blood and Marrow Transplant/Leukemia Program', 'Barbara', 'A', 'Ziegler', 'APRN', 'Acute Care', '', '', NULL, 'O', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083043', '8014088453', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083043', '8014088453', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2012-02-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144598764', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'W12013583', 'W12013583', 'UT01', 'Emery Medical Center', 'Richard', 'J', 'Donaldson', 'DO', 'Family Practice', '', '', NULL, 'O', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|', '1841495066', 0, 'N', 0, '2013-07-09', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('621762357', 'W12013584', 'W12013584', 'UT01', 'Emery Medical Center', 'Richard', 'J', 'Donaldson', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|', '1841495066', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('320271992', 'W12018790', 'W12018790', 'UTMH1', '', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8019300020', '8013051395', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8019300020', '8013051395', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-22', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('261712543', 'W12016786', 'W12016786', 'UT01', 'Family First Chiropractic & Wellness Center', 'Kimberly', '', 'Glasgow', 'DC', 'Chiropractic', '', '', NULL, 'O', '495 E 4500 S Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', '495 E 4500 S Ste 202', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-12-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508192311', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018799', 'W12018799', 'UT01', 'Utah Heart-Riverton', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12018800', 'W12018800', 'UT01', 'Utah Heart PC Ute', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1612 Ute Blvd Ste 112', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', '1612 Ute Blvd Ste 112', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.7246, -111.542, NULL, NULL),
('942854057', 'W12018801', 'W12018801', 'UT01', 'Utah Heart PC Homestead', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2720 Homestead Rd Ste 100', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', '2720 Homestead Rd Ste 100', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.756, -111.57, NULL, NULL),
('942854057', 'W12018802', 'W12018802', 'UT01', 'Utah Heart PC Ute', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1612 Ute Blvd Ste 112', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', '1612 Ute Blvd Ste 112', 'Park City', 'Summit', 'UT', '84098', '8015073500', '8015073505', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.7246, -111.542, NULL, NULL),
('942854057', 'W12018803', 'W12018803', 'UT01', 'Utah Heart-Park City', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '8015073500', '8015073503', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12018804', 'W12018804', 'UT01', 'Utah Heart-Riverton', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12018806', 'W12018806', 'UTIHCPHY', 'River Road InstaCare', 'Stephen', 'A', 'Welsh', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-02-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841516747', 0, 'Y', 0, '2013-06-03', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12018808', 'W12018808', 'UTIHCPHY', 'Logan Hyperbaric and Wound Care', 'Steven', '', 'Nail', 'MD', 'Hyperbaric Medicine', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114978137', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12018809', 'W12018809', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'David', 'A', 'Tomb', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639269269', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018811', 'W12018811', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Gloria', '', 'Tong', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043354095', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018813', 'W12018813', 'UTIHCPHY', 'Bountiful Clinic', 'Regan', '', 'Haight', 'APRN', 'Mental Health', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-01', '2012-03-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356679641', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('453598776', 'W12019120', 'W12019120', 'UT01', 'Oquirrh Radiology Associates', 'Aaron', 'E', 'Frodsham', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'WUUTIMAGE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184807208', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('453598776', 'W12019121', 'W12019121', 'UT01', 'Oquirrh Radiology Associates', 'Maryellyn', '', 'Gilfeather', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1598764847', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('451659913', 'W12018817', 'W12018817', 'UT01', '', 'Cameron', 'J', 'Egbert', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '6360 S 3000 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018999737', NULL, '6360 S 3000 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018999737', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|DEN|', '1033320957', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('454342687', 'W12018820', 'W12018820', 'UT01', '', 'Michael', 'R', 'Hinckley', 'MD', 'Dermatology', '', '', NULL, 'O', '602 E Fort Union Blvd Floor 2', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', '602 E Fort Union Blvd Floor 2', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1760665707', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.6207, -111.874, NULL, NULL),
('820441031', 'W12018831', 'W12018831', 'ID01', 'Ada Orthopaedic Clinic', 'William', 'C', 'Lindner', 'MD; Shoulder, General', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1982649927', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.612, -116.262, NULL, NULL),
('272923067', 'W12019287', 'W12019287', 'WYT1', 'Big Horn Urgent Care', 'Sylvia', 'A', 'Rife', 'ARNP', 'Urgent Care', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245292242', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('680576367', 'W12018832', 'W12018832', 'UT01', 'Clarus Consultants', 'Adam', 'J', 'Lofgran', 'OD', 'Optometry', '', '', NULL, 'O', '803 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356284464', '4356285015', '803 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356284464', '4356285015', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528297900', 0, 'N', 0, '2012-05-03', NULL, NULL, 37.0944, -113.586, NULL, NULL),
('820529971', 'W12019290', 'W12019290', 'ID02', 'Childrens Therapy Place', 'Carrie', 'L', 'Saks', 'OT', 'Pediatrics', '', '', NULL, 'O', '6855 W Fairview Ave', 'Boise', 'Ada', 'ID', '83704', '2083238888', '2083238889', '6855 W Fairview Ave', 'Boise', 'Ada', 'ID', '83704', '2083238888', '2083238889', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2012-04-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740427285', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019289', 'W12019289', 'WYT1', 'Big Horn Urgent Care', 'Travis', 'M', 'Preszler', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770565764', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'W12018835', 'W12018835', 'WY01', 'Big Horn Urgent Care', 'Darren', 'L', 'Mikesell', 'DO', 'Family Practice', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1275733180', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019288', 'W12019288', 'WY01', 'Big Horn Urgent Care', 'Travis', 'M', 'Preszler', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770565764', 0, 'Y', 0, '2013-06-18', NULL, NULL, 41.1607, -104.789, NULL, NULL),
('270248138', 'W12018836', 'W12018836', 'WYT1', 'Big Horn Urgent Care', 'Darren', 'L', 'Mikesell', 'DO', 'Family Practice', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1275733180', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('451014751', 'W12018841', 'W12018841', 'UT01', 'Utah Audiology and Hearing', 'Leanne', 'M', 'Norman', 'AUD', 'Audiology', '', '', NULL, 'O', '2041 Sidewinder Dr Ste 1', 'Park City', 'Summit', 'UT', '84060', '4356558824', '4356554965', '2041 Sidewinder Dr Ste 1', 'Park City', 'Summit', 'UT', '84060', '4356558824', '4356554965', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972806651', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.6641, -111.495, NULL, NULL),
('271963340', 'W12018842', 'W12018842', 'ID01', 'Recovery 4 Life', '', '', 'Recovery 4 Life', 'Group', 'Mental Health Facility', '', '', NULL, 'O', '8950 W Emerald St Ste 178', 'Boise', 'Ada', 'ID', '83704', '2083767083', '2083215069', '8950 W Emerald St Ste 178', 'Boise', 'Ada', 'ID', '83704', '2083767083', '2083215069', 'REC4LIFE', '', '', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194962829', 0, 'N', 0, '2013-10-15', NULL, NULL, 43.6109, -116.294, NULL, NULL),
('454027438', 'W12018843', 'W12018843', 'UT01', 'HIllside Medical Clinic', 'Stanley', 'D', 'Roberts', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '118 N Main St Ste B', 'Salem', 'Utah', 'UT', '84653', '8014779007', '8014779006', '118 N Main St Ste B', 'Salem', 'Utah', 'UT', '84653', '8014779007', '8014779006', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1316993520', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.0564, -111.673, NULL, NULL),
('454027438', 'W12018844', 'W12018844', 'UT01', 'HIllside Medical Clinic', 'Stanley', 'D', 'Roberts', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '385 Jordan Rd', 'Troy', 'Rensselaer', 'NY', '12180', '8014779007', '8014779006', '385 Jordan Rd', 'Troy', 'Rensselaer', 'NY', '12180', '8014779007', '8014779006', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1316993520', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12018845', 'W12018845', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('271352178', 'W12018847', 'W12018847', 'UT01', 'Eyecare Wellness Clinic', 'David', 'B', 'Burnett', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '4848 S 900 W', 'Riverdale', 'Weber', 'UT', '84405', '8016279868', '8014472211', '4848 S 900 W', 'Riverdale', 'Weber', 'UT', '84405', '8016279868', '8014472211', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073520680', 0, 'N', 0, '2012-04-04', NULL, NULL, 41.1754, -112.001, NULL, NULL),
('271352178', 'W12018846', 'W12018846', 'UT01', 'Eyecare Wellness Clinic', 'David', 'B', 'Burnett', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '57 N Main St', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014472211', '57 N Main St', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014472211', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073520680', 0, 'N', 0, '2012-04-04', NULL, NULL, 40.9814, -111.888, NULL, NULL),
('331177233', 'W12018849', 'W12018849', 'UT01', 'Layton Specialty Clinic', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12018850', 'W12018850', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, 'N', 0, '2013-01-03', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870373083', 'W12018853', 'W12018853', 'UT01', 'Heart and Lung Institute of Utah Inc', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870299862', 'W12018855', 'W12018855', 'UTMH1', 'LDS Family Services', 'James', 'L', 'Wadman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84404', '8016216510', '8013363041', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84404', '8016216510', '8013363041', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2012-03-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659420503', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12018856', 'W12018856', 'TX01', 'South Texas Oncology and Hematology', 'Randall', 'D', 'Rogers', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78291', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78291', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-26', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679659791', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12018857', 'W12018857', 'TX01', 'South Texas Oncology and Hematology', 'Randall', 'D', 'Rogers', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '540 Madison Oak Dr Ste 320', 'San Antonio', 'Bexar', 'TX', '78258', '2104904499', NULL, '540 Madison Oak Ste 320', 'San Antonio', 'Bexar', 'TX', '78258', '2104904499', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-26', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679659791', 0, 'N', 0, '2012-06-25', NULL, NULL, 29.6212, -98.4921, NULL, NULL),
('742915297', 'W12018858', 'W12018858', 'TX01', 'South Texas Oncology and Hematology', 'Randall', 'D', 'Rogers', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1303 McCullough Ave Ste 265', 'San Antonio', 'Bexar', 'TX', '78212', '2102240402', '2102263585', '1303 McCullough Ste 265', 'San Antonio', 'Bexar', 'TX', '78212', '2102240402', '2102263585', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-03-26', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679659791', 0, 'N', 0, '2012-06-25', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('529744573', 'W12018859', 'W12018859', 'UTMH1', 'LDS Family Services', 'Maryanne', '', 'McFarland', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '130 W 100 N', 'Bountiful', 'Davis', 'UT', '84010', '8015106864', NULL, '130 W 100 N', 'Bountiful', 'Davis', 'UT', '84010', '8015106864', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609069293', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12018861', 'W12018861', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870373083', 'W12018862', 'W12018862', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Bruce', 'R', 'Kenwood', 'DO', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1144279019', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('742915297', 'W12018863', 'W12018863', 'TX01', 'South Texas Oncology and Hematology', 'Kathy', 'D', 'Grove', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78212', '2102241971', '', '1200 Brooklyn Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78212', '2102241971', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-05-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710912860', 0, 'N', 0, '2014-07-25', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('870373083', 'W12018864', 'W12018864', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-02-10', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('331177233', 'W12018865', 'W12018865', 'UT01', 'Layton Specialty Clinic', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12018866', 'W12018866', 'UT01', 'Layton Specialty Clinic', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('271419508', 'W12017300', 'W12017300', 'UT01', 'Utah Pain Relief Institute', 'Gary', 'L', 'Child', 'DO', 'Pain Management', '', '', NULL, 'O', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', '32 W 6400 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8014667246', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063492304', 0, 'N', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('519748058', 'W12018873', 'W12018873', 'ID01', '', 'Jon', 'E', 'Ashton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336361336', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12018879', 'W12018879', 'ID02', 'West Valley Medical Center', 'Joe', 'M', 'Llenos', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1003073560', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12018880', 'W12018880', 'ID02', 'West Valley Medical Center', 'Steven', 'T', 'Koga', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144275512', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12018881', 'W12018881', 'ID02', 'West Valley Medical Center', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', '2013-05-23', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12018883', 'W12018883', 'ID02', 'Idaho Nephrology Associates', 'Christopher', '', 'Sjoberg', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', '45640 Schoenherr Rd', 'Utica', 'Macomb', 'MI', '48315', '5862474300', '2083673003', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235122284', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('381966107', 'W12018884', 'W12018884', 'ID02', 'Idaho Nephrology Associates', 'Christopher', '', 'Sjoberg', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '5610 W Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673332', '5610 W Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '2083673332', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235122284', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12018886', 'W12018886', 'ID01', 'Saint Alphonsus Medical Group Neurology Boise', 'Jane', 'K', 'Spencer', 'CNS', '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', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-04-02', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962709550', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W12018887', 'W12018887', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Calvin', 'M', 'Harrold', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-30', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1598705311', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12018888', 'W12018888', 'ID01', 'Saint Alphonsus Medical Group Inpatient Pain Boise ', 'Thomas', '', 'Rambow', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673053', '2083675688', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673053', '2083675688', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-03-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1679534184', 0, 'Y', 0, '2014-04-15', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12018890', 'W12018890', 'ID01', 'StAlphonsus Regional Medical Center', 'Steven', '', 'Brown', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083675170', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1700874682', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('742592013', 'W12013771', 'W12013771', 'TX01', 'Dermatology Associates of San Antonio', 'Alan', 'K', 'Silverman', '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, '2011-10-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316039811', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('770701557', 'W12003169', 'W12003169', 'UT01', 'Lone Peak Family Medicine', 'Matthew', 'T', 'Andersen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-01', '2010-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922070093', 0, 'N', 1, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12018874', 'W12018874', 'UT01', 'Ogden Internal Medicine and Urology', 'Melissa', 'J', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', '5405 S 500 E Ste Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639354897', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12018897', 'W12018897', 'UT01', 'Ogden Internal Medicine and Urology', 'Melissa', 'J', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8014750960', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8014750960', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639354897', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
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('202148889', 'W12018899', 'W12018899', 'TX01', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-05-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12018898', 'W12018898', 'TX01', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105723306', '2012490125', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105723306', '2012490125', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-05-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870470026', 'W12018901', 'W12018901', 'UT01', '', 'Patricia', '', 'Bearnson', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013920677', 0, 'N', 0, '2012-10-31', NULL, NULL, 40.6753, -111.866, NULL, NULL),
('830327475', 'W12018903', 'W12018903', 'WY01', 'Evanston Hospital Corporation', 'Justin', 'R', 'Fenus', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077838327', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077838327', '', '', '1000', '40.00', '0.00', '0.00', 6, '2012-04-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1912298530', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12018905', 'W12018905', 'WY01', 'Campbell County Clinics Pulmonology', 'Peter', 'L', 'Fort', 'MD', 'Pulmonary', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '', '', '', '0.00', '21.00', '0.00', 6, '2012-05-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932191319', 0, 'N', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W12018907', 'W12018907', 'WY01', 'Campbell County Clinics Pulmonology', 'Peter', 'L', 'Fort', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '3076883640', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '3076883640', '', '', '', '0.00', '21.00', '0.00', 6, '2012-05-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932191319', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12018910', 'W12018910', 'WYT1', 'Campbell County Clinics Pulmonology', 'Peter', 'L', 'Fort', 'MD', 'Pulmonary', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '', '', '', '0.00', '21.00', '0.00', 6, '2012-05-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932191319', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12018908', 'W12018908', 'WYT1', 'Campbell County Clinics Pulmonology', 'Peter', 'L', 'Fort', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '3076883640', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '3076883640', '', '', '', '0.00', '21.00', '0.00', 6, '2012-05-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932191319', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12018911', 'W12018911', 'UT01', 'Just Kids Pediatric and Adolescent Clinic', 'John', 'Bryant', 'Freer', 'MD', 'Pediatrics', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', '4052 W Pioneer Pkwy Ste 205', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-20', '2013-02-28', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821193947', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12018912', 'W12018912', 'UT01', 'Just Kids Pediatric and Adolescent Clinic', 'John', 'Bryant', 'Freer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-20', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821193947', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('412057748', 'W12018916', 'W12018916', 'UTMH1', 'Utah Pain and Rehab', 'Patricia', '', 'Henrie', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407917537', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('274179855', 'W12018926', 'W12018926', 'UT01', 'Diamond Springs Wellness Center', 'Judith', 'S', 'Moore', 'DO', 'Family Practice', '', '', NULL, 'O', '210 E Main St', 'Midway', 'Wasatch', 'UT', '84049', '4356571777', '4356570098', '210 E Main St', 'Midway', 'Wasatch', 'UT', '84049', '4356571777', '4356570098', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1659443539', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.5121, -111.468, NULL, NULL),
('830234097', 'W12018930', 'W12018930', 'WY01', 'Campbell County Clinics', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2012-04-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12018928', 'W12018928', 'WY01', 'Campbell County Clinics Neurology and Pain', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '5001', '0.00', '0.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W12018929', 'W12018929', 'WY01', 'Campbell County Clinics', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'M', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2012-04-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12018931', 'W12018931', 'WYT1', 'Campbell County Clinics', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2012-04-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12018927', 'W12018927', 'WYT1', 'Campbell County Clinics Neurology and Pain', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12018932', 'W12018932', 'WYT1', 'Campbell County Clinics', 'Romer', '', 'Mosquera', 'MD', 'Neurology', '', '', NULL, 'M', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '', '0.00', '21.00', '0.00', 6, '2012-04-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1790930782', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12018934', 'W12018934', 'TX01', 'The San Antonio Orthopaedic Group', 'Andres', '', 'Rahal', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '2829 Babcock Rd Ste 140', 'San Antonio', 'Bexar', 'TX', '78229', '2105931470', '2105931497', '2829 Babcock Rd Ste 140', 'San Antonio', 'Bexar', 'TX', '78229', '2105931470', '2105931497', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-02-01', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902008709', 0, 'Y', 0, '2014-07-18', NULL, NULL, 29.5129, -98.5916, 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
('743003947', 'W12018933', 'W12018933', 'TX01', 'The San Antonio Orthopaedic Group', 'Andres', '', 'Rahal', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 140', 'San Antonio', 'Bexar', 'TX', '78216', '2108045480', '2108045471', '400 Concord Plaza Dr Ste 140', 'San Antonio', 'Bexar', 'TX', '78216', '2108045480', '2108045471', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-02-01', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902008709', 0, 'Y', 0, '2014-07-18', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
('743003947', 'W12018935', 'W12018935', 'TX01', 'The San Antonio Orthopaedic Group', 'Andres', '', 'Rahal', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2105931470', '2105931497', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2105931470', '2105931497', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-02-01', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902008709', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12018937', 'W12018937', 'NM01', 'Southwest Medical Associates', 'Hien', 'T', 'Tran', 'MD', 'Pediatrics', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5058236544', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5058236544', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', '2014-08-13', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1700097458', 0, 'N', 0, '2014-07-18', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12018938', 'W12018938', 'NM01', 'Southwest Medical Associates', 'Hien', 'T', 'Tran', 'MD', 'Pediatrics', '', '', NULL, 'B', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058236544', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058236544', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2012-01-01', '2014-08-13', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1700097458', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12018945', 'W12018945', 'ID01', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', NULL, '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', '', '', '', 'ID01', '0.00', '0.00', '0.00', 3, '2011-12-09', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'N', 0, '2014-04-22', NULL, NULL, 43.6602, -116.659, NULL, NULL),
('876000545', 'W12018946', 'W12018946', 'UT01', 'Health Clinics Of Utah', 'Shirley', 'L', 'Ala', 'PA', 'Family Practice', '', '', NULL, 'O', '168 N 1950 W', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', '8015321183', '168 N 1950 W', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8017153500', '8015321183', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871654459', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.773, -111.947, NULL, NULL),
('711047862', 'W12018947', 'W12018947', 'WY01', 'Center for Surgical Excellence', '', '', 'Center for Surgical Excellence', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1503 Cressett St', 'Gillette', 'Campbell', 'WY', '82716', '3076821911', '3076821181', '1503 Cressett St', 'Gillette', 'Campbell', 'WY', '82716', '3076821911', '3076821181', '', '', '5005', '0.00', '25.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1700042942', 0, 'N', 0, '2012-06-26', NULL, NULL, 44.2982, -105.529, NULL, NULL),
('711047862', 'W12018948', 'W12018948', 'WYT1', 'Center for Surgical Excellence', '', '', 'Center for Surgical Excellence', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1503 Cressett St', 'Gillette', 'Campbell', 'WY', '82716', '3076821911', '3076821181', '1503 Cressett St', 'Gillette', 'Campbell', 'WY', '82716', '3076821911', '3076821181', '', '', '5005', '0.00', '25.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1700042942', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12018954', 'W12018954', 'ID01', 'Boise Orthopedic Clinic', 'Jeffrey "Jake"', '', 'Griggs', 'PA This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2083232600', '2083239172', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2083232600', '2083239172', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2012-05-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861577597', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820161600', 'W12018953', 'W12018953', 'ID01', 'Boise Orthopedic Clinic', 'Jeffrey "Jake"', '', 'Griggs', 'PA This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '2083239172', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '2083239172', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2012-05-01', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861577597', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('273972429', 'W12018956', 'W12018956', 'ID01', 'Idaho Center for Regenerative Medicine', 'Robert', 'J', 'Haake', 'DO', 'Internal Medicine', '', '', NULL, 'O', '500 E Shone Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', NULL, '500 E Shone Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', '          ', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1295747046', 0, 'N', 0, '2014-01-13', NULL, NULL, 0, 0, NULL, NULL),
('260848435', 'W12018958', 'W12018958', 'UTMH1', 'Hales Counseling Center', 'Jason', 'A', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '316 Heber Ln', 'Grantsville', 'Tooele', 'UT', '84029', '4352435760', '4358429939', '316 Heber Ln', 'Grantsville', 'Tooele', 'UT', '84029', '4352435760', '4358429939', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659314201', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('260848435', 'W12018957', 'W12018957', 'UTMH1', 'Hales Counseling Center', 'Jason', 'A', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '40 N Main', 'Tooele', 'Tooele', 'UT', '84074', '4352435760', '4358429939', '40 N Main', 'Tooele', 'Tooele', 'UT', '84074', '4352435760', '4358429939', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659314201', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('273782425', 'W12018959', 'W12018959', 'WY01', 'Canyon Hand Therapy', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.525, -109.055, NULL, NULL),
('273782425', 'W12018960', 'W12018960', 'WYT1', 'Canyon Hand Therapy', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('273782425', 'W12018961', 'W12018961', 'WY01', 'Canyon Hand Therapy', 'Allison', 'A', 'Tipton', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871685560', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.525, -109.055, NULL, NULL),
('273782425', 'W12018962', 'W12018962', 'WYT1', 'Canyon Hand Therapy', 'Allison', 'A', 'Tipton', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871685560', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('273901533', 'W12018963', 'W12018963', 'WY01', 'Pharmacy Solutions', '', '', 'Pharmacy Solutions Inc', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', '136 S Mckinley St', 'Casper', 'Natrona', 'WY', '82601', '3072370757', '3072373213', '136 S Mckinley St', 'Casper', 'Natrona', 'WY', '82601', '3072370757', '3072373213', '', '', '1001', '0.00', '40.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194024224', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('273901533', 'W12018964', 'W12018964', 'WYT1', 'Pharmacy Solutions', '', '', 'Pharmacy Solutions Inc', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', '136 S Mckinley St', 'Casper', 'Natrona', 'WY', '82601', '3072370757', '3072373213', '136 S Mckinley St', 'Casper', 'Natrona', 'WY', '82601', '3072370757', '3072373213', '', '', '1001', '0.00', '40.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194024224', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W12018966', 'W12018966', 'UT01', 'Western Anesthesia Associates', 'Tyson', '', 'Riesenberg', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272069', '8014322671', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272069', '8014322671', '', '', '1000', '48.50', '35.00', '0.00', 3, '2012-08-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1255590642', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12018968', 'W12018968', 'ID02', 'Foothills Physical Therapy', 'Lisa', 'M', 'Swan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2012-05-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275603086', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12018967', 'W12018967', 'ID02', 'Foothills Physical Therapy', 'Lisa', 'M', 'Swan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2012-05-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275603086', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('453598776', 'W12018969', 'W12018969', 'UT01', 'Oquirrh Radiology Associates', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8017966199', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8017966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568734143', 0, 'Y', 0, '2012-10-12', NULL, NULL, 40.5716, -112.295, NULL, NULL),
('453598776', 'W12018970', 'W12018970', 'UT01', 'Oquirrh Radiology Associates', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8017966199', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8017966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568734143', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12018982', 'W12018982', 'ID02', '', 'Dwaine Anthony', '', 'Tesnohlidek', 'MD', 'General Surgery', '', '', NULL, 'O', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084528600', '5418811244', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084528600', '5418811244', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2008-10-01', '2012-10-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1437240009', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12018194', 'W12018194', 'Sinclair', 'Laramie Physicians for Women and Children', '', '', 'Laramie Physicians for Women and Children', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, '', 'Change', 'Laramie', 'Albany', 'WY', '82072', '          ', '3077458167', 'Change', 'Laramie', 'Albany', 'WY', '82072', '          ', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009878', 0, 'Y', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12018989', 'W12018989', 'WY01', 'Big Horn Basin', 'Wade', 'T', 'Bomengen', 'MD', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710959168', 0, 'N', 0, '2012-04-09', NULL, NULL, 44.3811, -108.039, NULL, NULL),
('836000182', 'W12018990', 'W12018990', 'WY01', 'Big Horn Basin', 'Wade', 'T', 'Bomengen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710959168', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12018991', 'W12018991', 'WYT1', 'Big Horn Basin', 'Wade', 'T', 'Bomengen', 'MD', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710959168', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12018992', 'W12018992', 'WYT1', 'Big Horn Basin', 'Wade', 'T', 'Bomengen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710959168', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('820482736', 'W12018993', 'W12018993', 'ID01', '', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', NULL, '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', '', 'IDMD', '', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2013-02-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820482736', 'W12018994', 'W12018994', 'SACN', '', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', NULL, '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870552514', 'W12018995', 'W12018995', 'UTMH1', '', 'Clark', 'B', 'Holladay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '45 E 600 N', 'Nephi', 'Juab', 'UT', '84648', '4356601137', '4356234339', '45 E 600 N', 'Nephi', 'Juab', 'UT', '84648', '4356601137', '4356234339', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619172806', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870552514', 'W12018996', 'W12018996', 'UTMH1', '', 'Clark', 'B', 'Holladay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 170', 'Nephi', 'Juab', 'UT', '84648', '4356601137', '4356234339', 'PO Box 170', 'Nephi', 'Juab', 'UT', '84648', '4356601137', '4356234339', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619172806', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870526286', 'W12018997', 'W12018997', 'UT01', 'Wasatch Internal Medicine', 'Jacqueline', '', 'Lobsiger', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497774525', 0, 'N', 0, '2012-04-23', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870526286', 'W12018998', 'W12018998', 'UT01', 'Wasatch Internal Medicine', 'Jacqueline', '', 'Lobsiger', 'NP-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 26975 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012621771', '8012889101', 'PO Box 26975 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497774525', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12019000', 'W12019000', 'WY01', 'Big Horn Clinic', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 44.3811, -108.039, NULL, NULL),
('836000182', 'W12019001', 'W12019001', 'WY01', 'Big Horn Clinic', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12018999', 'W12018999', 'WYT1', 'Big Horn Clinic', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'O', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '156 N 6th St', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12019002', 'W12019002', 'WYT1', 'Big Horn Clinic', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', 'PO Box 388', 'Basin', 'Big Horn', 'WY', '82410', '3075682499', '3075682699', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12018699', 'W12018699', '', 'St Lukes Clinic Boise Orthopedic Clinic', '', '', 'Boise Orthopedic Clinic', '', 'Clinic', '', '', NULL, '', 'Change', 'Meridian', 'Ada', 'ID', '83642', '          ', NULL, 'Change', 'Meridian', 'Ada', 'ID', '83642', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009880', 0, 'Y', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12019006', 'W12019006', 'UT01', 'After Hours Medical Company M-Sun 9am-8pm', '', '', 'After Hours Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '3934 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018498500', '8018498502', '3934 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018498500', '8018498502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000832961', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.686, -111.825, NULL, NULL),
('204043287', 'W12019010', 'W12019010', 'NM01', 'ABQ Health Partners', 'Miguel', '', 'Trujillo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5150 Journal Ctr Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699970012', 0, 'N', 0, '2012-04-06', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12019009', 'W12019009', 'NM01', 'ABQ Health Partners', 'Naomi', '', 'Swanson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '10511 Golf Course Rd NW Ste 204', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052546500', '5052321121', '10511 Golf Course Rd NW Ste 204', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052546500', '5052321121', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1124245642', 0, 'N', 0, '2013-12-31', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('830334941', 'W12019004', 'W12019004', 'WY01', 'Red Rock Family Practice', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.6466, -108.198, NULL, NULL),
('830334941', 'W12019003', 'W12019003', 'WYT1', 'Red Rock Family Practice', 'Kevin', 'R', 'Mahoney', 'MD', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164494241', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('830334941', 'W12019017', 'W12019017', 'WY01', 'Red Rock Family Practice', 'Jennifer', 'A', 'Rice ', 'MD', 'Family Practice', '', '', NULL, 'O', '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', NULL, '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', 'Johnson County Hospital District', NULL, NULL, 'HCFA|UB|', '1336229624', 0, 'N', 0, '2012-06-30', NULL, NULL, 44.01, -107.954, NULL, NULL),
('830334941', 'W12019015', 'W12019015', 'WY01', 'Red Rock Family Practice', 'Jennifer', 'A', 'Rice ', 'MD', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', 'Johnson County Hospital District', NULL, NULL, 'HCFA|UB|', '1336229624', 0, 'N', 0, '2012-06-30', NULL, NULL, 43.6466, -108.198, NULL, NULL),
('830334941', 'W12019016', 'W12019016', 'WYT1', 'Red Rock Family Practice', 'Jennifer', 'A', 'Rice ', 'MD', 'Family Practice', '', '', NULL, 'O', '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', NULL, '120 N C Ave', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645534', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', 'Johnson County Hospital District', NULL, NULL, 'HCFA|UB|', '1336229624', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'W12013770', 'W12013770', 'TX01', 'Dermatology Associates of San Antonio', 'Alan', 'K', 'Silverman', '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, '2011-10-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316039811', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6125, -98.4829, NULL, NULL),
('830327475', 'W12018919', 'W12018919', 'WYT2', 'Evanston Hospital Corporation', 'Tyler', 'L', 'Hunt', '', 'Anesthesia', '', '', NULL, 'B', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077838327', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077838327', '', '', '1000', '40.00', '0.00', '0.00', 6, '2012-04-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1891091898', 0, 'N', 0, '2013-06-14', NULL, NULL, 0, 0, NULL, NULL),
('870560083', 'W12019018', 'W12019018', 'UTDT01', '', 'Mark', '', 'Lloyd', 'DDS', 'Dentist', '', '', NULL, 'O', '6783 S Redwood Rd Ste 202', 'West Jordan', 'Salt Lake', 'UT', '84084', '8019571850', NULL, '6783 S Redwood Rd Ste 202', 'West Jordan', 'Salt Lake', 'UT', '84084', '8019571850', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007308', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019020', 'W12019020', 'UTIHC01', '', 'Kevin', 'G', 'Baird', 'AUD', 'Audiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023134434', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019021', 'W12019021', 'UTIHC02', '', 'Kevin', 'G', 'Baird', 'AUD', 'Audiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023134434', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019022', 'W12019022', 'UTIHC03', '', 'Kevin', 'G', 'Baird', 'AUD', 'Audiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023134434', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019023', 'W12019023', 'UTIHC04', '', 'Kevin', 'G', 'Baird', 'AUD', 'Audiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023134434', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019027', 'W12019027', 'UTIHC01', '', 'Julie', 'A', 'Bouck', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801905831', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019028', 'W12019028', 'UTIHC02', '', 'Julie', 'A', 'Bouck', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801905831', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019029', 'W12019029', 'UTIHC03', '', 'Julie', 'A', 'Bouck', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801905831', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
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('830334941', 'W12019031', 'W12019031', 'WYT1', 'Red Rock Family Practice', 'Jennifer', 'A', 'Rice ', 'MD', 'Family Practice', '', '', NULL, 'O', '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', NULL, '1125 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472449', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Hot Springs County Memorial Hospital', 'Johnson County Hospital District', NULL, NULL, 'HCFA|UB|', '1336229624', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019032', 'W12019032', 'UTIHC01', '', 'Keshav', '', 'Chander', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700816600', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019033', 'W12019033', 'UTIHC03', '', 'Keshav', '', 'Chander', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700816600', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019034', 'W12019034', 'UTIHC04', '', 'Keshav', '', 'Chander', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700816600', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019035', 'W12019035', 'UTIHC01', '', 'Holly', 'M', 'Jensen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639343502', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019036', 'W12019036', 'UTIHC02', '', 'Holly', 'M', 'Jensen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639343502', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12019039', 'W12019039', 'UTIHC01', '', 'Jerold', 'L', 'Hagen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639102635', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12019050', 'W12019050', 'UTIHC04', '', 'Holly', 'H', 'Hanna', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134327315', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12019051', 'W12019051', 'UTIHC01', '', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-06-19', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019052', 'W12019052', 'UTIHC02', '', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-06-19', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019053', 'W12019053', 'UTIHC03', '', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-06-19', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12019056', 'W12019056', 'UTIHC01', 'PCMC Rehab Sandy', 'Danni', 'M', 'Miller', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225341142', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12019059', 'W12019059', 'UTIHC04', 'PCMC Rehab Sandy', 'Danni', 'M', 'Miller', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225341142', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.5806, -111.867, NULL, NULL),
('942854057', 'W12019060', 'W12019060', 'UTIHC01', '', 'Lynn', 'R', 'Nimer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689635922', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019061', 'W12019061', 'UTIHC03', '', 'Lynn', 'R', 'Nimer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689635922', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019062', 'W12019062', 'UTIHCPHY', '', 'Lynn', 'R', 'Nimer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689635922', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019064', 'W12019064', 'UTIHC04', '', 'Mark', 'G', 'Oraskovich', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587500', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-08-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083634562', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12019068', 'W12019068', 'UTIHC01', '', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357162220', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357162220', '', '', '', '0.00', '15.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019069', 'W12019069', 'UTIHC04', '', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357162220', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357162220', '', '', '', '0.00', '15.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12019070', 'W12019070', 'UTIHC01', '', 'Mark', 'William', 'Pulsipher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689631913', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019071', 'W12019071', 'UTIHC03', '', 'Mark', 'William', 'Pulsipher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689631913', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019072', 'W12019072', 'UTIHC04', '', 'Mark', 'William', 'Pulsipher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689631913', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019074', 'W12019074', 'UTIHC01', '', 'Emily', 'Ann', 'Quinn', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770861676', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12019075', 'W12019075', 'UTIHC02', '', 'Emily', 'Ann', 'Quinn', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770861676', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019076', 'W12019076', 'UTIHC03', '', 'Emily', 'Ann', 'Quinn', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770861676', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019077', 'W12019077', 'UTIHC04', '', 'Emily', 'Ann', 'Quinn', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770861676', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.8923, -111.881, NULL, NULL),
('942854057', 'W12019079', 'W12019079', 'UTIHC01', 'PCMC Rehab Bountiful', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-18', '2012-08-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019080', 'W12019080', 'UTIHC02', 'PCMC Rehab Bountiful', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-18', '2012-08-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019081', 'W12019081', 'UTIHC03', 'PCMC Rehab Bountiful', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-18', '2012-08-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019082', 'W12019082', 'UTIHC04', 'PCMC Rehab Bountiful', 'Gregory', 'V', 'Reber', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-18', '2012-08-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1407134364', 0, 'N', 0, '2012-08-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019087', 'W12019087', 'UTIHC04', 'Anesthesia', 'Richard', 'G', 'Watts', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023113545', 0, 'N', 0, '2012-04-10', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12019089', 'W12019089', 'UTIHC01', 'PCMC Rehab Services', 'Erin', '', 'Williams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396039616', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019090', 'W12019090', 'UTIHC02', 'PCMC Rehab Services', 'Erin', '', 'Williams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396039616', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019091', 'W12019091', 'UTIHC03', 'PCMC Rehab Services', 'Erin', '', 'Williams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396039616', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019092', 'W12019092', 'UTIHC04', 'PCMC Rehab Services', 'Erin', '', 'Williams', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', NULL, '3903 Harrison Blvd Ste 400', 'Ogden', 'Weber', 'UT', '84403', '8013872080', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396039616', 0, 'N', 0, '2012-04-10', NULL, NULL, 41.1922, -111.949, NULL, NULL),
('942854057', 'W12019093', 'W12019093', 'UTIHC01', '', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'N', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019094', 'W12019094', 'UTIHC03', '', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'N', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019095', 'W12019095', 'UTIHC04', '', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'N', 0, '2012-11-05', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019096', 'W12019096', 'UTIHC01', '', 'Gregory', 'D', 'Price', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1699761106', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019097', 'W12019097', 'UTIHC03', '', 'Gregory', 'D', 'Price', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1699761106', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019098', 'W12019098', 'UTIHC04', '', 'Gregory', 'D', 'Price', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1699761106', 0, 'N', 0, '2014-04-16', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019099', 'W12019099', 'UTIHC01', '', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019100', 'W12019100', 'UTIHC03', '', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019101', 'W12019101', 'UTIHC04', '', 'Jamison', 'C', 'Jones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205031549', 0, 'N', 0, '2013-12-06', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019103', 'W12019103', 'UTIHC01', '', 'Leann', 'Schow', 'Smith', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-04-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547100', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019104', 'W12019104', 'UTIHC02', '', 'Leann', 'Schow', 'Smith', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-04-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547100', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019105', 'W12019105', 'UTIHC03', '', 'Leann', 'Schow', 'Smith', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-04-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547100', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019106', 'W12019106', 'UTIHC04', '', 'Leann', 'Schow', 'Smith', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624941', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-04-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547100', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12019107', 'W12019107', 'UTIHC01', '', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019108', 'W12019108', 'UTIHC03', '', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019109', 'W12019109', 'UTIHC04', '', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12019111', 'W12019111', 'UTIHC03', '', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2013-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019112', 'W12019112', 'UTIHC04', '', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2013-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('453598776', 'W12019113', 'W12019113', 'UT01', 'Oquirrh Radiology Associates', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'PO Box 639', 'Tooele', 'Tooele', 'UT', '84074', '4358433630', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
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('451659913', 'W12019119', 'W12019119', 'UT01', 'Summit Oral and Maxillofacial Surgery', 'Cameron', 'J', 'Egbert', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '642 E Kirby Ln Ste 101', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989500', '8017985460', '642 E Kirby Ln Ste 101', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989500', '8017985460', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|DEN|', '1033320957', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.1244, -111.643, NULL, NULL),
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('454855728', 'W12019199', 'W12019199', 'UT01', 'Obstetrix Medical Group of Utah', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019196', 'W12019196', 'UT01', 'Obstetrix Medical Group of Utah', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 40.6871, -111.859, NULL, NULL),
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('454855728', 'W12019198', 'W12019198', 'UT01', 'Obstetrix Medical Group of Utah', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
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('454855728', 'W12019202', 'W12019202', 'UT01', 'Obstetrix Medical Group of Utah', 'Sterling', 'W', 'McColgin', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1760513204', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019203', 'W12019203', 'UT01', 'Obstetrix Medical Group of Utah', 'Sterling', 'W', 'McColgin', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1760513204', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('870574059', 'W12019206', 'W12019206', 'UT01', 'Mountain Land Sun River', 'Quinn', '', 'Christensen', 'OT', 'Physical Therapy', '', '', NULL, 'O', '1404 W Sun River Pkwy Ste 100', 'St George', 'Washington', 'UT', '84790', '4357679094', '4357679096', '1404 W Sun River Pkwy Ste 100', 'St George', 'Washington', 'UT', '84790', '4357679094', '4357679096', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1972691749', 0, 'N', 0, '2012-04-18', NULL, NULL, 37.0302, -113.62, NULL, NULL),
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('870574059', 'W12019209', 'W12019209', 'UT01', 'Mountain Land West Point', 'Zachary', 'Tracy', 'Kernan', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8018257500', '8018257511', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8018257500', '8018257511', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427344340', 0, 'N', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870464264', 'W12019210', 'W12019210', 'UT01', 'Fit Stop Physical Therapy & Health Club', 'Alan', 'Wilson', 'Bluth', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '51 S Main St Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8014114383', NULL, '51 S Main St Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8014114383', '          ', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1568436681', 0, 'N', 0, '2012-04-18', NULL, NULL, 40.7683, -111.891, NULL, NULL),
('820161600', 'W12019212', 'W12019212', 'ID02', 'St Lukes Idaho Endocrinology', 'Gihan', '', 'Dawood', 'DO', 'Endocrinology', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-04-12', '2012-06-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1255489746', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('820536340', 'W12019214', 'W12019214', 'ID02', 'The Clinic at Eagle', 'Marcia', 'D', 'Price-Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-03-23', '2012-03-25', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1376504498', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12019216', 'W12019216', 'ID02', 'West Valley Medical Center', 'Gloria', 'L', 'Henao', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-04-12', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1306036835', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12019217', 'W12019217', 'ID02', 'West Valley Medical Center', 'Steven', 'Richard', 'Newman', 'MD', 'Family Practice', 'Sports Medicine', 'Occupational Therapy', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-04-12', '2013-02-18', 0, 0, 1, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134157613', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('201710678', 'W12019220', 'W12019220', 'ID02', 'Orthopaedic Associates PA', 'Virginia', '', 'Jeppesen', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083674888', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083674888', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-04-21', '2012-07-01', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174896419', 0, 'N', 0, '2012-11-08', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820299231', 'W12019224', 'W12019224', 'ID02', 'Saltzer Medical Group', 'Taya', '', 'Gill', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-04-12', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790058618', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('931224010', 'W12019226', 'W12019226', 'ID02', 'Praxis Endocrinology and Thyroid', 'Lynn', '', 'GeZerbe', 'MD', 'Endocrinology', '', '', NULL, 'O', '3080 Gentry Way Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2083876546', '2082788360', '3080 Gentry Way Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2083876546', '2082788360', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-23', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1003881970', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('931224010', 'W12019227', 'W12019227', 'ID02', 'Praxis Endocrinology and Thyroid', 'Lynn', '', 'GeZerbe', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 670', 'Bend', 'Deschutes', 'OR', '97709', '5412784332', '2082788360', 'PO Box 670', 'Bend', 'Deschutes', 'OR', '97709', '5412784332', '2082788360', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-23', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1003881970', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('900406130', 'W12019229', 'W12019229', 'SACN', '', 'John', 'C', 'Preece', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', NULL, '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093871436', 0, 'N', 0, '2013-04-23', NULL, NULL, 43.6086, -116.268, NULL, NULL),
('270592513', 'W12019239', 'W12019239', 'UTPEHP', 'Mesquite Medical Associates', 'Enrique', '', 'Alfaro', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1184606279', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('270592513', 'W12019240', 'W12019240', 'UTPEHP', 'Mesquite Medical Associates', 'Donald', 'J', 'Dixon', 'MD', 'Family Practice', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1790787034', 0, 'N', 0, '2012-04-19', NULL, NULL, 0, 0, NULL, NULL),
('270592513', 'W12019241', 'W12019241', 'UTPEHP', 'Mesquite Medical Associates', 'Lonnie', 'R', 'Empey', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407838584', 0, 'N', 0, '2012-04-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12019248', 'W12019248', 'ID01', 'Saint Alphonsus Medical Group EHP Family Medicine ', 'Carla', '', 'Pharris', 'MD', 'Internal Medicine', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2086375750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2086375750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-04-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1134177744', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820425454', 'W12019250', 'W12019250', 'ID01', 'Boise Anesthesia, PA', 'Jeffrey', '', 'Varga', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2012-04-12', '2012-04-12', 0, 15, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1306173026', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12019253', 'W12019253', 'ID01', 'Saint Alphonsus Rehabilitation Services', 'Jason', '', 'Gage', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '717 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', '717 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2014-02-03', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1548280699', 0, 'Y', 0, '2014-05-22', NULL, NULL, 43.6111, -116.261, NULL, NULL),
('820200895', 'W12019252', 'W12019252', 'ID01', 'Saint Alphonsus Rehabilitation Services', 'Jason', '', 'Gage', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '901 N Curtis Rd Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', '901 N Curtis Rd Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2014-02-03', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1548280699', 0, 'Y', 0, '2014-05-22', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'W12019256', 'W12019256', 'ID01', 'Saint Alphonsus Rehabilitation Services', 'Brett', '', 'Thomas', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '717 N Liberty ', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', '717 N Liberty ', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952403552', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6111, -116.261, NULL, NULL),
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('820200895', 'W12019259', 'W12019259', 'ID01', 'Saint Alphonsus Rehabilitation Services', 'Clay', 'H', 'Ward', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '717 N Liberty', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', '717 N Liberty', 'Boise', 'Ada', 'ID', '83706', '2083678989', '2083676908', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2014-01-02', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1053348441', 0, 'Y', 0, '2014-03-14', NULL, NULL, 43.6111, -116.261, NULL, NULL),
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('205652129', 'W12019270', 'W12019270', 'NM01', 'New Mexico Chiropractic Center', 'David', 'W', 'Peer', 'DC', 'Chiropractic', '', '', NULL, 'O', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5088889616', '5053234419', '10555 Montgomery Blvd NE Ste 30 Bldg 1', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5088889616', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-02-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427099381', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
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('830216782', 'W12018435', 'W12018435', 'Sinclair', 'Laramie Physicians for Women and Children', 'Amanda', '', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '2710 E Harney St', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1730202623', 0, 'N', 0, '2012-07-16', NULL, NULL, 0, 0, NULL, NULL),
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('870179340', 'W12019281', 'W12019281', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'N', 0, '2013-06-04', NULL, NULL, 41.2734, -111.974, NULL, NULL),
('202148889', 'W12019282', 'W12019282', 'TX01', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'O', '2897 NE Loop 410 Ste 2', 'San Antonio', 'Bexar', 'TX', '78218', '2105723306', '2102490125', '2897 NE Loop 410 Ste 2', 'San Antonio', 'Bexar', 'TX', '78218', '2105723306', '2102490125', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-05-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5166, -98.4058, NULL, NULL),
('830300467', 'W12019293', 'W12019293', 'WY01', 'Powell Valley Healthcare', 'Michael', 'D', 'Tracy', 'MD', 'Pediatrics', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', NULL, '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Powell Valley Healthcare', NULL, NULL, NULL, 'HCFA|UB|', '1689662595', 0, 'N', 0, '2012-04-24', NULL, NULL, 44.7567, -108.769, NULL, NULL),
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('264795006', 'W12019297', 'W12019297', 'UT01', 'Gasman Anesthesia', '', '', 'Gasman Anesthesia', '', 'Anesthesia', '', '', NULL, 'B', 'PO Box 210', 'Roy', 'Weber', 'UT', '84067', '8018254700', NULL, 'PO Box 210', 'Roy', 'Weber', 'UT', '84067', '8018254700', '          ', '', '', '1000', '30.00', '0.00', '0.00', 3, '2011-04-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1609002872', 0, 'Y', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202861303', 'W12019298', 'W12019298', 'UT01', 'Mountain View Foot and Ankle Institute', 'David', 'B', 'Glover', 'DPM', 'Podiatry', '', '', NULL, 'O', '5957 S Fashion Point Ste 101', 'Ogden', 'Weber', 'UT', '84403', '8014755683', '8014759499', '5957 S Fashion Point Ste 101', 'Ogden', 'Weber', 'UT', '84403', '8014755683', '8014759499', 'WUOGORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-02', '2013-09-09', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1740371681', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870575989', 'W12019291', 'W12019291', 'UT01', 'Country Hills Eye Center', 'Jonathan', 'B', 'Gunther', 'MD', 'Ophthalmology', '', '', NULL, 'O', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', '875 Country Hills Dr', 'Ogden', 'Weber', 'UT', '84403', '8013991149', '8013944481', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-28', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1023073459', 0, 'N', 0, '2013-08-16', NULL, NULL, 41.1889, -111.958, NULL, NULL),
('208394720', 'W12019304', 'W12019304', 'UTMH1', 'Northern Utah Counseling', '', '', 'Northern Utah Counseling', '', 'Mental Health Facility', '', '', NULL, 'O', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', 'NOUTCSLG', '', '', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073640322', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('820520642', 'W12019306', 'W12019306', 'ID02', 'Better Life Chiropractic', 'Jedediah ', 'D', 'Badders', 'DC', 'Chiropractic', '', '', NULL, 'O', '1220 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088845000', '2088848121', '1220 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088845000', '2088848121', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932474160', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('262660272', 'W12019307', 'W12019307', 'NM01', '', 'Pamela', 'S', 'Barrett', 'DOM', 'Acupuncture', '', '', NULL, 'O', '7510 Montgomery Blvd NE Ste 206', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058841701', '5058841785', '7510 Montgomery Blvd NE Ste 206', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058841701', '5058841785', '', '', '', '0.00', '0.00', '75.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972818367', 0, 'N', 0, '2012-10-05', NULL, NULL, 35.1307, -106.561, NULL, NULL),
('870373083', 'W12019311', 'W12019311', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12019310', 'W12019310', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 40.6408, -111.883, NULL, NULL),
('870373083', 'W12019309', 'W12019309', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('453251093', 'W12019313', 'W12019313', 'UT01', 'Avalon Oculoplastics', 'Conley', 'B', 'Call', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '78 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017944964', '8017988298', '78 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017944964', '8017988298', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1659640548', 0, 'N', 0, '2012-06-22', NULL, NULL, 40.1214, -111.653, NULL, NULL),
('453251093', 'W12019314', 'W12019314', 'UT01', 'Avalon Oculoplastics', 'Conley', 'B', 'Call', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017944964', '8017988298', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017944964', '8017988298', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1659640548', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('205652129', 'W12019315', 'W12019315', 'NM01', 'Peer Chiropractic ', 'David', 'W', 'Peer', 'DC', 'Chiropractic', '', '', NULL, 'O', '7520 Montgomery Blvd NE Ste D10', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', '7520 Montgomery Blvd NE Ste D10', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427099381', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.1307, -106.561, NULL, NULL),
('721527725', 'W12019316', 'W12019316', 'UT01', 'Parzych Family Practice', 'Mary Michelle', '', 'Cashman Thomas', 'NP', 'Family Practice', '', '', NULL, 'O', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740590769', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('721527725', 'W12019317', 'W12019317', 'UT01', 'Parzych Family Practice', 'Mary Michelle', '', 'Cashman Thomas', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740590769', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019439', 'W12019439', 'WY01', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('264696078', 'W12019319', 'W12019319', 'UT01', 'Mountain Springs Family Medicine', 'Elizabeth', '', 'Daniels', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8015046117', '8015046328', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8015046117', '8015046328', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578707352', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('271522028', 'W12019320', 'W12019320', 'UT01', 'Fairbanks Plastic Surgery', 'Grant', 'A', 'Fairbanks', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1151 E 3900 S Ste B110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688838', '8012688264', '1151 E 3900 S Ste B110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688838', '8012688264', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013056357', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('271522028', 'W12019321', 'W12019321', 'UT01', 'Fairbanks Plastic Surgery', 'Grant', 'A', 'Fairbanks', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 900622', 'Sandy', 'Salt Lake', 'UT', '84090', '8012688838', '8012688264', 'PO Box 900622', 'Sandy', 'Salt Lake', 'UT', '84090', '8012688838', '8012688264', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013056357', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12019322', 'W12019322', 'ID02', 'Riverside Rehab', 'Amy', 'L', 'Korb', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306128046', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('454762655', 'W12019152', 'W12019152', 'UT01', '', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '4357891524', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '4357891524', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('565864939', 'W12019324', 'W12019324', 'ID01', '', 'Kathy', '', 'Rodgers', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5172 Redbridge Dr', 'Boise', 'Ada', 'ID', '83705', '2088635592', '2083366794', '5172 Redbridge Dr', 'Boise', 'Ada', 'ID', '83705', '2088635592', '2083366794', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274327', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('565864939', 'W12019323', 'W12019323', 'ID01', '', 'Kathy', '', 'Rodgers', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '963 S Orchard Ste B', 'Boise', 'Ada', 'ID', '83705', '2088635592', '2083366794', '963 S Orchard Ste B', 'Boise', 'Ada', 'ID', '83705', '2088635592', '2083366794', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274327', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019327', 'W12019327', 'UT01', 'Obstetrix Medical Group of Utah', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019326', 'W12019326', 'UT01', 'Obstetrix Medical Group of Utah', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019325', 'W12019325', 'UT01', 'Obstetrix Medical Group of Utah', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12019329', 'W12019329', 'UT01', 'Pediatrix Medical Group', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12019328', 'W12019328', 'UT01', 'Pediatrix Medical Group', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12019330', 'W12019330', 'UT01', 'Pediatrix Medical Group', 'Carol', 'A', 'Lindsay', 'MD', 'Perinatology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826720', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019294', 'W12019294', 'Group', 'Obstetrix Medical Group of Utah', '', '', 'Pediatrix - Utah', '', 'Neonatology', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '          ', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009780', 0, 'Y', 0, '2013-01-29', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019331', 'W12019331', 'WY01', 'Mountain Towers HC & Rehab Ctr', '', '', 'Mountain Towers HC & Rehab Ctr', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1215946546', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019332', 'W12019332', 'WYT1', 'Mountain Towers HC & Rehab Ctr', '', '', 'Mountain Towers HC & Rehab Ctr', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1215946546', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019333', 'W12019333', 'WY01', 'South Central Wyoming Health Care', '', '', 'South Central Wyoming Health Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008827', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019334', 'W12019334', 'WYT1', 'South Central Wyoming Health Care', '', '', 'South Central Wyoming Health Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008827', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019336', 'W12019336', 'UT01', 'Wasatch Care Center', '', '', 'Wasatch Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1467472241', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019337', 'W12019337', 'UT01', 'St George Care & Rehab Center', '', '', 'St George Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834500', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('522085558', 'W12019338', 'W12019338', 'UT01', 'Crosslands Rehab & Healthcare', '', '', 'Crosslands Rehab & Healthcare', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-06-07', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831937', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019339', 'W12019339', 'WY01', 'Wind River Health Care & Rehab Center', '', '', 'Wind River Health Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009642', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019340', 'W12019340', 'WYT1', 'Wind River Health Care & Rehab Center', '', '', 'Wind River Health Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009642', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019341', 'W12019341', 'ID02', 'Kindred Nursing and Rehabilitation Canyon West', '', '', 'Kindred Nursing and Rehabilitation Canyon West', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1902810492', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019342', 'W12019342', 'ID02', 'Kindred Transitional Care and Rehabilitation', '', '', 'Kindred Transitional Care and Rehabilitation', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1538181672', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870669961', 'W12019343', 'W12019343', 'UT01', 'Universal Diagnostic Testing', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2012-12-31', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019344', 'W12019344', 'UT01', 'Federal Heights Rehab & Nursing', '', '', 'Federal Heights Rehab & Nursing', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-06-07', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831952', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019345', 'W12019345', 'WYT1', 'Sage View Care Center', '', '', 'Sage View Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008530', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019346', 'W12019346', 'WY01', 'Sage View Care Center', '', '', 'Sage View Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008530', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019347', 'W12019347', 'ID02', 'Kindred Nursing and Rehabilitation Caldwell', '', '', 'Kindred Nursing and Rehabilitation Caldwell', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1881616878', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12019348', 'W12019348', 'ID02', 'Kindred Nursing and Rehabilitation Nampa', '', '', 'Kindred Nursing and Rehabilitation Nampa', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'M', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '10653 S River Front Pkwy Ste 200', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020071', '8014469154', '', '', '7', '0.00', '100.00', '0.00', 3, '2012-04-01', '2013-03-31', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1265455273', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('454599454', 'W12019349', 'W12019349', 'UTMH1', 'Salt Lake Mental Health Inc', 'Frank', 'G', 'Clayton', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '220 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8012449049', NULL, '220 E 3900 S Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8012449049', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700944741', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('611251391', 'W12019351', 'W12019351', 'UT01', 'Rehab Without Walls', '', '', 'Gentiva Rehab Without Walls LLC', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '261 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012640213', '8012640219', '261 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012640213', '8012640219', '', '', '4', '0.00', '100.00', '0.00', 3, '2012-04-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833759', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('751365258', 'W12024177', 'W12024177', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Tammi', '', 'Williams', 'MD', 'Pediatrics', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 250', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2021 N MacArthur Blvd Ste 250', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972677193', 0, 'N', 1, '2012-10-24', NULL, NULL, 32.8355, -96.9602, NULL, NULL),
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('261891316', 'ELHCA0200', 'ELHCA0200', 'TXHOUSTD', 'Pediatric Surgery Associates of Clear Lake', 'Heather', NULL, 'Sandifer', 'PA', 'General Surgery', 'Pediatrics', '', NULL, 'B', 'PO Box 281009 ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 281009 ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457300022', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('271524083', 'W12019386', 'W12019386', 'WYT1', 'Big Horn Health Network', 'Michael', 'J', 'Strahan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1401 W 5th St Ste 209', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', NULL, '1401 W 5th St Ste 209', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', '          ', 'BHHN3', '', '', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1639177769', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('271524083', 'W12019387', 'W12019387', 'WY01', 'Big Horn Health Network', 'Michael', 'J', 'Strahan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1401 W 5th St Ste 209', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', NULL, '1401 W 5th St Ste 209', 'Sheridan', 'Sheridan', 'WY', '82801', '3076754662', '          ', '', '', 'BHHN', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1639177769', 0, 'N', 0, '2012-04-27', NULL, NULL, 44.8074, -106.976, NULL, NULL),
('942938348', 'W40017439', 'W40017439', 'UTMH1', ' Valley Mental Health Inc', 'Clover', NULL, 'Sanders', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689742728', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003866', 'W12003866', 'UTIHC04', 'Radiology', 'Thomas', 'B', 'Sanders', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629266317', 0, 'N', 0, '2013-11-25', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('271524083', 'W12019390', 'W12019390', 'WY01', 'Big Horn Health Network', 'Derek', '', 'Gilbert', 'MD', 'Family Practice', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', '          ', '', '', 'BHHN', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1477665925', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('264260933', 'ELHCA0198', 'ELHCA0198', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Tracey', NULL, 'Samuels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1558354845', 0, 'Y', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('264260933', 'ELHCA0197', 'ELHCA0197', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Tracey', NULL, 'Samuels', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1558354845', 0, 'N', 0, '2014-01-14', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
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('942854057', 'W12019426', 'W12019426', 'UTIHCPHY', 'Southern Utah Surgical-Garfield', 'Michael', 'G', 'Stults', 'MD', 'General Surgery', '', '', NULL, 'O', '224 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355868192', '4355867564', '224 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528087236', 0, 'N', 0, '2012-05-01', NULL, NULL, 37.8262, -112.428, NULL, NULL),
('562514687', 'W12019427', 'W12019427', 'UT01', 'Advanced Spine and Pain Solutions', 'Howard', 'A', 'Knudsen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3549 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013100851', '8013773697', '3549 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013100851', '8013773697', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992863906', 0, 'N', 0, '2012-05-04', NULL, NULL, 40.2809, -111.658, NULL, NULL),
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('870574059', 'W12019429', 'W12019429', 'UT01', 'Mountain Land Stansbury', 'John', 'Robert', 'Elmer', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '4358824144', '4358824151', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '4358824144', '4358824151', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-05-01', '2013-06-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1366477093', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12019431', 'W12019431', 'UT01', 'Wasatch Therapy Inc', 'Melissa', 'A', 'Ita aehau', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', '505 E Gentile St', 'Layton', 'Davis', 'UT', '84041', '8015938300', '8015938307', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-23', '2013-06-10', 0, 0, 0, '', '', '', '', 'HCFA|', '1043319528', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('201081850', 'W12019433', 'W12019433', 'UTDT01', 'Huntington Dental', 'Nathan', '', 'Huntington', 'DDS', 'Dentist', '', '', NULL, 'O', '1055 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623800', NULL, '1055 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623800', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009882', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('263588931', 'W12019436', 'W12019436', 'UT01', 'Salt Lake Eye Associates', 'Gregory', 'A', 'Christiansen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831175629', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.6999, -111.862, NULL, NULL),
('263588931', 'W12019435', 'W12019435', 'UT01', 'Clarus Vision', 'Gregory', 'A', 'Christiansen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5171 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8018928222', '8018928299', '5171 Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8018928222', '8018928299', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831175629', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.659, -111.894, NULL, NULL),
('264696078', 'W12019437', 'W12019437', 'UT01', 'Mountain Springs Family Medicine', 'Elizabeth', '', 'Daniels', 'NP', 'Family Practice', '', '', NULL, 'O', '468 S Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', '8015046328', '468 S Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', '8015046328', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578707352', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.1032, -111.655, NULL, NULL),
('272923067', 'W12019283', 'W12019283', 'WY01', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', NULL, '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'Y', 0, '2013-06-18', NULL, NULL, 41.7898, -107.245, NULL, NULL),
('272923067', 'W12019440', 'W12019440', 'WY01', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'B', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076376707', NULL, '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076376707', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019438', 'W12019438', 'WYT1', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019284', 'W12019284', 'WYT1', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'O', '519 8th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3073242294', NULL, '519 8th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3073242294', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('272923067', 'W12019441', 'W12019441', 'WYT1', 'Big Horn Urgent Care', 'Paul', 'J', 'Jacquay', 'PA', 'Family Practice', '', '', NULL, 'B', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076376707', NULL, '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076376707', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053554402', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12007581', 'W12007581', 'UT01', 'University Health Care', 'Benjamin', 'A', 'Kalm', 'MD', 'Pediatrics', '', '', NULL, 'O', '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', NULL, '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-01-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427130285', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12007582', 'W12007582', 'UT01', 'Pediatric Inpatient Services Riverton', 'Benjamin', 'A', 'Kalm', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-01-01', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427130285', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12019445', 'W12019445', 'UT01', 'Pediatric Inpatient Services Riverton', '', '', 'Pediatric Inpatient Services Riverton', 'Group', 'Pediatrics', '', '', NULL, 'O', '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', NULL, '3741 W 126000 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851609564', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('300638000', 'W12019446', 'W12019446', 'UT01', 'Pediatric Inpatient Services Riverton', '', '', 'Pediatric Inpatient Services Riverton', 'Group', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851609564', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('205529469', 'W12006716', 'W12006716', 'UT01', 'University Health Care', 'Arlan', 'M', 'Henrie', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'o', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-01', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235168592', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W12006715', 'W12006715', 'UT01', 'University Health Care Park City Mountain Resort Urgent Care', 'Arlan', 'M', 'Henrie', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-01', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235168592', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('454633415', 'W12019467', 'W12019467', 'UT01', '', 'Jon', 'W', 'Ahlstrom', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '550 E 1400 N Ste I', 'Logan', 'Cache', 'UT', '84341', '4357531545', '4357533153', '550 E 1400 N Ste I', 'Logan', 'Cache', 'UT', '84341', '4357531545', '4357533153', 'WISE++', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437146065', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('742412898', 'W12019923', 'W12019923', 'UT01', 'Central City Clinic Medical', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-08', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.7593, -111.88, NULL, NULL),
('270852226', 'W12019470', 'W12019470', 'UT01', 'Silverton Group', 'Mitchell', 'E', 'Deshazer', 'MD', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023276870', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12019469', 'W12019469', 'UT01', 'Silverton Group', 'Mitchell', 'E', 'Deshazer', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023276870', 0, 'N', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('454868316', 'W12019471', 'W12019471', 'UT01', '', 'Elie', 'P', 'Elovic', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656739', '8019420607', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656739', '8019420607', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1306835145', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.6046, -111.853, NULL, NULL),
('454868316', 'W12019472', 'W12019472', 'UT01', '', 'Elie', 'P', 'Elovic', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656739', '8019420607', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656739', '8019420607', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1306835145', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('363771396', 'W12019473', 'W12019473', 'ID02', 'Overton/Stiff Professional Anesthesia Services', 'Sharon', 'K', 'Gray', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', 'PO Box 2203', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085252090', '8025238928', '', '', '', '59.00', '35.00', '0.00', 3, '2012-07-01', NULL, 1, 15, 1, '', '', '', '', 'HCFA|UB|', '1306848635', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12019474', 'W12019474', 'ID02', 'Riverside Rehabilitation', 'Kimberly', 'O', 'Ledwa', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023315108', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12019949', 'W12019949', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'O', '5980 S Fashion Place Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8019128222', '8019643860', '5980 S Fashion Place Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8019128222', '8019643860', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.6647, -111.883, NULL, NULL),
('752536818', 'W12030870', 'W12030870', 'TXDALSTD', 'Health Texas Provider Network', 'Jeffrey', '', 'Zsohar', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063494839', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('454820915', 'W12019477', 'W12019477', 'ID02', 'Cottonwood Family Medicine', 'Marcia', 'D', 'Price-Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '100 N Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', '100 N Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1376504498', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830231263', 'W12019478', 'W12019478', 'WY01', 'Casper Obstetrical and Gynecological Assoc', 'Susan', 'M', 'Sheridan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 N Melrose St', 'Casper', 'Natrona', 'WY', '82601', '3072346988', '3074722854', '150 N Melrose St', 'Casper', 'Natrona', 'WY', '82601', '3072346988', '3074722854', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891751533', 0, 'N', 0, '2014-05-01', NULL, NULL, 42.8508, -106.308, NULL, NULL),
('830231263', 'W12019479', 'W12019479', 'WYT2', 'Casper Obstetrical and Gynecological Assoc', 'Susan', 'M', 'Sheridan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 N Melrose St', 'Casper', 'Natrona', 'WY', '82601', '3072346988', '3074722854', '150 N Melrose St', 'Casper', 'Natrona', 'WY', '82601', '3072346988', '3074722854', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1891751533', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('454666074', 'W12019480', 'W12019480', 'ID01', '', 'Mary', '', 'Simon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1412 W Washington St', 'Boise', 'Ada', 'ID', '83702', '2083196948', '2083679242', '1412 W Washington St', 'Boise', 'Ada', 'ID', '83702', '2083196948', '2083679242', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922298603', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12019482', 'W12019482', 'WY01', 'North Platte Physical Therapy', 'Tatiana', 'M', 'Torres', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760767701', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12019484', 'W12019484', 'WY01', 'North Platte Physical Therapy', 'Tatiana', 'M', 'Torres', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760767701', 0, 'N', 0, '2012-06-30', NULL, NULL, 44.2835, -105.51, NULL, NULL),
('830283425', 'W12019481', 'W12019481', 'WYT1', 'North Platte Physical Therapy', 'Tatiana', 'M', 'Torres', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760767701', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12019483', 'W12019483', 'WYT1', 'North Platte Physical Therapy', 'Tatiana', 'M', 'Torres', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760767701', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('263981143', 'W12019485', 'W12019485', 'UT01', 'Peak ENT Associates', 'Douglas', 'K', 'Worthington', 'AUD', 'Audiology', '', '', NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', NULL, '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467460246', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.2476, -111.664, NULL, NULL),
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('454707017', 'W12019492', 'W12019492', 'UT01', 'University of Utah Pediatric Cardiology Electrophysiology Svcs', '', '', 'University of Utah Pediatric Cardiology Electrophysiology Svcs', 'Group', 'Pediatric Cardiology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770841785', 0, 'N', 0, '2012-05-08', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('208515551', 'W12019505', 'W12019505', 'ID02', 'West Valley Medical Group', 'J Cinda', 'J', 'Bitters', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', NULL, 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104089556', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12019508', 'W12019508', 'ID01', 'Saint Alphonsus Express Care Inc', 'Kelly', 'R', 'Whitehead Price', 'NP-C', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-05-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1710268099', 0, 'N', 0, '2012-12-26', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'W12019509', 'W12019509', 'ID01', 'Saint Alphonsus Express Care Inc', 'Kelly', 'R', 'Whitehead Price', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '2084522140', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-05-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1710268099', 0, 'N', 0, '2012-12-26', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('836000891', 'W12019513', 'W12019513', 'WY01', 'North Big Horn Hospital Clinic', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 44.8258, -108.39, NULL, NULL),
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('820482491', 'W12019520', 'W12019520', 'SACN', 'Intermountain Eye & Laser Centers', 'Kathryn', 'M', 'Fethke', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3090 Gentry Way Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2088880005', '2083731216', '3090 Gentry Way Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2088880005', '2083731216', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1578657094', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('611681251', 'W12019531', 'W12019531', 'ID01', 'Epic Psychological Services', 'Ryan', 'J', 'Hulbert', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '2088988989', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-04-16', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053689356', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12019533', 'W12019533', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '2380 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357139681', '4357531201', '2380 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357139681', '4357531201', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.775, -111.823, NULL, NULL),
('830320797', 'W12019542', 'W12019542', 'WY01', 'Rock Springs IV Center', '', '', 'Rock Springs IV Center', 'Group', 'Infusion Agency', '', '', NULL, 'O', '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', '3073826987', '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', '3073826987', '', '', '1001', '0.00', '60.00', '0.00', 3, '2012-05-01', '2012-10-31', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332970', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('830320797', 'W12019543', 'W12019543', 'WYT1', 'Rock Springs IV Center', '', '', 'Rock Springs IV Center', 'Group', 'Infusion Agency', '', '', NULL, 'O', '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', '3073826987', '400 2nd St Ste A1', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823544', '3073826987', '', '', '1001', '0.00', '60.00', '0.00', 3, '2012-05-01', '2012-10-31', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332970', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12019544', 'W12019544', 'UT01', 'Granger Medical Clinic', 'Matthew', 'S', 'Wilson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750543955', 0, 'N', 0, '2013-05-24', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12019545', 'W12019545', 'UT01', 'Granger Medical Clinic', 'Matthew', 'S', 'Wilson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750543955', 0, 'N', 0, '2013-05-24', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12019546', 'W12019546', 'UT01', 'Granger Medical Clinic', 'Matthew', 'S', 'Wilson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750543955', 0, 'N', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12019552', 'W12019552', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2014-04-30', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174617310', 0, 'N', 0, '2012-05-14', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12019553', 'W12019553', 'UT01', 'Salt Lake Regional Womens Center', 'Jennifer', '', 'Jensen', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962643858', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12019554', 'W12019554', 'UT01', 'Salt Lake Regional Womens Center', 'Jennifer', '', 'Jensen', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962643858', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('543560339', 'W12019555', 'W12019555', 'UTMH1', '', 'Lauralee', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '5711 S 1450 E', 'Ogden', 'Weber', 'UT', '84403', '8012982000', '8019511490', '5711 S 1450 E', 'Ogden', 'Weber', 'UT', '84403', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730246521', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('611632192', 'W12019556', 'W12019556', 'WY01', 'Cloud Peak Chiropractic', 'Sarah', 'E', 'Radabaugh', 'DC', 'Chiropractic', '', '', NULL, 'O', '614 S 12th St', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '614 S 12th St', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144349598', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('611632192', 'W12019557', 'W12019557', 'WYT1', 'Cloud Peak Chiropractic', 'Sarah', 'E', 'Radabaugh', 'DC', 'Chiropractic', '', '', NULL, 'O', '614 S 12th St', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '614 S 12th St', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '', '', '5004', '0.00', '100.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144349598', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019558', 'W12019558', 'UT01', 'Wasatch Pediatrics Inc', 'Andrea', '', 'Stout', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478001', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-04-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1902040355', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019559', 'W12019559', 'UT01', 'Wasatch Pediatrics Inc', 'Andrea', '', 'Stout', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-04-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1902040355', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('262918561', 'W12019562', 'W12019562', 'ID01', 'MedNow Infusion LLC Meridian', '', '', 'MedNow Infusion LLC', 'GROUP', 'Infusion Agency', '', '', NULL, 'B', '6886 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2088843469', NULL, '6886 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2088843469', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518795', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('262918561', 'W12019561', 'W12019561', 'ID01', 'MedNow Infusion LLC Meridian', '', '', 'MedNow Infusion LLC', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', '800 S Industry Way Ste 240', 'Meridian', 'Ada', 'ID', '83642', '2088840669', NULL, '800 S Industry Way Ste 240', 'Meridian', 'Ada', 'ID', '83642', '2088840669', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518795', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('273972429', 'W12019563', 'W12019563', 'ID01', 'Idaho Center for Regenerative Medicine', 'Robert', 'J', 'Haake', 'DO', 'Internal Medicine', '', '', NULL, 'O', '500 E Shore Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', NULL, '500 E Shore Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', '          ', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-05-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1295747046', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6885, -116.348, NULL, NULL),
('870354442', 'W12019564', 'W12019564', 'UT01', 'Rocky Mountain Womens Health Center', 'Rebecca', 'M', 'Vance', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-22', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1942242458', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870354442', 'W12019565', 'W12019565', 'UT01', 'Rocky Mountain Womens Health Center', 'Rebecca', 'M', 'Vance', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017737399', '8017738625', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017737399', '8017738625', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-22', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1942242458', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('710896918', 'W12019566', 'W12019566', 'ID01', 'Cherry Lane Counseling Center', 'Shirley', '', 'Henderson', 'LCPC LMFT', 'Mental Health', 'Marriage and Family Therapy', 'Counseling', NULL, 'O', '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088871911', NULL, '403 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2088871911', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790768455', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870663870', 'W12019567', 'W12019567', 'UT01', 'UNI-OutReach Services', '', '', 'UNI-OutReach Services', 'Group', 'Pediatric Psychiatry', '', '', NULL, 'O', '650 S Komas Dr Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', NULL, '650 S Komas Dr Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851212', '          ', 'WUUPEDS', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720140114', 0, 'N', 0, '2012-05-14', NULL, NULL, 40.7553, -111.83, NULL, NULL),
('870663870', 'W12019568', 'W12019568', 'UT01', 'UNI-OutReach Services', '', '', 'UNI-OutReach Services', 'Group', 'Pediatric Psychiatry', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720140114', 0, 'N', 0, '2012-05-14', NULL, NULL, 0, 0, NULL, NULL),
('030578114', 'W12019569', 'W12019569', 'UTMH1', '', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1224 S River Rd Ste B-221', 'St George', 'Washington', 'UT', '84790', '4356321445', '4356881091', '1224 S River Rd Ste B-221', 'St George', 'Washington', 'UT', '84790', '4356321445', '4356881091', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('030578114', 'W12019570', 'W12019570', 'UTMH1', '', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 153', 'St George', 'Washington', 'UT', '84771', '4356321445', '4356881091', 'PO Box 153', 'St George', 'Washington', 'UT', '84771', '4356321445', '4356881091', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870659638', 'W12019571', 'W12019571', 'UTMH1', 'England Counseling Services', 'Michael', 'T', 'Boman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3564 S 7200 W Ste C', 'Magna', 'Salt Lake', 'UT', '84044', '8012502909', '8012520444', '3564 S 7200 W Ste C', 'Magna', 'Salt Lake', 'UT', '84044', '8012502909', '8012520444', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508828930', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019572', 'W12019572', 'UTMH1', 'Comprehensive Psychological Services', 'AMIE', '', 'ASLAMI', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MD-5', '', '', '0.00', '35.00', '0.00', 6, '2012-05-14', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083685796', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019573', 'W12019573', 'UTMH1', 'Comprehensive Psychological Services', 'Nathan', '', 'Currier', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MD-5', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407085848', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019574', 'W12019574', 'UTMH1', 'Comprehensive Psychological Services', 'Timothy', 'S', 'Enniss', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750487864', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('943346533', 'W12019512', 'W12019512', 'UTMH1', 'Youth Care', '', '', 'Youth Care of Utah', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '12595 S Minuteman Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015726989', NULL, '12595 S Minuteman Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015726989', '          ', '', '', '8', '0.00', '50.00', '0.00', 3, '2012-05-09', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1083767297', 0, 'N', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('943346533', 'W12019511', 'W12019511', 'UTMH1', 'Youth Care', '', '', 'Youth Care of Utah', 'GROUP', 'Mental Health Facility', '', '', NULL, 'M', '20400 Stevens Creek Blvd Ste 600', 'Cupertino', 'Santa Clara', 'CA', '95014', '8669527930', NULL, '20400 Stevens Creek Blvd Ste 600', 'Cupertino', 'Santa Clara', 'CA', '95014', '8669527930', '          ', '', '', '8', '0.00', '50.00', '0.00', 3, '2012-05-09', '2012-05-09', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1083767297', 0, 'N', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('943346533', 'W12019510', 'W12019510', 'UTMH1', 'Youth Care', '', '', 'Youth Care of Utah', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '2650 W 2700 S', 'Syracuse', 'Davis', 'UT', '84075', '8669527930', NULL, '2650 W 2700 S', 'Syracuse', 'Davis', 'UT', '84075', '8669527930', '          ', '', '', '8', '0.00', '50.00', '0.00', 3, '2012-05-09', '2012-05-09', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1083767297', 0, 'N', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12019582', 'W12019582', 'ID01', 'Mountain States Neonatology', '', '', 'Mountain States Neonatology', '', 'Neonatology', '', '', NULL, '', 'Change', 'Boise', 'Ada', 'ID', '83704', '          ', NULL, 'Change', 'Boise', 'Ada', 'ID', '83704', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009884', 0, 'Y', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('262906168', 'W12019591', 'W12019591', 'SACN', '', 'Thomas', 'C', 'Manning', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-02-01', '2013-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861501637', 0, 'N', 0, '2014-02-10', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('262906168', 'W12019590', 'W12019590', 'ID02', '', 'Thomas', 'C', 'Manning', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDPPONEURO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-02-01', '2013-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1861501637', 0, 'N', 0, '2014-02-10', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('460179485', 'W12001267', 'W12001267', 'Sinclair', '(Sinclair Health Services Provider)', 'Robert', 'M', 'Mena', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 N Lincoln', 'Jerome', 'Jerome', 'ID', '83338', '2083246656', NULL, '1100 N Lincoln  ', 'Jerome', 'Jerome', 'ID', '83338', '2083246656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073657182', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('460179485', 'W12001268', 'W12001268', 'Sinclair', '', 'Robert', 'M', 'Mena', 'MD', 'Family Practice', '', '', NULL, 'B', '4306 W Houston Rd', 'Mackay', 'Custer', 'ID', '83251', '2083246656', NULL, '4306 W Houston Rd   ', 'Mackay', 'Custer', 'ID', '83251', '2083246656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073657182', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'W12019592', 'W12019592', 'ID01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', NULL, 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', '          ', 'wisecardio', '', '', '0.00', '35.00', '0.00', 3, '2012-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'W12019593', 'W12019593', 'TX01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', NULL, 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', '          ', 'wisecardio', '', '', '0.00', '35.00', '0.00', 3, '2012-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
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('770644336', 'W12019595', 'W12019595', 'WY01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', NULL, 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', '          ', 'wisecardio', '', '', '0.00', '35.00', '0.00', 3, '2012-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'W12019596', 'W12019596', 'WYT2', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', NULL, 'PO Box 204076', 'Houston', 'Harris', 'TX', '77216', '2818955700', '          ', 'wisecardio', '', '', '0.00', '35.00', '0.00', 3, '2012-04-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('155675546', 'W12019597', 'W12019597', 'ID02', '', 'Michael', 'V', 'Hajjar', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDPPONEURO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154343309', 0, 'N', 0, '2013-03-14', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('155675546', 'W12019598', 'W12019598', 'SACN', '', 'Michael', 'V', 'Hajjar', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154343309', 0, 'N', 0, '2013-03-14', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('262887520', 'W12019600', 'W12019600', 'ID02', '', 'Kenneth', 'M', 'Little', 'MD', 'Neurosurgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 1245', 'Meridian', 'Ada', 'ID', '83642', '2083673500', NULL, '520 S Eagle Rd Ste 1245', 'Meridian', 'Ada', 'ID', '83642', '2083673500', '          ', 'IDPPONEURO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-02-01', '2012-11-09', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023039468', 0, 'N', 0, '2013-10-25', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('262887520', 'W12019599', 'W12019599', 'ID02', '', 'Kenneth', 'M', 'Little', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDPPONEURO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-02-01', '2012-11-09', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023039468', 0, 'N', 0, '2013-10-25', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('262887520', 'W12019601', 'W12019601', 'SACN', '', 'Kenneth', 'M', 'Little', 'MD', 'Neurosurgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 1245', 'Meridian', 'Ada', 'ID', '83642', '2083673500', NULL, '520 S Eagle Rd Ste 1245', 'Meridian', 'Ada', 'ID', '83642', '2083673500', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-02-01', '2012-11-09', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023039468', 0, 'N', 0, '2013-10-25', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('262887520', 'W12019602', 'W12019602', 'SACN', '', 'Kenneth', 'M', 'Little', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-02-01', '2012-11-09', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023039468', 0, 'N', 0, '2013-10-25', NULL, NULL, 43.6151, -116.256, NULL, NULL),
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('371679068', 'W12019605', 'W12019605', 'ID01', 'Treasure Valley Surgery Center', '', '', 'Treasure Valley Surgery Center ', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884600', NULL, '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884600', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972861375', 0, 'N', 0, '2013-07-08', NULL, NULL, 43.5976, -116.517, NULL, NULL),
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